We report an 18-year-old male patient presented to us with complaints of fever and progressive weight loss for past 4 months. On examination, he also had multiple umbilicated papular to nodular lesions over his chin and forehead region. Blood count revealed anemia with leukopenia. An excisional biopsy of the skin lesion was suggestive of cutaneous histoplasmosis. On further investigations for anemia and leukopenia, he was found to have bone marrow histoplasmosis on trephine biopsy. Patient’s serology for HIV I and II was negative but his CD4 counts were low. Patient received amphotericin B and itraconazole. He showed remarkable improvement in his general condition and blood counts. A repeat CD4 count done at 4 months of treatment was also normal. Progressive disseminated histoplasmosis (PDH) presenting as cutaneous lesions in an immunocompetent host is very rare and has been reported in a few cases only

On 15 Feb 2012, food poisoning outbreak occurred in a primary school that never reported any incident before. A team was sent to identify the risk factor and to institute control measures. A retrospective cohort study design was applied. All persons who attended the school canteen meal on 15 Feb 2012 were interviewed, using a standard questionnaire. Environmental investigations included observations of kitchen, water supply, sanitation, food-handling procedures and the collection of environmental samples for microbiological analysis. 33 of 188 people had upper gastro-intestinal symptoms. All were students whereas school staff members ate food from outside the canteen. Mean incubation period was 30 minutes. Of 15 foods, nasi kuning was associated with the outbreak, RR 3.8 (95% CI 2.19-6.56). Kitchen cleanliness was poor. Temporary shortage of water supply caused them to use untreated water from the village well. Food handler practiced unhygienic food preparation. Bacillus cereus was isolated from water tank, preparation table surface and hand towel. Nasi kuning was most likely the source of B. cereus sp. outbreak probably from cross-contamination during food handling as a result of poor hygienic practices and using untreated water tank. The outbreak stopped with closure of school canteen. Food premises inspection must ensure all water is potable.

Acute-phase response is the sum of the systemic and metabolic changes occurred by release of acute-phase proteins in response to an inflammatory stimulus. The most important ones of these acute-phase reactants are erythrocyte sedimentation rate, C-reactive protein, fibrinogen, procalcitonin and ferritin. The most widely used ones are ESR and CRP while fibrinogen and ferritin are less commonly used. The other acute-phase reactants have limited role in routine clinical use. ESR and C-reactive protein have traditionally been used as markers for inflammation in infectious and noninfectious conditions. These markers have significant role in early diagnosis, in differentiating infectious from noninfectious causes, as a prognostic marker and in antibiotic guidance strategies. Procalcitonin and CRP are most commonly used in this regard. Although CRP is more specific than ESR, yet because of the high cost and limited availability, it has restricted clinical usage in developing countries. Not all acute-phase reactants behave the same way when stimulated;the concentration of some increases while others decrease in plasma

Lipomatosis is a condition characterized by multiple noncapsulated areas of fat accumulation with histology consistent with adipose tissue. Involvement of tongue along with multiple symmetrical lipomatosis is extremely rare. Here we report a case of multiple symmetrical lipomatosis involving tongue and presenting as macroglossia.

Thyrotoxic periodic paralysis (TPP) is a rare but potentially serious complication of hyperthyroidism characterized by muscular weakness and hypokalemia in a patient with thyrotoxicosis. It is predominantly seen in Asian males.The etiology of thyrotoxicosis in most of the cases of TPP is Graves’ disease. We present a case of a 19-year-old male who presented in emergency with paraparesis. Investigations revealed hypokalemia and thyrotoxicosis related to toxic nodular goitre. Diagnosis of thyrotoxic periodic paralysis was made and patient was treated with potassium replacement, propranolol and antithyroid treatment.

We report a case of scrub typhus presenting with fever and thrombocytopenia highlighting the wide variation in clinical presentations leading to delayed diagnosis in dengue epidemic. Fever and thrombocytopenia are the most common clinical presentations in viral hemorrhagic fever but other diseases like malaria, typhoid, leptospira, rickettsial and other arboviral diseases, should also be considered in differential diagnoses. A high clinical suspicion of scrub typhus and early differentiation from other diseases is important as lethal complications can occur because of delay in diagnosis and treatment.

Cytophagic histiocytic panniculitis(CHP) is a rare subtype of panniculitisthat usually follows a fatal course, with a terminal hemophagocytic syndrome. We observed a case of pancytopenia, generalized lymphadenopathy and panniculitis, which on subsequent investigations (skin biopsy and bone marrow biopsy) revealed hemophagocytic and cytophagocytic picture