Scrub typhus is a rickettsial infection commonly seen in Asia. The clinical presentation ranges from nonspecific febrile illness to potentially fatal multiorgan involvement such as liver, kidney, or lung. Central nervous system involvement is uncommon. We report a 45-year-old female renal transplant recipient who presented with fever, headache, meningeal signs, graft dysfunction, and eschar. IgM antibodies against Orientia tsutsugamushi were positive by enzyme-linked immunosorbent assay. Despite oral doxycycline therapy for 5 days, she did not improve but responded well to intravenous azithromycin. To the best of our knowledge, scrub typhus as a cause of meningitis in a renal transplant recipient has not been reported so far.

Background: Chronic kidney disease (CKD) is a progressive loss of kidney function over a period of months or years through five stages. The prevalence of end-stage renal disease (ESRD) in India is increasing with an estimated annual incidence of about 100 per million populations. About 50-100% of patients with ESRD have at least one associated cutaneous change. These cutaneous disorders can precede or follow the initiation of hemodialysis treatment, and there are more chances to develop newer skin changes during the course of hemodialysis therapy, which may affect the quality of life. Objectives of the study was to find out the prevalence of various dermatological manifestations in patients undergoing hemodialysis in a tertiary care centre. Methods: A cross sectional study was carried out in the general medicine department of a tertiary care Centre. All cases of chronic kidney disease were diagnosed according to the criteria of KDQQI CKD guidelines, age group between 30-60 years are included. Pediatric patients with chronic kidney disease, patients who had renal transplantations, patients on peritoneal dialysis and renal injury patients are excluded. Results: Out of the 100 study participants majority are males (60%). Majority of the patients belongs to lower socioeconomic status family (59%). Atleast one dermatological manifestation was present in all patients. 23% of the patients presented with two dermatological manifestations and 22% of the participants had three or more dermatological manifestations. Xerosis was the most common dermatological manifestation present among the patients. Conclusions: This study reflects that quality of life in dialysis patients is mainly depend on timely recognition and prompt management of these dermatological conditions.

Tetralogy of Fallot (ToF) is the most prevalent cyanotic congenital heart disease (CHD) at birth and is also the most common repaired cyanotic CHD encountered as an adult. Over the past several decades surgical improvement has made great strides in lowering morbidity/mortality and extending life expectancy of these patients, and most will reach adulthood and achieve pregnancy. Management of a parturient with either repaired or unrepaired ToF must be individualized and requires thorough workup and participation from multiple disciplines, but overall outcomes can be excellent with lower risk to mother and fetus compared to other types of cyanotic CHD. Because many parturients with repaired ToF have clinically silent disease until late, it is imperative for anesthesiologists to familiarize themselves with potential complications and pitfalls regarding cardiovascular changes during pregnancy and how they affect peripartum CHD management.

Rheumatoid arthritis (RA) is one of the commonest rheumatological diseases. Renal involvement is not common but can occur as a result of chronic inflammation as part of disease process or drug toxicity. Thrombotic microangiopathy (TMA) is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and organ failure of variable severity. Only a few cases of TMA in patients with RA were reported to date. We describe a 45-year-old female patient with RA who presented with oliguria and edema. Renal biopsy showed TMA with patchy cortical necrosis. She improved with hemodialysis and plasmapheresis.