Idiopathic CD4 lymphocytopenia (ICL) is a rare entity of immune deficit of CD4+ T cells (below 300/mm³) which was first defined in 1992, unrelated to human immunodeficiency virus (HIV) syndrome without predefined clinical presentation and natural history. The etiology, pathogenesis, and management of ICL remains poorly understood and inadequately defined. The clinical presentation can range from serious opportunistic infections to incidentally diagnosed asymptomatic individuals. Cryptococcal and nontuberculous mycobacterial infections and progressive multifocal leukoencephalopathy are the most significant presenting infections, although the spectrum of opportunistic diseases can be similar to that in patients with lymphopenia and HIV infection. The prognosis is influenced by the accompanying opportunistic infections and response to the treatment. This rare disease invites uncountable opportunistic infections sometimes leading to lethal outcome. We report a case of ICL in an immunocompetent 18-year-old male with a history of intermittent epistaxis, fungal nasal polyp diagnosed to have Rhizopus with drug-induced acute kidney injury during the course of treatment, a rarest diagnosis as underlying main disease entity. To the best of our knowledge, ICL presenting with opportunistic infection of Rhizopus is the first case to be reported here from a tertiary care center of India, a developing country where a major population lives with poor hygiene and low socioeconomic status.

H1N1 pneumonia is one of the most common causes of community-acquired pneumonia in India. It occurs throughout the year without any seasonal variation. The clinical presentation of the disease varies in severity each year and complications associated with it are most unusual. We recently reported a case of recurrent pneumomediastinum associated with H1N1. Here, we want to report another patient who was diagnosed with severe H1N1 pneumonia complicated by a cardiac tamponade. Cardiac tamponade is a life threatening complication of viral pneumonia and needs to addressed immediately. Ours is the first case report with cardiac tamponade associated with H1N1 pneumonia.

Human infection with Lophomonas sp. a protozoan that parasitizes the intestinal tracts of termites and cockroaches is extremely rare; also clinical features are not fully understood. China is the country with the majority of cases reported in the literature. Here, we reported a case of Lophomonas sp. infection confirmed by tracheal aspirate on the microscopic observations. The patient was a 49-year-old male from a jungle city called "Madre de Dios" where he works as taxi driver and stonemason. He was admitted to the Intensive Care Unit on February 5, 2013, because the course with respiratory failure and hypoxemia, high fever, and generalized myalgias. The patient was successfully treated by metronidazole 500 mg t.i.d. for 17 days. This is the first case report of Lophomonas sp. in Madre de Dios city in Peru.

Despite the recent advances in the pharmacotherapeutics of pediatric cancer, opportunistic invasive fungal infections still cause a significant mortality and morbidity in these immunocompromised population, being attributed to the continuous marrow suppression and aggressive chemotherapy. Mucormycosis is the third leading invasive fungal infection after candidiasis and aspergillosis. The elusive presentation and the pleiotropic clinical features of this rare, yet rapidly progressive and frequently fatal infection often cause diagnostic delays, thereby resulting in poor outcomes. A physician's early suspicion and preemptive treatment remains the important key element in the early identification, irrespective of the technological advancements. We report a case of disseminated mucormycosis in a child with relapsed acute lymphoblastic leukemia, who eventually succumbed to death despite timely intervention and appropriate treatment due to aggressive nature of the invasive fungal infection.

Bronchiectasis, defined as permanent dilatation of the airways, usually causes chronic cough and sputum production with intermittent bacterial exacerbations. Bronchiectasis can have a severe impact on quality of life for many patients due to these symptoms. Establishing the cause of bronchiectasis may be difficult. Even with exhaustive clinical, laboratory, and pathologic testing, up to 50-80% of cases of bronchiectasis may still be idiopathic. Congenital bronchiectasis is much rarer than previously considered. A variety of respiratory and systemic diseases such as autoimmune or rheumatologic diseases may be complicated by pathological bronchial dilatation, and therefore various medical specialists will be dealing with the condition in one-way or another. Some bowel diseases are associated with a variety of systemic manifestations including large and small airway involvement: One of the most commonly associated airway diseases is bronchiectasis. On this regard, we report five patients with bronchiectasis and rare diseases admitted to our hospitals since 2012. Patients were recruited over a period of 36 months after opening a bronchiectasis outpatient clinic.

Emphysematous pyelonephritis (EPN) is a rare form of renal suppuration. It is associated with a high mortality in the absence of rapid and effective treatment. Nephrectomy is suggested as the reference treatment associated to medical treatment. However, medical treatment exclusive is a conservative therapeutic option which is effective and successful in some cases. Many clinical and radiological criteria must be analyzed and gathered; we describe three cases of EPN treated successfully with medical treatment alone in two cases and associated to nephrectomy in one case.

Traditional eye medications (TEM) usage is still a common practice as most patients in India consult a traditional healer. Poverty, socio-cultural beliefs, poor health-seeking behavior, and lack of access to health facilities are reasons for the persistence of this practice. ^[1],[2] Fifty patients with kerato conjunctivo uveitis who used TEM, especially some leaf extract for 3 days, visited ophthalmology clinic, Narayana Medical College Hospital during June 2012. Ocular complications included purulent conjunctivitis in 25 subjects, keratitis in 15 subjects, corneal ulcer in 1 subject, and iridocyclitis in 9 subjects respectively. All patients' disease condition was reversed by the local application of steroid drops, topical antibiotics, anti-allergic drops, and artificial tears. The use of TEM is harmful, further leads to blindness. Proper health education to the public can reduce the prevalence of preventable blindness.

In this era of immune suppression and potential biological warfare, we need to be aware of cutaneous manifestations of relatively uncommon bacterium, their atypical variants, and the early treatment protocols. We present atypical presentation of Indian possible tick typhus diagnosed clinically and confirmed both by biopsy of the lesion and serological tests.