A Rare Diagnosis of Aseptic Hypertrophic Pachymeningitis: A Case of Mycobacterial Tuberculosis Origin

Tubercular meningitis is a rare yet devastating type of extrapulmonary tuberculosis (TB) posing great diagnostic challenges due to the nonspecific clinical presentation of the patients. Here, we present a rare diagnosis of hypertrophic pachymeningitis due to Mycobacterium tuberculosis. A 36-year-old male presented with a history of headaches and giddiness for one month. Neurological examination revealed hypo-reflexive triceps and ankle reflexes. Routine blood tests and autoimmune workup were normal. Brain MRI with contrast revealed diffuse dural thickening, focal leptomeningeal enhancement in the right temporal sulci, and enhancement in both the frontal and parietal convexity and the falx cerebri and along the tentorium cerebelli. Cerebrospinal fluid (CSF) analysis revealed elevated proteins, suggestive of aseptic meningitis. Meningeal biopsy revealed a chronic ill-formed granulomatous inflammatory lesion with occasional acid-fast bacilli, consistent with tubercular pachymeningitis. The patient was administered intravenous (IV) methylprednisolone for five days, following which the symptoms subsided. He was advised tablet prednisolone on discharge, and immunomodulation with rituximab was recommended as outpatient treatment. Hypertrophic pachymeningitis is a rare diagnosis characterized by the inflammation and fibrosis of the dura matter due to a diverse etiology. Tubercular etiology must be considered when the routine laboratory tests are negative, and the diagnosis should be confirmed by meningeal biopsy. The treatment of the underlying cause and corticosteroids remain the mainstay management of hypertrophic pachymeningitis. Hence, mycobacterial tuberculosis should be considered as a possible differential diagnosis while evaluating hypertrophic pachymeningitis, especially when the routine laboratory tests and immunological workup are negative.

Gitelman Syndrome Manifesting With Acute Hypokalemic Paralysis: A Case Report

Gitelman syndrome (GS) is a rare renal tubulopathy, classically characterized by renal salt wasting and metabolic alkalosis. It is usually an incidental diagnosis, being asymptomatic or with mild symptoms. GS manifesting with acute flaccid paralysis is extremely uncommon. We report a case of GS that mimicked Guillain-Barré syndrome (GBS), manifesting with acute hypokalemic paralysis. A middle-aged male with no known comorbidities presented to our center with paresthesias of all four limbs for one month and progressive, asymmetric limb weakness over the past eight days. Neurological examination revealed hypotonia, global areflexia, and power ranging from 3/5 to 4/5 in all four limbs, leading to our initial clinical diagnosis of GBS. Our patient's laboratory panel revealed hypokalemia, hypomagnesemia, metabolic alkalosis, and hypocalcemia, characteristic of GS. Additionally, he had significantly elevated creatine phosphokinase, suggestive of rhabdomyolysis. Further urine studies revealed renal potassium wasting, confirming the diagnosis of GS. Whole exome genome sequencing for common causative genes and workup for autoimmune disease were both negative. With gradual electrolyte correction, the patient rapidly improved symptomatically. Our case highlights an uncommon initial presentation of GS and emphasizes the need for more literature on its manifestations from the Indian subcontinent.

Ab-initio Calculation on Methylnitrenium Ion (CH3NH)+

Ab initio calculation were carried out on the singlet and triplet states of the methylnitrenium ion. The triplet state is the ground state for all values of angle at nitrogen.

Microstructure and stability of a lamellar liquid crystalline and gel phase formed by a polyglycerol ester mixture in dilute aqueous solution

The self-assembly behavior of a commercial mixture of polyglycerol fatty acid esters (PGE) and water is investigated as a function of temperature and surfactant content. The phase diagram of this pseudo-binary mixture was characterized using a combination of cross-polarized light and freeze-fracture electron microscopy (cryo-SEM), X-ray diffraction (XRD), small-angle neutron scattering (SANS), and differential scanning calorimetry (DSC). Our experiments show that the morphology of the supramolecular aggregates is lamellar and present in the form of a continuous or dispersed phase (multilamellar vesicles) depending on the water content of the system. Under the effect of temperature, the short- and long-range order of the bimolecular layers successively changes from a biphasic surfactant dispersion to a lamellar liquid-crystalline (Lalpha) and a stable lamellar gel phase (Lbeta) upon cooling; this transition is found to be irreversible. Formation of the lamellar aggregates can be related to the average molecular structure and shape factor of PGE. The stability of the resulting gel phase (Lbeta) appears to be due to the presence of small amounts of unreacted ionic co-surfactant, namely, fatty acid soaps, in this per se nonionic commercial mixture.