A 66-year-old male patient presented to the hospital with the complaints of weakness, loss of weight of about 10 kg in 2 months, decreased appetite, increased frequency of urination, not associated with burning sensation or hematuria. There was no history of fever or cough, altered bowel habits, or diabetes mellitus. Patient was suspected to harbour malignancy, underwent upper gastrointestinal endoscopy (UGI), high resolution computed tomography (HRCT) chest in an outside hospital which were normal. Patient came to this hospital for CT scan of abdomen. Patient was examined thoroughly and the clinically positive findings were, generalised wasting, tremors in the hands, heart rate 110 per min which led to investigate in lines of thyrotoxicosis. Thyroid stimulating hormone (TSH) was 0.01 free T3 was high and all other investigations normal. Random blood Sugar 115mg %, prostate-specific antigen 2.5ng/ml. patient underwent tc99 scan which was suggestive of were Graves’ disease. Endocrinology department has taken the patient and started on neomercazole, proponolol and discharged. Keywords: apathetic thyrotoxicosis; hyperthyroidism; weight loss; thyroid hormone

A 24-year-old male presented with fever, sore throat, and arthralgias for duration of 4 weeks. Fever was high grade, intermittent, associated with maculopapular rash. He was admitted in outside hospital and was started on antibiotics, antituberculosis treatment (ATT), and anti-malarials. The patient was discharged without any improvement. He was then admitted in KIMS hospital, Secunderabad, with persistence of initial symptoms and he was investigated thoroughly for all possible infections, malignancies and autoimmune disease. Rheumatologist consultation was taken, Adult-onset Still’s disease (AOSD) has been considered as he fulfilled the criteria of AOSD. He was started on appropriate therapy and was discharged in stable condition. Keywords: Adult-onset Still’s disease; maculopapular rash; systemic inflammatory disorder

17-year-old female, came with complaints of abdominal pain, vomitings, hypertension. Three days before admission she developed severe abdominal pain, backache and generalised body pains with extreme weakness. These symptoms worsened over 3 days, accompanied by nausea, vomiting, and emotional instability [1]. Her medical history is notable for 6 similar attacks with abdominal pain and vomiting. She took no medications. On admission she was lethargic but oriented. On day 4 of hospital stay patient developed generalised tonic clonic seizure, hyponatremia, fall in haemoglobin, and during this episode there was pinkish discoloration of urine. With suspicion of porphyria, urine was sent for porphobilins estimation, which was positive. 24 hour urine for porphoblilinogen, was elevated and there were decreased levels of PBG-deaminase activity. Patient was treated with high carbohydrate intake and correction of electrolyte disturbances. Haematin and heme arginate were not used, due to the difficulty to acquire the medication. Keywords: Acute intermittent porphyria; autosomal dominant metabolic disorder; porphobilinogen deaminase enzyme