To differentiate, grade and evaluate the histologic features seen in the biopsy specimens of osteomyelitis patients in a tertiary care centre according to their abundance/severity with the help of a pre-established scoring system and to correlate those features with their radiology and serology findings. 52 synovial biopsy specimens of patients suffering from osteomyelitis, from the year 2015 to 2017, were reviewed from the institute’s case files. The histopathological features were analyzed and a diagnostic criterion was set using a grading system involving five histological features to differentiate the same. It was observed that out of the 52 synovial specimens, 9 specimens were graded as acute osteomyelitis, 11 as chronically florid osteomyelitis, 20 as chronic osteomyelitis, 45 as subsided osteomyelitis, and the rest had no histopathological features of osteomyelitis (Table I). The radiology findings showed that 10 specimens showed osteosclerotic lesions, 4 had osteolytic lesions, 7 had osteopenic lesions and 2 of them had both osteosclerotic and osteolytic lesions (Table II). The serology findings revealed increased ESR values (>100mm/hr) in 3 of the specimens, increased WBC counts (>11,000 cells/mm³) in 8 specimens, increased neutrophil counts (>80%) in 3 specimens and increased lymphocyte counts (>40%) in 6 specimens (Table III). This analysis helped to classify osteomyelitis and better the understanding of its histopathological features present in synovial membrane tissue in patients suffering from different grades of osteomyelitis.

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Idiopathic intracranial hypertension (IIH) is a disorder that leads to isolated raised intracranial pressure characterized by classical symptoms and signs such as headache, papilledema, sixth nerve palsy causing diplopia and pulsatile tinnitus.In our case report, we present a 20-year-old primigravida suffering from IIH presenting with unusual clinically elicited signs, including bilateral proptosis, unilateral ophthalmoplegia, and unilateral facial nerve palsy. Fundoscopy revealed bilateral papilledema and visual field examination showed enlarged blind spots in both eyes. Lumbar puncture was done to detect the opening pressure of cerebrospinal fluid which was measured to be 57cm of water. MRI brain + venogram was suggestive of vertical kinking of right optic nerve and tortuosity of bilateral optic nerves along with stenosis in bilateral transverse sinuses. In previous literature, there are only two reported cases of IIH that were associated with proptosis, both presenting unilaterally, and one reported case of IIH presenting with complete unilateral facial palsy. When a patient presents with these unorthodox signs, the diagnosis of IIH cannot be excluded.