Plasmodium falciparum infection is known to be associated with a spectrum of systemic complications ranging from mild and self-limiting to life-threatening. This case report illustrates a patient who had a protracted course in hospital due to several rare complications of falciparum malaria. A 21-year old man presented with a five-day history of high-grade fever, jaundice and abdominal pain and a two-day history of altered conscious state. A diagnosis of severe falciparum malaria was made based on the clinical presentation and a positive blood smear with parasitaemia of 45%. Despite adequate anti-malarial therapy with artesunate, the patient had persistent and worsening abdominal pain. Investigations suggested a diagnosis of acute pancreatitis, a rare association with falciparum malaria. However, in spite of supportive therapy for acute pancreatitis and a 10-day course of intravenous artesunate and oral doxycycline at recommended doses, he continued to be febrile with peripheral blood smear showing persistence of ring forms. Antimalarial therapy was, therefore, changed to quinine on the suspicion of possible artesunate resistance. On the 17 th day of stay in hospital, the patient developed generalized tonic-clonic seizures. Computerized tomography of the brain showed bilateral fronto-parietal subdural haematomas that were surgically drained. His fever persisted beyond 30-days despite broad-spectrum antibiotics, quinine therapy and negative malarial smears. A possibility of drug fever was considered and all drugs were ceased. He subsequently became afebrile and was discharged on the 38 th hospital admission day. Recognition of complications and appropriate management at each stage facilitated successful outcome. This report has been presented to highlight the occurrence of several rare complications of falciparum malaria in the same patient.

Background Literature is scarce on primary sarcopenia among Indian older adults. This study was aimed to estimate the prevalence of primary sarcopenia among older persons in India using the European Working Group on Sarcopenia in the Older People 2010 (EWGSOP) diagnostic criteria and to elucidate the factors leading to its development. Methodology Two hundred twenty‐seven subjects over 60 years of age attending the geriatric outpatient clinic were recruited for the study. Sarcopenia was diagnosed based on set criteria for gait speed, handgrip, and skeletal muscle mass assessment by dual‐energy x‐ray absorptiometry. Result The prevalence of primary sarcopenia in the study population was 39.2% (n = 89). Male patients were more sarcopenic than women, 47% (n = 72) vs 23% (n = 17). Obese subjects (body mass index > 25 kg/m 2 ) had a lower prevalence of sarcopenia (odds ratio = 0.10; 95% confidence interval = 0.05–0.19). There was no association between sarcopenia and other postulated risk factors like low vitamin D levels, dietary protein or carbohydrate intake, or sedentary lifestyle. Conclusion Contrary to published data, primary sarcopenia appears to be higher among older Indians using presently available guidelines. Community studies with validated cutoffs suited for the Indian subcontinent may yield a lower prevalence of primary sarcopenia.

Acute haemorrhagic leukoencephalitis (AHL) is a fulminant inflammatory disease of cerebral white matter, characterised by demyelination and haemorrhagic necrosis. The outcome is usually fatal with only few survivors.An unusual presentation of a 44-year-old South Indian farmer who developed AHL following a snake bite is reported. Though the initial brain imaging showed extensive involvement of the white matter with multiple haemorrhagic foci, the patient improved spontaneously with no specific therapy. A repeat magnetic resonance imaging of the brain 28 days after the snake bite confirmed radiological improvement. KeywordsAcute haemorrhagic leukoencephalitis, Hurst's disease, snake bite Case reportA 44-year-old farmer from India was working in the fields when he was bitten on his right foot by a snake which he readily identified to be a Russell's viper (Daboia russelii). A few minutes after the bite, he developed severe pain, swelling and bleeding from the site, followed by diplopia and ptosis. He was brought to our centre and was initiated on intravenous polyvalent antisnake serum (Serum Institute of India Limited). He showed no immediate reaction to the anti-venom. While in the hospital he developed bleeding gums and oliguria. On examination, the vital signs were stable. The right foot was markedly swollen with two deep fang marks on the dorsum. Neurological examination revealed a normal sensorium, bilateral ptosis with ophthalmoparesis and normal deep tendon reflexes. He was admitted to the intensive care unit (ICU) where he developed anuria and respiratory failure within 24 h of admission. He was ventilated for respiratory failure and was transfused multiple blood products for various bleeding manifestations. His respiratory status gradually improved and he was extubated. His renal failure persisted and required maintenance haemodialysis.Following transfer to the ward from the ICU, on the seventh day following the snake bite, he was detected to have a low sensorium with bi-pyramidal signs. Neurological examination revealed a conscious but drowsy state and resolution of the ptosis and ophthalmoplegia. The limbs were spastic with a hypereflexic quadriparesis. Sensory examination was normal and Babinski reflex was positive bilaterally. Investigations revealed normal hemoglobin, white blood cell and platelet counts. His coagulation profile was deranged (prothrombin time 63.4 s [13-15 s], activated partial thromboplastin time 41.6 s [28-39 s]). He had severe renal failure, with serum creatinine 654mM [44-124 mM], microscopic haematuria and granular casts on urine microscopy. His serum electrolytes were normal (sodium: 145 meq/dl, potassium 3.6 meq/dl). Non-contrast computed tomography (CT) and magnetic resonance imaging (MRI) scans of the brain were done on the 10th day post snake bite.

Cysticercosis is a common public health problem in the Tropics. However, disseminated cysticercosis is rare. We report a patient with chronic liver disease and seizures, in whom a simple plain radiographic examination helped in narrowing down the differential diagnosis to disseminated cysticercosis. The diagnosis was confirmed by serum cysticercal antibody enzyme-linked immunosorbent assay (ELISA) and computerized tomography of the brain.

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