Paroxysmal Nocturnal Hemoglobinuria in Systemic Lupus Erythematosus: A Rare Manifestation

Paroxysmal nocturnal haemoglobinuria (PNH) is a rare disorder of hematopoietic stem cells. The occurrence of PNH in a patient with systemic lupus erythematosus (SLE) is even rarer. One such presentation was seen in a 19 years old woman who presented with fever, multiple joint pain, photosensitivity, oral ulcer, hair loss and was diagnosed as a case of SLE and was admitted in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh on 7th February 2019. Subsequently she developed progressive anaemia and passing of dark colored urine. Flow cytometry analysis showed PNH clone within red cells. We report this case so that clinicians are aware about this association between PNH and SLE. Informed written consent was obtained from the patient for the publication of this case report, the copy of which is available with the authors.

Anti-phospholipid Antibody Syndrome Presenting as Huge Ascites: A Case Report

Antiphospholipid Syndrome (APS) is characterized by arterial, venous or small vessel thromboses and/or pregnancy morbidity in the presence of persistently elevated titers of antiphospholipid antibodies. Since virtually any organ can be involved, the clinical presentation of APS is very varied. Abdominal manifestations are rare but may be life-threatening, and include Budd-Chiari Syndrome. We report the case of a 26-year-old woman with primary APS, on aspirin treatment, who presented to us at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh in March 2017 with ascites for which she had been receiving treatment for abdominal tuberculosis. Following clinical and laboratory evaluation, she was diagnosed as a case of Budd-Chiari Syndrome with portal hypertension and initiated treatment with warfarin. There should be a high index of clinical suspicion for Budd-Chiari as a cause of ascites in patients with APS, since early recognition and treatment can significantly improve patients' survival.

A Patient with Grave's Disease and Tuberculous Lymphadenitis

Immune reactivity between Mycobacteria and human antigens can play an important role in the pathogenesis of autoimmune disease. We report a case of Graves's disease and tuberculous lymphadenitis to explain the mechanism of correlation between immune-mediated diseases and tuberculosis and to raise awareness of the importance of screening for TB in this context, especially in endemic country. Screening for latent TB at immune mediated disease diagnosis and regular timely screening thereafter may be beneficial.

Total Serum IgE Level Estimation in Asthma Patient and Healthy Volunteers in a Tertiary Care Hospital, Bangladesh

A strong association between total serum Immunoglobulin E (IgE) levels, skin test reactivity to aeroallergens, and asthma phenotype was found in previous studies. The current study has been undertaken to observe the total serum IgE level in asthmatic patients compared with normal healthy volunteers (control) of Bangladeshi subjects and to see its prospect in diagnostic aid. This case-control study was carried out in the department of Respiratory Medicine of National Institute of Diseases of the Chest and Hospital (NIDCH), Dhaka during the period from July 2008 to June 2009. Four hundred & eight (408) cases (asthmatics matching age, sex and geographic location) and 478 controls (non-asthmatics matching age, sex and geographic location) were studied. The level of serum IgE was found more in asthma patients than control group which were 345.88 and 224.64 respectively (p<0.001). In both group, serum IgE level was more in male than female. There was wide variation in serum IgE level in both the asthma and control group (4.2 to 3471.0 iu/ml in asthma group and 1.2 to 1045.7 iu/ml in control). Considerable overlap has been observed between the IgE values of control and asthma group. Due to this overlap its diagnostic significance in allergic condition in Bangladeshi population seems to be limited.

Determination of Insulin Secretory Defect and Insulin Sensitivity in Type 2 Diabetic Subjects in Bangladesh

Diabetes mellitus (DM) is defined as a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. This study was undertaken to explore the basic defect in type 2 diabetes patients in Bangladesh. This was an observational study with case control design, was conducted in the Biomedical Research Group, Research Division, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine Metabolic Disorders (BIRDEM), Dhaka, Bangladesh, during the period of July 2008 to June 2009. A total of 153 subjects were included in study of which 63 belonged to type 2 diabetes mellitus group and 90 were healthy controls. Fasting and 2 hours postprandial blood glucose, serum insulin, HOMA%B, HOMA%S, QuickI, Glucose /insulin ratio, TG were measured and age, BMI, WHR were recorded. Waist-hip ratio (WHR), was significantly higher in T2DM as compared to control subjects [WHR, mean±SD, 0.94±0.12 vs. 0.88±0.06, p<0.001]; Glucose and insulin ratio of T2DM was significantly higher as compared to control subject [Glu: Ins, Median (range) of 0.54 (0.17-2.33) vs. 0.37(0.06-1.52)]. Insulin secretion (HOMA%B) was significantly lower in diabetic as compared to control subjects [HOMA%B, median (range), 71(4.90-391) vs. 180(59-634) p<0.001]; The quantitative insulin sensitivity check Index (QUICKI) of diabetic subjects were significantly higher as compared to control [QUICKI median (range) 39.90(4.80-138.10) vs. 0.55(0.36-0.85), <0.001]. Triglyceride (TG) and cholesterol (Chol) were significantly higher [(mg/dl), (mean±SD), TG (142±80.14) vs. (142±80.14); Chol (189±50.76) vs. (172±45), p=0.029] in T2DM as compared to control subjects. Those with diabetes showed significant association with insulin secretory defect (HOMA%B, p=0.006) and insulin resistance as assessed by GINR (p<0.001) and QuickI (p<0.001) but not by HOMA%S (p=0.127). The present data suggest that both insulin secretory defect and insulin sensitivity are present in T2 diabetic subjects of Bangladesh.

Methanol Induced Toxic Amblyopia--A Case Report

A 28-year-old man, smoker having history of occasional alcohol intake--was admitted in the Department of Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU) with gradual diminution of vision in both eyes 10 days after consumption of homemade alcoholic beverage in a wedding ceremony. His initial acuity of vision was limited to no perception of light in right eye and hand movement in left eye. Fundus examination revealed pale optic discs in both eyes. The patient was treated with Injection Methylprednisolone 1000 mg intravenous slowly over 1 hour for 3 consecutive days. This was followed by oral prednisolone 60 mg daily for 14 days and then gradually tapered over 4 weeks. The patient also received Injection Hydroxycobalamine and Injection Folinic Acid for 2 weeks. On the 3rd day of treatment there was perception of light in the right eye and on the 10th day the visual acuity improved to hand movement. In the left eye, the visual acuity gradually improved to 6/60 on 3rd day and on 10th day improved to 6/24. Four weeks later, the visual acuity had recovered in both eyes to 6/18. Combination of intravenous and oral steroid along with vitamin B1 and folinic acid has been found effective in treating severe methanol induced optic neuropathy.