Raised Sedimentation Rate Research Articles

Polymyalgia Rheumatica Presenting as Nocturnal Pyrexia of Unknown Origin: A Case Report

Background. Polymyalgia rheumatica (PMR) is a rheumatic disorder characterized by musculoskeletal stiffness and pain, primarily affecting the shoulder, neck, and hip areas. It is more common in females, with the peak incidence usually after the age of 70. Case Report. A 74-year-old man presented with a two-month history of low-grade nocturnal fever up to 100oF (37.7oC) which did not respond to multiple courses of antibiotics. There was unintentional weight loss of 5 kg and mild shoulder stiffness. The patient had a history of Type 2 diabetes mellitus treated with 34 units of insulin (Humulin 70/30) daily and active smoking of 40 pack-years. On examination, mild tenderness of both shoulder girdle muscles and discomfort on external rotation were noted. The initial blood work-up revealed raised erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels. Serologies for syphilis, human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) were negative. Given the negative results of infective and malignancy screening, along with raised inflammatory markers and mild shoulder stiffness, a diagnosis of PMR was made and a trial of prednisolone was initiated, resulting in the resolution of symptoms. Conclusions. The present case report highlights the importance of thoroughly investigating all differential diagnoses of pyrexia of unknown origin, regardless of the patient’s ethnic origin, to facilitate timely diagnosis.

Spondylodiscitis: A Diagnostic and Management Dilemma.

Aims Spondylodiscitis (SpD), a debilitating infective condition of the spine, mandates early diagnosis and institution of appropriate therapy, for which accurate microbiology and histological evaluation of the affected tissue is vital. The objectives of the study were to assess the correlation between clinical and magnetic resonance imaging (MRI) findings with histopathology (HPE) and microbiology (MB) in clinically diagnosed spondylodiscitis. Settings and design This was a prospective study of 34 consecutive patients reporting at the outpatient department of a tertiary hospital with clinical and imaging features of SpD, who underwent image-guided/surgical biopsy of lesions. Methods and material The provisional diagnosis of SpD in all patients was made on the combined basis of clinical profile and MRI Spine findings. Tissue samples in all patients, obtained by either open surgery or CT-guided biopsy, were subjected to HPE and MB analysis. Results SpD has a bimodal age distribution with the majority of patients being males in the fourth to fifth decades. Only raised erythrocyte sedimentation rate (ESR) was consistently seen amongst laboratory parameters, with leucocytosis being added pointer towards pyogenic etiology. MRI remained the imaging modality of choice for SpD but was not dependable for etiologic differentiation. On HPE and MB evaluations, 24 patients (71%) had findings consistent with infective SpD, while combined results augmented etiologic confirmation for 28 patients (82.4%). HPE was more sensitive than traditional MB methods to determine etiology in SpD, but the addition of the GeneXpert (Cepheid,Sunnyvale, California, United States) technique improved the MB positivity rate, especially in patients with tubercular SpD. Six patients (17.6%) with both negative HPE and MB results were categorized as 'Non-specific' SpD. Conclusions SpD poses a challenge to determine the etiology for the administration of specific antimicrobial therapy. A stratified standard institutional approach needs adoption to systematically evaluate SpD patients by having a high index of clinical suspicion, early imaging, followed by tissue biopsy for HPE and MB. Despite efforts to reach a diagnosis, a subset of patients without conclusive etiologic agent identification would remain as 'Non-specific', needing empiric antibiotic treatment based on clinico-radiologic profile.

