Primary toxoplasmosis with critical illness and multi-organ failure in an immunocompetent young man.

An immunocompetent young man became critically ill with multi-organ failure due to primary toxoplasmosis. Although treated successfully, he relapsed after 1 y with bilateral toxoplasmic chorioretinitis. Severe disseminated toxoplasmosis rarely occurs in immunocompetent patients and may reflect an increased risk of relapse. Secondary prophylaxis must be considered.

[From prison with coma]. / I koma frå fengselet.

A 42-year-old man was found unconscious in his prison cell. Investigations revealed non-recognized diabetes mellitus, possibly secondary to use of prescribed antipsychotic drugs. Second generation antipsychotics are associated with metabolic changes such as weight gain, hyperglycaemia and dyslipidaemia. Severe side effects may also occur; e.g. diabetic ketoacidosis in people without acknowledged diabetes (as presented in this case report). Providing adequate healthcare to people with psychotic disorders may be a demanding task. When these patients develop somatic conditions, a multidisciplinary approach is required. Personnel from many specialities may become involved, and they are not all familiar with drugs commonly used to treat psychiatric disorders or how to deal with their side effects. Several guidelines addressing these problems have been issued during the last years. Norwegian guidelines should aid clinicians in decision-making when confronted with these dilemmas.

Severe, reversible dysphagia and malnutrition in a patient with tumour-induced hypophosphataemia.

Up to 20% of hospitalised patients may have low serum phosphate concentrations. In certain groups, such as patients with chronic alcohol overconsumption, severe trauma or sepsis, the prevalence may be 30%-50%. Profound hypophosphataemia is less common, but may lead to severe physiological disturbances. In rare cases, hypophosphataemia is caused by phosphaturic substances excreted from a tumour. Osteomalacia with chronic bone pain and fractures, as well as muscle weakness, is common in such patients. The tumours are often small and difficult to detect. Studies suggest that fibroblast growth factor 23 is a reliable marker for detection of these tumours. Persistent hypophosphatemia unresponsive to supplements should raise clinical alertness. With complete resection of the neoplasm, the symptoms rapidly reverse. If the tumour cannot be removed, treatment relies on supplementation with phosphate and active vitamin D compounds. We present a case report of a patient with severe hypophosphataemia, osteomalacia, dysphagia and malnutrition.

[The many faces of endocarditis]. / Endokardittens mange ansikter.

BACKGROUND: Over the past years we have had a relatively large number of patients in our hospital with endocarditis. There has been a variety of clinical presentations, as illustrated by the following case presentations. MATERIAL AND METHODS: We have conducted a search in our data-based archives of the period from 1.1.1994 to 31.12.2001 and found 25 patients discharged with a diagnosis of endocarditis. We have chosen five case histories that we discuss in the context of published literature. RESULTS AND INTERPRETATION: The signs and symptoms presented include a stroke, severe back pain, a swollen knee, pneumonia and cardiac failure. We especially discuss intravenous drug users and endocarditis of the heart's right side.