Collagenous enterocolitis and maturity onset type 1 diabetes manifesting as uraemia, malabsorption and extreme weight loss.

A 37-year-old patient with type 1 diabetes had been recently diagnosed with collagenous colitis (CC) after sigmoidoscopy. She rapidly progressed from a fortnight of watery diarrhoea, to a malabsorptive state with severe dehydration and acute kidney injury. This necessitated admission to an intensive care unit for emergency dialysis. She was subsequently diagnosed with collagenous enterocolitis affecting gastric, small bowel and colonic mucosa which required systemic steroid therapy. Physicians caring for patients with CC should be aware of the potential extreme manifestations of upper gastrointestinal collagenous deposition.

Acute Legionella pneumophila infection masquerading as acute alcoholic hepatitis.

A middle-aged man had deteriorated rapidly in hospital after being misdiagnosed with acute alcoholic hepatitis. Acute Legionnaires disease (Legionellosis) was subsequently diagnosed on rapid antigen urinary testing and further confirmed serologically. This led to appropriate antibiotic treatment and complete clinical resolution. Physicians caring for patients with alcohol-related liver disease should consider Legionella pneumophila in their differential diagnosis even with a paucity of respiratory symptoms.

Internal carotid artery stenosis presenting as ipsilateral posterior cerebral artery ischaemic stroke: a lesson to be learnt.

A 71-year-old lady presented with a symptomatic left cerebral occipital lobe infarct. With a history of paroxysmal atrial fibrillation a cardioembolic source was initially postulated. Prior significant bleeding while anticoagulated precluded warfarin therapy. Further investigations revealed a critical left internal carotid stenosis with a persistent fetal origin of the left posterior cerebral artery. She was successfully treated surgically and suffered no further ischaemic events. Physicians encountering posterior circulation stroke should be aware of this potentially treatable important diagnosis.

Right ventricular inflow tract obstruction secondary to metastatic cutaneous squamous cell carcinoma.

We report the case of an immunocompetent 83-year-old man with metastatic neoplastic infiltration of the heart from primary squamous cell carcinoma (SCC) of the skin. Death was from cardiopulmonary collapse due to left ventricular failure with features of right ventricular inflow tract obstruction. Metastatic tumours involving the heart rarely originate from cutaneous SCC though have been reported in the literature in both immunocompetent and postrenal-transplant recipient patients. Most involve the pericardium and only rarely the endocardium or the myocardium. While the prognosis is generally poor, palliative radiotherapy may provide significant symptom relief. Cardiac metastases should be considered in patients with advanced cancer, especially when they show cardiac symptoms and signs.

Staphylococcal sepsis with multiple abscesses, urinary tract infection, and bilateral renal vein thrombosis in a patient with uncontrolled diabetes mellitus.

We report a case of staphylococcal sepsis with vascular complications including peripheral emboli and renal vein thrombosis. Bilateral renal vein thrombosis has not been reported as a complication of Staphylococcus aureus (SA) axillary abscess. Uncontrolled diabetes was the only detected predisposing medical condition. The patient was treated successfully with incision and drainage of soft-tissue abscesses and intravenous antibiotic for six weeks and with anticoagulation for renal vein thrombosis.