Outcome of Open Repair of Thoracoabdominal Aortic Aneurysm in Takayasu Arteritis: A Retrospective Analysis

Takayasu Arteritis (TA) is an immune mediated arteritis causing inflammation of the aorta and its branches, which can result in aortic aneurysms. Our aim is to describe the outcome of surgical management in these patients who presented with Thoracoabdominal aortic aneurysm (TAAA). Between 2003 and 2023, 40TA patients with TAAA underwent operative repair. There were 24 females and 16 males, in the age group of 19-53years, with hypertension in 20 patients. Raised Erythrocyte sedimentation Rate was present in 13 patients. According to Crawford classification, there were 2 patients with type I, 2 with type II, 17 with type III, 12 patients with type IV and 7 with type V aneurysm. Multiple steno-occlusive lesions of aortic branches were present in 21 patients, with majority affecting the renal artery. Femoral Artery Femoral Vein Partial cardiopulmonary bypass was used for types I, II, III and V. Separate bypass to visceral branches was done in eight patients, of whom five had multiple bypasses and three patients only had renal bypass. Twelve patients underwent reimplantation of branches, out of which nine had multiple vessel reimplantation. Four patients underwent staged repair of the aneurysm, which included visceral debranching in the first day, followed by repair of the aneurysm in the next day. In the immediate postoperative period, ten patients developed acute kidney injury and two required dialysis. Other morbidities included acute respiratory distress syndrome (ARDS), spinal cord dysfunction, bleeding, and wound complications. Three patients expired in the immediate postoperative period. Mean duration of intensive care unit stay was 4.1days and hospital stay was 12.7days. Comparison of disease activity with morbidity and mortality was statistically insignificant. Patients were on follow-up for a range of 6months to 14years and median follow-up of 25months. Over this time period four patients expired and four developed anastomotic pseudoaneurysm requiring intervention. On comparing the disease activity at the time of surgery with the long-term arteritis related complications that required intervention, the P value was 0.653 and hence statistically not significant. The 10-year survival rate is 84.4%. Surgical repair has good and satisfactory outcome, with low early and late mortality rates. Progression of disease can occur at any stage of the disease, hence indicating the need for long term follow-up and frequent imaging.

Diagnostic dilemma- choroidal granuloma as an atypical rare presentation: A case report

Purpose: To report a rare atypical case of ocular toxoplasmosis presenting as choroidal granuloma in a young adult. Case presentation: A 16-year-old male presented with sudden diminution of vision in the right eye. The visual acuity was 6/12p in the right eye. The anterior segment examination was normal. No relative afferent pupillary defect was present. The fundus examination of the right eye showed grade 1 vitritis, a normal disc with a well circumscribed active choroidal lesion on the posterior pole, inferior to the fovea along with surrounding Subretinal Fluid (SRF) pocket. The Optical Coherence Tomography (OCT) of the right eye showed choroidal elevation with the highest dimension just inferior to the fovea, along with surrounding SRF at the fovea. Fluorescein angiography showed punctate hyperfluorescent leakage points around the lesion. Intervention: Blood hemogram was normal with a raised erythrocyte sedimentation rate. Serological screening was positive for toxoplasmosis (IgM and IgG antibodies). Human Immunodeficiency Virus (HIV) and tuberculosis (QuantiFERON Gold test) were negative. Oral medications spiramycin 500 mg three times a day for 3 weeks along with folic acid once a day was started after paediatrician consult. Result: Follow up at 1 week, the visual acuity improved to 6/9 and the choroidal elevation along with the SRF was resolving on the OCT scan. After 3 weeks of treatment the visual acuity improved to 6/6 and the fundus showed complete resolution of the choroidal granuloma along with the surrounding SRF with no residual chorioretinal scar formation. Conclusions: Our case reports a rare atypical presentation of ocular toxoplasmosis with only one more case available in the literature of ocular toxoplasmosis presenting as a posterior pole choroidal granuloma. Timely intervention lead to complete resolution of the lesion and complete restoration of the visual acuity.

Case Report: Branch Retinal Vein Occlusion Post mRNA SARS-CoV-2 (COVID-19) Vaccination.

