A patient with lower-limb onset ALS presented with a one-month history of vasovagal episodes and a one-week history of cough productive of green sputum and lethargy. She was drowsy and in acute on chronic type-two respiratory failure. She responded to non-invasive ventilation, however she suffered recurrent episodes of profound bradycardia on removal of the mask, which gradually resolved over t...

Neonatal-onset propionic acidemia is the most common form of disorder. A 9-days old new born admitted to our hospital with lethargy suggested urea cycle defect at first look due to lack of metabolic acidosis, normal ketone and anion gap in laboratory evaluations. The case mimicking urea cycle defect, which was diagnosed as neonatal-onset propionic acidemia by specific tests, was presented becau...

A 10-year-old tame zebra gelding was presented after suffering from lethargy, nervousness, reported anaemia and icterus as well as a decreased appetite. These symptoms were seen over some months, with changing severity. The animal was immobilised, treated, and blood specimens were submitted for haematology and biochemistry. This report describes molecular characterisation of Theileria equi reco...

DOI: 10.4103/ijd.IJD_597_16 A 55-year-old Malay woman presented with widespread, asymptomatic skin lesions of 4 years duration. She reported recurrent nasal blockage since 2005 requiring surgical excisions for nasal masses. There was associated lethargy without other constitutional symptoms. Physical examination revealed pallor, multiple indurated violaceous plaques and nodules over the bilater...

In June, an alert Anchorage pediatrician notified our office of a possible case of botulism in a three-month old Valdez resident. The infant presented to Providence Hospital with a 9 day history of constipation, increasing lethargy, and decreasing muscular tone. The mother reported a decreased suck reflex, inability to swallow, choking, a droopy head and a weak cry. These symptoms developed ove...

Light microscopic examination of feces from a human immunodeficiency virus-positive patient with chronic diarrhea, anorexia, and lethargy revealed the presence of numerous refractile bodies resembling microsporidian spores. They were subsequently identified as belonging to the genus Nosema on the basis of their ultrastructural characteristics. However, the microsporidia were enclosed within str...

Herpes simplex encephalitis is a potentially fatal infection of central nervous system that typically involves frontal and temporal lobes. Occasionally, it presents an extratemporal involvement and in rarer cases, it is limited to the brainstem. We describe a case of an adolescent who presented with fever, sore throat, and vertigo. Clinical picture evolved to lethargy, tetraparesis, consciousne...

A 9-month-old male child was brought with complaints of increasing head size for 2 months, increasing lethargy and vomiting for the last 2 days. Radiology revealed a heterogeneously enhancing, globular lesion in the pineal region with hydrocephalus. Near total excision of the tumor was carried out. The histopathological examination of the lesion showed heterogenous elements in the form of matur...

The authors present the case report of a child with abdominal epilepsy who had suffered from abdominal pain for several months under the label of psychogenic pain. The important historical clues were pallor and cold sweating during the paroxysm, followed by lethargy and prolonged sleep. An abnormal electroencephalogram and a remarkable response to anticovulsants confirmed the diagnosis. This co...

An AIDS patient with multiple opportunistic infections (Candida, Pneumocystis carinii and Isospora belli) was identified at the University Hospital, Kuala Lumpur. The patient presented with profuse diarrhoea associated with lethargy, anorexia and weight loss. Routine stool examination showed Isospora belli oocysts. The infection responded to treatment with trimethroprim-sulfamethoxazole but rel...