Purpura fulminans is an acute life threatening disorder characterized by cutaneous haemorrhagic manifestations and necrosis caused by disseminated intravascular coagulation and dermal vascular thrombosis. In this case a 60-year-old male presented with purpuric lesions over both upper and lower limbs and consumption coagulopathy following rickettsial infection. It was diagnosed as purpura fulminans secondary to rickettsial infection with disseminated intravascular coagulation and treated with replacement of platelets and coagulation factors along with antibiotics and doxycycline.

Background: Outcomes of metabolic acidosis remain unsure and needs to be explored deeply. This article presents a rational approach to diagnosis and management of metabolic acidosis. The data focusing specifically on severe metabolic acidosis (pH<7.20) is scanty.  Methods: It was a prospective observational study. A total of 50 consecutive critically ill patients (APACHE II score of 18 or more) with single severe metabolic acidosis (pH<7.20) admitted to the intensive care units (ICUs) of Shri BM Patil Medical College, Vijayapura. Arterial blood gas analysis along with other relevant investigations was done within first 24 h of ICU admission.Results: Among 50 patients, 32 patients expired compared to 18 patients who were discharged from hospital in stable condition. Out of 29 patients, who had lactic acidosis, 21 (72%) patients died compared to 8 (28%) patients who were discharged in stable condition. Out of 22 patients who have low Strong Ion Difference (SID) 16 patients had expired (76%) remaining 6 (24%) patients are discharged at stable condition. Out of 27 patients who were put on mechanical ventilator on the first day, 22 (80%) patients expired. 18 patients required vasopressor support on admission out of which 16 (90%) patients had lactic acidosis.  Conclusions: Lactic acidosis and strong ion gap are found to be associated with higher mortality. Hypotensive patients required vasopressor support on admission. Monitoring of serum pH, HCO3−, lactate levels and strong ion gap may have prognostic and therapeutic implications.

Background. Bullous pemphigoid (BP) is a rare autoimmune blistering skin disease in the elderly and it is manifested by cutaneous blisters on the skin lesions. The objective was to emphasize the rare case of BP. Methods. A case report of BP in a 58-year-old male patient admitted to a dermatology ward is presented. Results. A 58-year-old male patient with complaints of fluid-filled skin lesions, was examined initially over the trunk, gradually progressed involving B/L upper and lower extremities. Even though the patient was treated with the recommended therapy of corticosteroid (Dexamethasone) along with adjuvant drugs, new skin lesions continued to develop, and the patient’s condition worsened. The Prednisolone was started in place of Dexamethasone on the fifth day of treatment at its higher dose (50mg/day), the Prednisolone proved its efficacy to combat the extensive condition of BP. Conclusions. Bullous pemphigoid is a distressing blistering skin disease. Untreated disease is often fatal because of the susceptibility to infection and fluid-electrolyte disturbances. The mortality of patients with bullous pemphigoid has been significantly reduced with the advent of new therapies and treatment modalities. The treatment with systemic and topical corticosteroids forms the mainstay of treatment along with other adjuvant drugs. In the present case study, the use of Prednisolone has proven its efficacy in the extensive disease state of BP and improved the patient’s quality of life.

Background: Anaemia is one of the commonest clinical problems in our country. It affects various organs including the heart. Clinical manifestations of anaemia referable to cardiovascular system may closely simulate symptoms and signs of organic heart disease. It includes some electrocardiogram (ECG) changes also. ECG changes in anaemia show correlation to haemoglobin (Hb) concentration and the changes are reversible after correction of anaemia. In this study, the main objective was to study electrocardiographic changes in patients with severe anaemia and ECG reversibility after treatment of anaemia.Methods: 50 patients admitted in medicine wards of Shri B. M. Patil Medical College, Hospital and Research Center, Vijayapura for severe anaemia (Hb concentration less than or equal to 7 gm %) were studied for ECG changes. All patients were reassessed for reversibility of changes after treatment.Results: Out of 50 patients with severe anaemia, 20 patients were having Hb % of 3 to 5 gm %. Of which 16 patients were having ECG changes (10 were females and 6 were males). All ECG changes were reverted to normal after correction of anaemia, except one patient (showed pre-treatment T wave inversion and post-treatment flat T waves).Conclusions: ECG abnormalities in patients with severe anaemia are more common in females. ECG abnormalities in patients with severe anaemia (Hb 5 gm %) can get reverted to normal after correction of anaemia.

A 55-year-old male presented to the hospital with fever and cough since the past one week. The fever was on and off with intermittent headache. He had been diagnosed with diabetes mellitus (DM) five years back for which he had taken oral hypoglycaemic which he discontinued after four months and has been on herbal therapy since.On admission the patient was afebrile (36.4degree), his pulse rate was 100 beats per minute and BP of 120/70 mmHg. Physical examination was normal, on auscultation of chest occasional coarse crepitations were found and rest of the systems was normal. Laboratory investigations revealed haemoglobin of 16.8 g/dL, total white blood cell of 28000 cells per cumm (80% neutrophil) and ESR of 50mm in first hour. Serum biochemistry showed creatinine 2.3mg/dL, blood glucose level was 374 mg/ dL, sodium 131 mmol/L, potassium 4.7 mmol/L. Urine analysis revealed a 1.5% glucose, ketone bodies, and albumin 2+. Chest radiograph showed left upper lobe homogenous opacity suggesting consolidation [Table/ Fig-1]. He was empirically started on ceftriaxone.His sputum was sent for analysis which showed fungal elements on KOH mount. Diagnostic nasal endoscopy showed extensive crests filling left nasal cavity and maxillary sinus which was suggestive of mucormycosis.The patient was started on insulin therapy and amphotericin B intravenously at 1.5mg/kg body weight for 21 days with oral fluconazole of 150mg daily for six weeks. Renal profile was ABSTRACTMucormycosis is the name given to several different diseases caused by fungi of the order mucorales. It is commonly seen in patients with decreased immunity like patients with chronic renal failure, organ transplantation, neutropenia and most commonly in those with poorly controlled diabetes. We present a case of 55-year-old diabetic man who presented with headache and fever diagnosed with pulmonary and maxillary sinus mucormycosis presenting as diabetic ketoacidosis.