Systemic thromboembolic complications are well documented to be associated with Coronavirus disease 2019 (COVID-19), however, there has been a growing number of reports regarding ocular complications stemming from COVID-19 vaccinations. This case illustrates a clear temporal and possible causal relationship of COVID-19 vaccination with an ocular microvascular disorder, namely retinal vein occlusion. To report a case of inferotemporal branch retinal vein occlusion after mRNA SARS-CoV-2 vaccination. A middle-aged female developed right eye central scotoma two days after COVID-19 vaccination. She had transient hypertension during the first two days post-vaccination. A decrease in visual acuity (6/18) was documented. Initial retinal findings included flame-shaped hemorrhages and cotton wool spots along inferotemporal branch retinal vessels. Optical coherence tomography revealed right eye cystoid macular edema. Laboratory investigation revealed mildly raised erythrocyte sedimentation rate and C-reactive protein. Other systemic examinations were unremarkable. She was treated for right eye inferotemporal branch retinal vein occlusion with cystoid macular edema and was given intravitreal anti-vascular endothelial growth factor monthly in three doses. Her visual acuity improved to 6/6 with resolved cystoid macular edema. This case illustrates a clear temporal and possible causal relationship between COVID-19 vaccination and retinal vein occlusion. Post vaccination transient hypertension, or the immunological and inflammatory response to the vaccine may have contributed to the venous occlusive event in this case. Eye care providers should remain aware of this possibility. The effectiveness of intravitreal anti-vascular endothelial growth for the treatment of macular edema secondary to branch retinal vein occlusion was demonstrated in this patient.

Pre-COVID-19 Kawasaki disease and COVID-19 era multisystem inflammatory syndrome in children: A single-center experience

Context: Multisystem inflammatory syndrome in children (MIS-C) seen during the COVID-19 pandemic time most likely represents a severe variant of Kawasaki disease (KD). Aim: The aim of this study was to study the clinical difference between KD and MIS-C. Study Design: A prospective observational study of MIS-C patients was done during the COVID-19 pandemic period and a descriptive comparative study was done with available institutional data on KD. Materials and Methods: Consecutive patients admitted with clinical features of MIS-C were enrolled and compared with the available records on KD patients. Statistical Analysis Used: Qualitative data were analyzed using percentages and proportions. Quantitative data were analyzed using mean, standard deviation, and median. Differences between groups were compared with Student’s t-test for parametric continuous variables. Results: Thirty-three pre-COVID-19 KD patients and 28 MIS-C patients were compared. Median age in KD and MIS-C was 2.4 and 7.7 years, respectively (P < 0.001). More gastrointestinal and neurological symptoms were seen in MIS-C (P < 0.001). KD patients had more leukocytosis, raised erythrocyte sedimentation rate, and thrombocytosis. MIS-C patients had higher mean levels of procalcitonin, ferritin, troponin, and brain natriuretic peptide. Coronary artery aneurysms and mitral regurgitation occurrence were similar in both, with a higher incidence of left ventricular dysfunction in MIS-C.

Subacute nodular migratory panniculitis, a rare presentation of a rare disease: a case report

Panniculitis refers to the inflammation of the subcutaneous fat. Subacute nodular migratory panniculitis (Aka Vilanova disease) is a rare type of panniculitis seen predominantly in women. Clinically, it closely resembles erythema nodosum but is often unilateral as opposed to the bilateral involvement in erythema nodosum. Triggering factors include infections, drugs, thyroid disorders, pregnancy, or malignancies. We report a rare case of a 52-year-old female who was a known case of hypothyroidism and presented with sudden onset of red colored painful lesions with raised temperature over both lower limbs. Hematological evaluation was unremarkable except for raised erythrocyte sedimentation rate. Histopathological examination of the lesion showed septal panniculitis with giant cells, suggestive of subacute nodular migratory panniculitis. The patient responded very well to treatment with capsule indomethacin.

Multimodality imaging of myocardial tuberculosis presenting as right ventricular cardiomyopathy: A case report.

