Moraxella lacunata: a rare cause of infective endocarditis.

We describe the first case of Moraxella lacunata definite native valve endocarditis in a patient with previously normal mitral valves. The disease was complicated with embolizations of the brain and spleen. After 6 weeks of antimicrobial treatment, valvular replacement was performed. The clinical course and diagnostic findings suggest that Moraxella lacunata possesses high aggressiveness leading to progressive valvular destruction and embolizations.

Virological and immunological characteristics of fatal Epstein-Barr virus mononucleosis in a 17-year-old Caucasian male presenting with meningoencephalitis and hemophagocytic syndrome.

In this report, the authors present a detailed immunological and virological assessment of an immunocompetent 17-year-old Caucasian male with a fatal Epstein-Barr virus (EBV) infectious mononucleosis presenting with meningoencephalitis and hemophagocytic syndrome. The patient with serologically confirmed EBV infectious mononucleosis was admitted to the hospital because of 3 weeks' fever. Fine-needle aspiration of lymph nodes showed reactive hyperplasia with prominent hemophagocytosis. Percentages of intracellular interferon-gamma (IFN-gamma) in CD4(+) and CD8(+) T cells in the peripheral blood progressively increased during the course of disease (10.2% and 8.5% on day 35; 30.1% and 53.2% on day 44; 42.2% and 75.2% on day 50; 36.1% and 50.6% on day 59, respectively). On day 50, the patient developed meningoencephalitis. Brain computed tomography (CT) was normal. Brain magnetic resonance imaging (MRI) showed multifocal inflammatory lesions in frontal and temporal cortex of the right hemisphere as well as severe perivascular inflammatory reaction. The patient was treated with steroids, cyclosporin A, and methotrexate intratecally. Following treatment, EBV viremia in the blood and cerebrospinal fluid (CSF) decreased from pretreatment values (54,490 copies of EBV DNA/ml and 39,500 copies/ml, respectively) to 8715 copies/ml in the blood and 14,690 in the CSF. Despite treatment, the patient remained unconscious and died of sepsis and pneumonia 3 months after initial symptoms. Immunohistochemical staining showed the presence of EBV in both perivascular infiltrates and grey matter. Enhanced Th1 response as shown by high levels of IFN-gamma in peripheral blood lymphocytes may be a predictor of severe complications during acute EBV infection. Early implementation of immunosuppressive therapy in these patients should be considered.

Anti-ganglioside antibodies-mediated leptospiral meningomyeloencephalopolyneuritis.

A case of leptospirosis complicated with meningo-myelo-encephalo-polyneuritis and nephrotic syndrome is presented. Anti-ganglioside antibodies were detected for the first time in a patient with neurological complications of leptospirosis. Possible pathogenic mechanisms and treatment options of these rare manifestations are discussed.

McKittrick-Wheelock syndrome: a rare cause of diarrhoea.

McKittrick-Wheelock syndrome is a rare disorder caused by fluid and electrolyte hypersecretion from a rectal tumour. The most frequently reported tumours are villous adenomas. Dehydration with severe hyponatremia, hypokalemia, metabolic acidosis, acute renal failure and watery diarrhoea is typical. The authors present a case of McKittrick-Wheelock syndrome caused by rectal adenocarcinoma.

Chlamydia pneumoniae infection as a trigger for a Cogan's syndrome.

Cogan's syndrome is often preceded by upper respiratory tract symptoms. The only reported specific agent possibly involved in pathogenesis of the Cogan's syndrome was Chlamydia pneumoniae. Positive IgA, IgM and IgG antibodies against C. pneumoniae in our patient suggest possibility of Chlamydia's role as a trigger for the vasculitis.

Idiopathic Cd4+T-lymphocytopenia--two unusual patients with cryptococcal meningitis.

Idiopathic CD4+T-lymphocytopenia (ICL) is a syndrome characterised by the depletion in the CD4+T-cells but without evidence of HIV infection. Aside from low CD4+lymphocyte counts, the immunologic findings in these patients are distinct from the abnormalities found in HIV infection. There are numerous reports of ICL associated with different diseases and clinical conditions. Opportunistic infections, mostly seen in HIV patients are the most common among them. We describe two patients without risk factors for human immunodeficiency virus (HIV) infection, each of whom presented with cryptococcal meningitis and was found to have idiopathic CD4+T-lymphocytopenia. One of them also acquired EBV and CMV coinfection of the central nervous system.

Atypical Cogan's syndrome mimicking encephalitis.

Cogan's syndrome is a rare autoimmune multisystem disease. The main clinical features of typical Cogan's syndrome are vestibuloauditory dysfunction and interstitial keratitis. The authors present a case of atypical Cogan's syndrome with headache, fever, deafness, trigeminal neuralgia and electroencephalographic abnormality which mimicked viral encephalitis.