Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Recurrent focal myositis of the thigh in a patient with end-stage kidney disease: An unusual association.(Canadian Institute for Knowledge Development (CIKD), 2024) Arumugam, J.; De Silva, S.T.A 40-year-old woman, with a ten-year history of diabetes and hypertension, was diagnosed with end-stage kidney disease necessitating regular hemodialysis twice weekly for the past year. The patient reported recurrent episodes of swelling and pain in the left thigh, initially treated as cellulitis. The pain was persistent and there was an ill-defined firm lump in the thigh muscle. Biopsy of the mass revealed endomysial mononuclear cell infiltrates, including lymphocytes and histiocytes, focal muscle fiber necrosis, and regeneration, indicating an inflammatory myopathy. MRI of the thigh confirmed patchy myositis with no definitive collection or mass identified. Focal myositis was diagnosed and the patient was managed expectantly with physiotherapy and analgesics. Over a span of approximately three months the condition completely resolved. Muscle pain in end-stage kidney disease often stems from causes such as peripheral neuropathy, critical lower limb ischemia, muscle cramps due to electrolyte abnormalities, and chronic infection. Focal myositis is rarely documented in literature and only a few cases of recurrent focal myositis have been reported previously in patients with end-stage kidney disease.Item Disseminated tuberculosis presenting as meningitis and spondylodiscitis in an immunocompetent adult(Medknow Publications, 2023) Arumugam, J.; de Silva, S.Rationale: Disseminated tuberculosis involves the central nervous system in up to a third of cases. However, meningitis and spondylodiscitis due to miliary tuberculosis rarely occur together, particularly in the immuno-competent population. Patient concerns: A 37-year-old immunocompetent male presented with altered level of consciousness for one week and lower back pain with evening pyrexia for one month. Examination revealed spastic paraplegia and left hemiparesis. Diagnosis: Disseminated tuberculosis presenting with meningitis and spondylodiscitis. Interventions: Category I anti-tuberculous therapy with a tapering regimen of intravenous dexamethasone was administered. Outcomes: There was clinical improvement after nine months of treatment. Lessons: Tuberculosis may present with atypical clinical manifestations. Contrast enhanced computed tomography scan or magnetic resonance imaging combined with histopathological features, a high index of suspicion and clinical improvement with anti-tuberculous treatment can confirm the diagnosis in the absence of microbiological evidence, especially in extrapulmonary tuberculosis.