An 18-year male with no significant past medical history presented with features of right-sided heart failure. Haematological investigations revealed raised erythrocyte sedimentation rate (23 mm/h). Transthoracic echocardiography (TTE) demonstrated biventricular systolic dysfunction with thickened free wall of right ventricle (RV). Whole-body fluorodeoxyglucose (FDG)-positron emission tomography (PET) computed tomography (FDG-PET-CT) showed intensely increased FDG uptake in the thickened RV wall and an FDG avid lesion in the left medial temporal lobe. Cardiac magnetic resonance imaging (CMR) characterized thickening and suggested an infiltrative disease (isointense on TI, hyperintense on myocardial oedema sensitive sequence with transmural enhancement on late gadolinium sequence). Magnetic resonance imaging (MRI) brain showed a thick rim enhancing ring lesion in the body of hippocampus. Endomyocardial biopsy revealed moderately dense lymphomononuclear inflammation with the formation of granulomas. Since tuberculosis is endemic in our country and considering all laboratory, imaging and biopsy findings a working diagnosis of tuberculosis was considered, and standard anti-tubercular treatment was started. There was an improvement in clinical status and follow-up imaging (TTE, CMR, brain MRI and FDG-PET-CT) showed improvement in biventricular function with regression in myocardial thickening and resolution of brain lesion, confirming the diagnosis of tuberculosis.

Orbital tuberculosis presenting as proptosis: A case report

A 53-year-old male complained of gradual, painless dimness of vision with swelling of the right eye (R/E) for 15 days. Best-corrected visual acuity in R/E: Hand movement, left eye: 6/9, abaxial proptosis, restricted extraocular movements in all directions, conjunctival injection, and high intraocular pressure R/E were noted. Fundus showed pale optic disc R/E and macular exudates in both eyes. The patient was diabetic and on oral hypoglycemic agents with raised erythrocyte sedimentation rate and C-reactive protein; random blood sugar: 152 mg/dL. Magnetic resonance imaging (MRI) showed right-sided orbital abscess involving extraconal compartment extending into the right orbital apex with compression of the right optic nerve. Mantoux test was positive and computed tomography thorax was normal. Histopathology of biopsy from middle turbinate showed granulomatous inflammatory cellular lesion. The patient was started on anti-tubercular therapy. He got relieved of symptoms. Repeat MRI showed reduction in disease process.

Risk factors and inflammatory markers in acute coronary syndrome-ST elevation myocardial infarction (STEMI).

The increasing prevalence of coronary artery disease [CAD] poses worrying statistics. Atherosclerosis of coronary vessels is the main culprit for the spectrum of CADespecially acute coronary syndrome. Atherosclerosis is regarded as a consequence of inflammatory changes in the coronaries. Our study aimed to assess the role of risk factors and inflammatory markers with acute ST-elevation myocardial infarction [STEMI]. 100 patients with ST-elevation Myocardial infarction [STEMI] and 100 age and sex matched controls were included in the study. A history of risk factors like smoking, hypertension, diabetes and hypertension was noted. A venous blood sample was obtained for analysis of inflammatory markers. The data thus obtained was statistically analyzed. The cases had a significant number of risk factors such as smoking, hypertension, and diabetes mellitus, previous history of CAD, increased body mass index [BMI], and raised high sensitive C-reactive protein [hs-CRP]. Patients with anterior myocardial infarction were older and had hypertension and diabetes mellitus. Patients with inferior myocardial infarction had high BMI, raised erythrocyte sedimentation rate [ESR] and alcoholism. Smokers, patients with diabetes mellitus, high total cholesterol, Low-density lipoprotein [LDL] cholesterol, and hs-CRP were more prone to complications. Patients with a greater number of risk factors and raised inflammatory markers were at high risk of STEMI and its complications. An approach to control the modifiable risk factors like obesity and lifestyle changes can reduce the disease burden.

