Browsing by Author "Saraf, Awin"
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Publication A case report of hemophagocytic lymphohistiocytosis (HLH) associated with sarcoidosis(Nepalese Respiratory Society, 2024) Gurung, Naresh; Karthak, Ashish; Saraf, Awin; Shrestha, Sanjeet KrishnaAbstract: Hemophagocytic Lymphohistiocytosis (HLH) is a rapidly progressing, fatal disorder characterized by severe systemic hyperinflammation presenting with unremitting fever, organomegaly (hepatosplenomegaly), cytopenias, raised inflammatory markers, liver failure, neurological issues, coagulopathy, and multiorgan failure. It is classified as primary due to mutations inherent to the individual causing increased macrophage activation or due to underlying secondary causes ranging from infections, malignancies, metabolic disorders, or rarely, rheumatological disorders such as juvenile idiopathic arthritis, SLE, sarcoidosis, and so on. However, the association between sarcoidosis and HLH has been rarely reported in the literature, which can present with features of sepsis, making the diagnosis challenging and requiring high clinical suspicion. We report the case of a patient with sarcoidosis presenting with recurrent fever, bilateral lower limb swelling, and fatigue, eventually developing fatal HLH that was unresponsive to high-dose steroids.Publication Unusual presentation of ruptured non coronary sinus of valsalva with new onset heart failure(Nepal Health Research Council, 2024) Saraf, Awin; Hirachan, Anish; Sharma, Ranjit Kumar; Rajbanshi, Bijoy GopalRupture of sinus of Valsalva is a rare cardiac condition which is associated with severe left to right shunting. Symptoms may include breathlessness, chest pain and fatigue or even cardiogenic shock and when untreated, this condition carries a grave prognosis. We report a case of a 57-year-old gentleman without any past comorbidities who presented to our hospital with features of acute heart failure due to rupture of sinus of Valsalva which was diagnosed by echocardiogram and further confirmed by cardiac computed tomography scan. Patient underwent successful patch closure of the defect and made a good recovery. His hospital stay was uneventful and is under regular follow up. This highlights the importance of multimodality imaging and timely treatment for cases of rupture of sinus of Valsalva. Keywords: Echocardiogram; ruptured sinus of Valsalva; sinus of Valsalva aneurysm.