A Rare Case of Chronic Invasive Pulmonary Aspergillosis

Invasive pulmonary aspergillosis (IPA) and invasive aspergillosis (IA) are two examples of the broad clinical spectrum of Aspergillus infection. It mainly affects severely immunocompromised hosts, while immunocompetent people can sometimes be affected, especially those receiving treatment in the intensive care unit (ICU) for emergency cases with few instances of chronic cases. The risk factors in ICU patients for aspergillosis include intubated patients receiving hot and humidified air, viral infections like covid, and influenza, and diseases like diabetes, chronic obstructive pulmonary disease, etc. A case of 35-year-old male reported to us with a complaint of stomach discomfort that was acute and non-progressive in the epigastric area, radiating to the back, not accompanied by fever, and not linked with loose stools/vomiting. In addition, the patient experienced a nonproductive cough for two days that was not associated with dyspnea or chest discomfort. He had a high-resolution computed tomography (HRCT) thorax, which revealed a single pulmonary nodule in the left lung's middle zone; histology of the same nodule biopsy material revealed that it was caused by Aspergillus. He had an abdominal ultrasound, which revealed portal vein thrombosis, dilated periportal tortuous veins, evident peri splenic and mesenteric collaterals, and significant splenomegaly - suggestive of portal cavernoma formation with chronic liver parenchymal disease. Our patient has a past history of alcohol use disorder for the last 15 years due to which the patient has had recurrent episodes of acute pancreatitis for the last three years which has now progressed to chronic pancreatitis, also the patient has been diabetic for the last 10 years on insulin for the same. A patient with multiple comorbidities, such as cirrhotic portal cavernoma, type 2 diabetes, diabetic neuropathy, and acute and chronic pancreatitis, is the subject of our case study on chronic IPA.

A Young Male With Non-cirrhotic Cryptogenic Portal Cavernoma: An Authoritative Case Study

The growth of several porto-portal collateral veins encircling an existing stenosed or obstructed entry vein is an uncommon condition known as portal cavernoma. It is traditionally shown as the entry vein thrombosis (portal vein thrombosis - PVT) outcome. A male of 25 years with stomach discomfort for three days that was acute, nonprogressive, and was not accompanied by fever, loose stools, or vomiting. After he had undergone abdominal ultrasonography, portal vein thrombosis was discovered, and based on no involvement of suprahepatic veins according to ultrasonography, Budd-Chiari syndrome was ruled out. It was accompanied by dilated periportal tortuous veins and visible mesenteric and peri-splenic collaterals. Moderate splenomegaly was also present. All these features on ultrasound were suggestive of the "portal cavernoma" formation. The patient is not an alcoholic and does not have any chronic, hereditary, or metabolic liver disease. Thrombophilia and cancer screening through tumor markers were also negative. We, with this, present a rare case of non-cirrhotic idiopathic portal cavernoma. This rare case contributes to advancing medical and scientific knowledge that will encourage further dialogue on the topic.

Dengue and Chikungunya Co-Infection-Associated Multi-Organ Dysfunction Syndrome: A Case Report

Dengue and chikungunya infections are increasing globally, especially in India. While the majority of patients settle with symptomatic management, some develop life-threatening complications. Here we discuss a case of co-infection between dengue virus (DENV-2) and chikungunya virus (CHIKV) in a young Indian male who presented with an acute febrile illness that progressed to multi-organ dysfunction involving the hepatic, nervous, respiratory, and hematological systems. We discuss the management of this complicated case and attempt to generate awareness regarding the severity of co-infection by these viruses.

A Case of Acquired Angioedema Leading to the Diagnosis of Systemic Lupus Erythematosus

We describe a case of a young 32-year-old Indian female who presented with a solitary symptom of facial swelling for two months. The patient's blood test results showed hypocomplementemia and C1 INH deficiency and fell into the "third type" of acquired angioedema (AAE), leading to the diagnosis of systemic lupus erythematosus (SLE), with SLE inactivity at the time of presentation, which makes this an interesting case due to the rarity of such findings in our clinical settings.

Pyrethroid and Neonicotinoid Poisoning: A Good Prognosis

Insecticide poisoning is still one of the major means of suicide in rural India. We report a case of a 38-year-old male who had come to us with ingestion of thiamethoxam and lambda-cyhalothrin in an alcohol-intoxicated state. The prompt response and intensive care given by our center gave him a second chance to make better decisions ahead.