Correlation of Clinico-Hematological Parameters in Adult Dengue with Survival and Death: Emphasis on Cause of Mortality

ABSTRACT Objective: Dengue is a systemic and dynamic disease ranging from asymptomatic seroconversion to severe dengue with hemorrhagic and organ impairment. Although many reports exist on clinical and hematological aspects, surprisingly there are no articles that take in to account these parameters in people who have survived and succumbed to the illness in a matched cohort study with healthy controls from an endemic region. The present study is carried out with this objective. Patients and Methods: This was a retrospective study conducted at Father Muller Medical College Hospital, a tertiary care hospital, at Mangalore, Karnataka from January 2017 to December 2019 to compare the clinico-hematological parameters in the adult patients diagnosed with dengue fever. The data collected were entered into Microsoft Excel, and statistical analysis was done by Student’s t-test. P < 0.05 was considered as statistically significant. Results: A total of 429 patients were included in the study, with 274 (63.87%) males and 237 (55.24%) patients belonging to the age group of 18–30 years. The most common symptoms were fever (100%), vomiting (96.04%), and headache (36.83%). The dengue patients had leukopenia, lymphocytosis, monocytosis, thrombocytopenia, raised erythrocyte sedimentation rate, and hematocrit. In addition to this, the deceased dengue patients (27) had deranged liver and renal parameters compared to alive. Conclusions: The results suggest that when a patient presents with fever, persistent vomiting, thrombocytopenia, and raised hematocrit, dengue fever should be the first differential diagnosis, especially in endemic area. Furthermore, the elderly and people with comorbidities are at high risk of death if medical care is delayed.

HEMATOLOGIC MANIFESTATIONS OF SYSTEMIC LUPUS ERYTHEMATOSUS IN A TERTIARY CARE CENTRE

Background: Systemic lupus erythematosus (SLE) can present with hematologic manifestations alone or with features of systemic involvement. Diagnosis may be delayed or missed at presentation time, especially in those with hematologic abnormalities as the initial manifestation, with low index of clinical suspicion or inadequate follow-up. Aim And Objectives: To study the prevalence and the type of hematologic manifestations in SLE from pathologist's perspective. Setting And Design: Retrospective observational study. Material And Methods: Study was done in 63 SLE patients in a tertiary care hospital in Secunderabad for duration of one and half years, from January 2018 to June 2019. Hematological parameters of the same were retrieved. Results :It was observed that anemia was the most common hematologic nding with iron deciency anemia (IDA) being the commonest cause followed by hemolytic anemia. Leucopenia with predominant lymphopenia was the most common WBC abnormality and thrombocytopenia was seen in majority of the patients. Bi and pancytopenia was also observed. Raised erythrocyte sedimentation rate (ESR) was a common nding. Deranged coagulation prole was seen due to secondary anti-phospholipid antibody (APLA) syndrome, hemolysis and sepsis on anticoagulant. Bone marrow studies showed varied ndings including hypocellularity, dyspoiesis in the erythroid, myeloid and megakaryocytic series and abnormal localisation of immature precursors (ALIP) aggregates. Conclusion: This study was conducted to estimate the proportion of patients with hematological abnormalities as the manifestation of SLE and to study the nature of hematological problems, so that the empirical treatment can be started.

Un mal di schiena fastidioso

A 7-year-old boy was admitted to the Emergency Unit for a one-month history of low back pain, which got worse and resulted in a refusal to walk. On physical examination, the patient refused to stand, and palpation of the spinous processes of the lumbosacral spine evoked pain. Blood tests were normal, except for raised erythrocyte sedimentation rate (51 mm/h, ULN 20 mm/h). An X-ray showed fecaloma and MRI of the spine was performed. Different diagnostic hypotheses and diagnostic exams are discussed.

P40 Dry eyes and a dry mouth: is it Sjögren’s syndrome?

P40 Dry eyes and a dry mouth: is it Sjögren’s syndrome?

