Background: Dengue fever is a common arboviral infection that is typically self-limiting, but rare complications such as myositis, rhabdomyolysis, and electrolyte disturbances can pose diagnostic and therapeutic challenges. Case Presentation: We report a patient with dengue confirmed by non-structural 1 antigen who initially improved with supportive care but re-presented with severe myalgia, tea-colored urine, and markedly elevated creatine kinase (54,000 U/l), consistent with rhabdomyolysis. Her symptoms were refractory to hydration and analgesia but responded rapidly to corticosteroids. Subsequently, she developed polyuria and profound hypotonic hyponatremia with inappropriately concentrated urine and high urinary sodium, consistent with renal salt wasting syndrome (RSW). Management required careful fluid resuscitation to maintain euvolemia and intermittent desmopressin to control polyuria. Autoimmune screening revealed positive anti-ribonucleoprotein antibodies and anti-Ro antibodies, suggesting an immune-mediated process. She achieved full recovery with normalization of muscle enzymes and electrolytes. Conclusion: This case highlights the diverse and clinically significant complications of dengue,... Continue Reading

Background: Common variable immunodeficiency (CVID) is recognized as the most common form of primary immunodeficiency. Despite its prevalence, CVID often remains underdiagnosed due to its heterogenous clinical manifestations and a lack of awareness among healthcare providers. Early and accurate diagnosis is crucial, as it significantly impacts patient management and outcomes. This case report aims to highlight notable features of CVID, emphasizing the importance of enhanced detection and awareness. Case Presentation: A 39-year-old male, with no significant medical history, presented with recurrent sinopulmonary infections characterized by intermittent fevers and respiratory symptoms over several months. Initial examinations during his first hospital admission revealed patchy lung consolidations and positive tests for human rhinovirus and influenza A. Despite treatment, follow-up was missed, leading to a subsequent hospital admission. Further investigations, including CT scans and biopsies, were negative for infections and malignancies but revealed deficiencies in immunoglobulins IgA, IgM, and IgG. The patient's inadequate response... Continue Reading

Background: Episiotomy, a perineal incision during labor to facilitate vaginal delivery, is now selectively used in instrumental births like vacuum-assisted procedures to lessen severe perineal trauma, though it risks rare extensions into the rectal wall. Such full-thickness rectal tears, classified as fourth-degree injuries, occur more commonly with midline incisions and can lead to fecal incontinence, pain, or sepsis if not addressed swiftly. Case Presentation:A 32-year-old woman with an unremarkable prenatal history underwent vacuum-assisted vaginal delivery complicated by a mediolateral episiotomy extending to a full-thickness anterior rectal tear 10 cm from the anal verge. She presented hemodynamically stable with perineal pain, bleeding, and stool spillage; digital exam confirmed the injury without soiling. Under anesthesia, a triple-layer closure was used with absorbable sutures for mucosa, muscularis, and serosa, avoiding colostomy. Broad-spectrum antibiotics continued for two weeks, with nil per os for 48 hours followed by enteral feeding. Postoperative monitoring showed no infection or incontinence;... Continue Reading

Background: Wolfram syndrome type 1 is a rare, autosomal recessive neurodegenerative disorder caused by pathogenic variants in the WFS1 gene. It is classically characterized by diabetes insipidus, diabetes mellitus, optic atrophy, and deafness, but its clinical spectrum is highly heterogeneous. Delayed recognition is common, especially when features are misattributed to diabetes complications. Case Report: We present a 39-year-old man with insulin-dependent diabetes mellitus since adolescence, who developed progressive multisystem involvement including optic atrophy, neurogenic bladder with end-stage renal disease, psychiatric manifestations, and neurological complications. Despite early diabetes onset, Wolfram syndrome was not suspected until late in the disease course. Genetic analysis revealed a homozygous missense variant in WFS1 (c.1672C>T; p.Arg558Cys), previously described as a founder mutation and classified as pathogenic according to the criteria of the American College of Medical Genetics and Genomics. The patient exhibited an incomplete phenotype, with optic atrophy and suspected central diabetes insipidus, but without documented... Continue Reading