Pituitary apoplexy: report of two cases.

Pituitary apoplexy is a common clinical syndrome characterised by acute headache, ophthalmoplegia, diminished visual acuity and altered mental status caused by the sudden haemorrhage or infarction of the pituitary gland. The two cases reported highlight the variability in presentation which underscores the need for a high index of suspicion and the need for MRI in patients presenting with a thunderclap headache and 'normal' initial investigations.

Utility of liver biopsy in HIV-infected patients presenting with febrile illnesses and inconclusive evaluation.

OBJECTIVES: To determine the utility of liver biopsy in providing a diagnosis in HIV-infected patients presenting with febrile illnesses and inconclusive initial investigative work up. DESIGN: A retrospective descriptive study. SETTING: The Aga Khan University Hospital, Nairobi. SUBJECTS: Twelve in-patients with HIV disease who underwent liver biopsy following inconclusive initial investigative work up for febrile illnesses between January and December 2007. RESULTS: Seven out of 12 patients had granulomatous hepatitis reported on histology with characteristic tuberculous epitheloid granulomas all having stainable acid-alcohol fast bacilli on Ziehl-Nielsen (ZN) stain. The mean alkaline phosphatase (ALP) and gamma glutamyl transpeptidase (GGT) levels in these seven patients were 260 U/L and 304 U/L respectively, while the mean aspartate aminotransferase (SGOT) and alanine aminotransferase (SGPT) were 106U/L and 72 U/L respectively. CONCLUSION: Disseminated tuberculosis is still among the most common causes of unexplained pyrexia in our HIV-infected cohort and a liver biopsy, performed earlier in the investigative work up of unexplained fever in the HIV-infected patient, would be a useful adjunct in providing a diagnosis.