Clinicoepidemiologic considerations in the diagnosis of tuberculous lymphadenitis: evidence from a high burden country

ObjectivesTuberculosis is the biggest health issue worldwide, with tuberculous lymphadenitis (TBL) being its most common extrapulmonary manifestation. Clinical diagnoses of TBL often pose challenges; thus, this study aimed to analyze the clinical, epidemiologic, and laboratory aspects of TBL in Debre Markos Specialized Comprehensive Hospital, northwest Ethiopia. MethodsThe study was conducted at Debre Markos Specialized Comprehensive Hospital from October 2019 to March 2021. Patients with lymphadenitis displaying cytomorphologic features of tuberculosis were enrolled. A checklist was used to collect clinicodemographic data. ResultsAmong a total of 294 patients with TBL, 237 (80.61%) were adults aged 15-45 years. A fluctuant consistency (177; 60.20%; n = 294) with predominant involvement of cervical lymph nodes (229; 77.8%) was the most frequent presentation. Most patients did not have either HIV infection (235; 94.37%; n = 261) or known chronic medical illnesses (250; 95.8%). Constitutional symptoms (113; 41.85%; n = 270) and chronic cough (56; 20.74%; n = 270) were infrequent. The erythrocyte sedimentation rate (ESR) was increased in the majority of patients (133; 80%; n = 165), of whom extreme elevation (≥100 mm/hour) seen in 63 (38.18 %) patients and the mean ESR for our participants was 78.64 mm/hour. ConclusionTBL typically presents as a fluctuant neck mass, predominantly in young adults. The majority of patients have no constitutional symptoms or cough. HIV infection or chronic medical illnesses are uncommon. The raised erythrocyte sedimentation rate is a fairly consistent finding.

008 Systemic inflammatory response in relapsing-remitting multiple sclerosis

Multiple sclerosis (MS) is often described as an inflammatory disease of the central nervous system (CNS). However, the aberrant immune response may not be fully compartmentalised within the CNS. Here we present two strands of evidence for an active systemic inflammatory process in MS. First, we describe a case series of six individuals with relapsing-remitting MS (RRMS) and sustained raised serum inflammatory markers. All displayed persistent leucocytosis and/or raised erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), with no evidence of any other systemic or alternative neuro-inflammatory condition on long-term follow-up. All but one met criteria for rapidly-evolving severe (RES) RRMS. We hypothesised that these cases reflect the extreme end of a systemic inflammatory response spectrum in MS. Therefore, we sought to further investigate the systemic inflammatory response in RRMS by a more sensitive method, namely liquid chromatography-mass spectrometry to detect urinary neopterin, a molecular product of activated macrophages and a non-specific marker of systemic inflammation. A separate group of individuals with RRMS showed significantly higher concentrations of urinary neopterin compared to age- and gender- matched healthy controls.a.varatharaj@soton.ac.uk

A 52-year-old woman with beading of intracranial arteries

A 52-year-old woman of Indian ethnicity with a history of well-controlled hypertension, hyperlipidaemia and recurrent transient ischaemic attacks presented with altered mentation and slurred speech. Physical examination revealed generalised weakness. Initial blood tests showed raised total white cell count, raised erythrocyte sedimentation rate at 35mm/h and fasting low-density lipoprotein of 1.7mmol/L. Magnetic resonance imaging (MRI)

Subacute thyroiditis presenting as a painful suspicious thyroid nodule.

SummaryWe report a case of subacute thyroiditis in a 40-year-old female who initially presented with painful thyroid nodules without clinical and biochemical evidence of hyperthyroidism. Thyroid ultrasound was done to evaluate the thyroid nodules and fine-needle aspiration (FNA) was performed in view of the suspicious features. As the FNA showed a follicular lesion of undetermined significance or atypia of undetermined significance (FLUS/AUS, Bethesda III), she was advised for surgical excision. She was subsequently diagnosed with subacute thyroiditis based on her clinical symptoms, biochemical evidence of hyperthyroidism, raised erythrocyte sedimentation rate (ESR) as well as low uptake on thyroid scintigraphy. The thyroid lesions disappeared after symptomatic treatment. It is important to recognise that subacute thyroiditis can present with painful thyroid lesions with ultrasound features similar to suspicious thyroid nodules which can resolve with the resolution of the thyroiditis.Learning pointsSubacute thyroiditis can present with atypical features such as the absence of pain, normal erythrocyte sedimentation rate or absence of hyperthyroidism.In subacute thyroiditis, ultrasound findings are commonly described as focal or multifocal lesions with poorly defined and heterogeneous and hypoechoic echogenicity which can be misdiagnosed as malignancy.Thyroid lesions can resolve with the resolution of thyroiditis with or without symptomatic treatment.

