Browsing by Author "Munidasa, D."

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Comparing two different presentations of Takayasu arteritis
(Sri Lanka College of Internal Medicine, 2024) Kurukulasuriya, S.A.F.; Munidasa, D.
Reported here are two Asian patients with Takayasu arteritis (TA) with contrasting presentations and responses to treatment. The first patient was a 53-year-old man who presented with disabling abdominal pain. Imaging revealed thickening of the coeliac axis extending to common hepatic and splenic arteries causing external compression with luminal narrowing. There was uniform thickening of the aortic arch and the wall of the descending aorta along with retroperitoneal fibrosis. Early treatment resulted in almost complete remission in eight weeks. The second patient was a 48-year-old woman with pain down the left upper limb with eventual ischaemia of the fourth finger. Imaging revealed circumferential wall thickening at the origin of the left subclavian artery. Treatment started after 3 weeks of the initial presentation, and took up to 14 months for clinical improvement. The relative rarity of this disease and the heterogeneous nature of its clinical manifestations predispose to late diagnosis and delayed treatment. Clinical suspicion and relevant imaging are crucial for the early and accurate diagnosis and management of patients with TA.
Tuberculous monoarthritis of the wrist in a patient with systemic lupus erythematosus: a case report
(Biomed Central, 2017) Luke, W.A.N.V.; Gunathilake, M.P.M.L.; Munidasa, D.; de Silva, S.T.
BACKGROUND: Unusual forms of tuberculosis are common among immune-suppressed patients, leading to challenges in diagnosis and management. We present a Sri Lankan patient with systemic lupus erythematosis, investigated for chronic wrist pain with low inflammatory markers and without systemic symptoms, who was subsequently diagnosed to have tuberculosis of the joint. CASE PRESENTATION: A 31-year-old woman with systemic lupus erythematosis in remission was evaluated for chronic left wrist pain without significant examination findings on presentation. She did not have any constitutional symptoms. Basic investigations did not reveal any significant abnormalities. She was treated with increasing immunosuppression as for lupus related arthritis. Subsequently she developed a wrist effusion with high inflammatory markers, and was treated as septic arthritis. Synovial biopsy features suggested tuberculosis. The patient's symptoms improved with surgical intervention and anti-tuberculosis treatment. CONCLUSION: Tuberculosis should be considered in patients with systemic arthritis with unusual symptoms. Delayed diagnosis along with continuing immunosuppression can lead to extensive tissue damage. Clinically detectable effusions should be analyzed along with synovial biopsy in order to exclude concurrent infections. Radiography of the joint has poor sensitivity to detect early joint damage, but changes may be evident early on magnetic resonance imaging, sothis should be considered in patients with unusual features.