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An infection Burden on thyroid (Tuberculosis of thyroid): A case report
Sankaran Muthukumar, Hamid Syed Ahamed Kamil, Palanisamy Jayakumar, Dhanasekaran Latha, Kathiresan Karunakaran, Maruthupandian Adharshkumar
World Journal of Endocrine Surgery, 2020
Ab s t r Ac t Aim: To enlighten the treating physician about the importance of tuberculosis (TB) of thyroid. Background: Though the prevalence of TB is high in country like India, TB affecting the thyroid gland is a rare entity due to inherent antibacterial properties of the gland. A high degree of suspicion and thorough clinical knowledge is absolutely necessary for identification of this entity. Case description: A 55-year-old man presented with 8 weeks’ history of swelling in midline of the neck and 2 weeks’ history of pain over the swelling. Blood investigations including the thyroid profile were normal. Clinical examination was suggestive of infected thyroglossal cyst along with multinodular goiter. Ultrasound confirmed the clinical diagnosis and in addition revealed bilateral cervical lymph nodes. Ultrasound-guided fine-needle aspiration cytology (FNAC) of thyroid was inconclusive and FNAC of lymph nodes showed reactive changes. Patient underwent total thyroidectomy along with Sistrunk operation and biopsy of both rightand left-sided cervical lymph nodes. Incidentally, he was diagnosed with hypocortisolism as the patient went in for hypotension intraoperatively, which was managed appropriately. Histopathology revealed TB of the thyroid. Conclusion: Tuberculosis of thyroid, though a rare entity, should be borne in mind and included in the differential diagnosis, particularly in countries with high TB burden. Clinical significance: Identification of such conditions preoperatively can avoid unnecessary surgeries as these conditions can be managed by medical treatment.
Lipodystrophy and adrenal insufficiency: Potential mediators of peripheral neuropathy in HIV infection?
Palanisamy Jayakumar, Esaki Muthu Shankar, Murugesan Karthikeyan, Pandian Ravikannan
Medical Hypotheses, 2012
The mechanisms behind certain co-morbid conditions associated with chronic HIV disease still remain elusive. HIV-associated peripheral neuropathy is one among those rarely studied manifestations in HIV-1 infection. Numerous underlying factors associated with peripheral neuropathy have been described in HIV disease. Herein, we hypothesized certain heretofore undescribed potential mechanisms that lead to HIV associated neuropathy. Being a multifactoral manifestation, HIV-associated neuropathy is presumed to have an association with physiological factors namely, adrenal inadequacy/steroid resistance and lipodystrophy-induced cushion-effect loss in peripheral nerves. Therefore, management of the adrenals with steroids at the time-point of high inflammatory burden thereby preventing lipodystrophy by selecting the optimum treatment regimen could markedly alleviate the severity of HIV-associated neuropathic manifestations.
Current views on the pathophysiology of GB virus C coinfection with HIV-1 infection
Esaki Muthu Shankar, Pachamuthu Balakrishnan, Ramachandran Vignesh, Vijayakumar Velu, Palanisamy Jayakumar, Suniti Solomon
Current Infectious Disease Reports, 2011
GB virus C (GBV-C), a member of the Flaviviridae family of viruses, recently received considerable attention largely owing to its potential role in decelerating HIV-1 disease progression by interfering with HIV replication. With similar transmission features, GBV-C is parenterally transmitted, similar to the serum hepatitis viruses and HIV-1, and replicates in hemopoietic cells and T lymphocytes in particular, with no observable disease pathology. Progressive T-cell depletion and subsequent immune abrogation being the cardinal features of HIV-1 infection, accumulating evidence indicates that GBV-C effectively overturns HIV’s chances of exploiting the T-cell machinery and leads to enhanced survival rates of HIV-infected subjects. Much effort has been devoted to understanding the beneficial role of GBV-C in HIV disease. This review discusses recently proposed mechanisms underlying the pathophysiology of GBV-C coinfection in HIV disease.
Could adrenal insufficiency serve as a predictor of immune reconstitution inflammatory syndrome (IRIS) in HIV disease?
Palanisamy Jayakumar, Esaki Muthu Shankar, Sundaramoorthy Ezhilnambi, Murugesan Karthikeyan
Bioscience Hypotheses, 2009
Immune reconstitution inflammatory syndrome (IRIS) is an inflammatory manifestation that occurs subsequent to initiation of highly active antiretroviral therapy in terminal (HAART) HIV infection, mainly due to the restoration of robust immune responses directed against latent microbial antigens. IRIS is believed to be multifactorial and less studied. Herein, we postulate that hypothalamo–pituitary–adrenal (HPA) dysregulation, a well-documented manifestation in HIV/AIDS, could possibly disturb the balance between pro-inflammatory and anti-inflammatory cytokines leading to clinical IRIS. Drugs, opportunistic infections, stress and numerous intrinsic and extrinsic factors have been described to be the possible causes of IRIS in HIV illness.