Oral pemphigus vulgaris: A case-based rheumatological and immunological perspectives on a rare autoimmune mucocutaneous disease

A 52-year-old female patient was referred for suspected rheumatic or connective tissue disease due to one-year history of recurrent oral ulcers along with recent history of nasal ulcers, erythematous rash, puffy fingers, raised erythrocyte sedimentation rate, raised c-reactive protein, and acute inflammatory exudates on biopsy of buccal mucosal ulcers. Her intra-oral examination revealed ulcerative lesions in the mouth. Her anti-nuclear antibody (ANA) by indirect immunofluorescence showed intensity of +2 and cytoplasmic pattern. The repeat deep biopsy from oral lesions was done in view of multiple recurrent inflammatory oral ulcers, non-supportive ANA test, and bleeding with peeling of mucosal surface from oral ulcers on manipulation (Nikolsky’s sign). The histopathological examination showed acantholysis. Her test for anti-desmoglein3 antibody was strongly positive and was diagnosed with oral pemphigus vulgaris (PV). Most of the times, PV is encountered by a dermatologist, but patients with only oral involvement may end up consulting a physician or rheumatologist as a suspected rheumatic or connective tissue disease due to the underlying inflammatory or autoimmune nature. The present case-based review revisits this rare chronic inflammatory autoimmune mucocutaneous disease and provides a recent review of literature based on rheumatological and immunological perspectives.

Clinical Profile and Treatment Response in Section Tuberculous Meningitis- A Comparison between HIV Positive and HIV Negative Patients

Introduction: Tuberculous Meningitis (TBM) is a common infection in patients with Human Immunodeficiency Virus (HIV) and it shows significant differences in clinical profile, treatment response, and outcome compared to patients without HIV infection. Aim: To describe the clinical presentation, laboratory parameters, and radiological findings of TBM patients with and without HIV co-infection and to observe differences between them in treatment response, complications, and mortality. Materials and Methods: This was a prospective observational study, conducted on 80 TBM patients with (n=40) and without (n=40) HIV co-infection. Demographic, clinical, laboratory data, and various imaging findings were noted at the start of the study and at three and six months follow-up, for any changes from baseline to know the treatment response. Appropriate statistical tests were applied, and p-value less than 0.05 were considered statistically significant. Results: Mean age of HIV patients was 36.75 years and that of the non HIV patients was 29.35 years (p<0.05). Altered sensorium (90% in HIV and 72.5% in non HIV), seizures (50% in HIV and 20% in non HIV) were common in HIV patients, and weight loss (95% in non HIV and 87.5% in HIV) was common in non HIV patients. Common signs noted were nuchal rigidity (90% in HIV and 87.5% in the non HIV group), focal neurological deficit (50% in HIV and 22.5% in non HIV), and cranial nerve palsy (37.5% in HIV and 12.5% in non HIV). Anaemia was seen in 56.3% (87.5% in HIV and 25% in non HIV) and raised Erythrocyte Sedimentation Rate (ESR) was seen in 56.3% (25% in HIV and 87.5% in non HIV) patients. Tuberculoma was the most common (32.5%) Magnetic Resonance Imaging (MRI) brain finding. Adverse drugs reactions due to ATT (other causes ruled out) were seen in 22.5% of HIV patients (none in non HIV), and Antiretroviral Therapy (ART)-induced Adverse Drugs Effects (ADE) was noted in 10% of patients. Patient survival was better among non HIV (65%) compared to HIV (55%) patients. Multidrug-resistant Tuberculosis (MDR-TB) was more prevalent in HIV (7.5%) than non HIV (2.5%) cases. Conclusion: TBM involves a younger population, has a worse prognosis in HIV co-infection patients with more adverse reactions to treatment.