Polyarthritis as the initial symptom of secondary syphilis: case report and review.

The differential diagnosis of the patient with acute polyarthritis is lengthy. We present the case of a young man with acute inflammation of the knees and ankles in whom a diagnosis of acute rheumatic fever was initially considered. The clinical course and laboratory findings suggested that secondary syphilis was also a likely etiology of his problem. We believe that in some patients with acute polyarthritis, secondary syphilis must be seriously considered as part of the differential diagnosis.

Acute hepatic failure in a child treated with lamotrigine.

An 8-year-old boy with a known seizure disorder that was being treated with lamotrigine developed acute hepatic failure. The patient, who had been well previously, presented with jaundice, elevated liver enzymes, and a coagulopathy. After discontinuation of lamotrigine and aggressive resuscitation, the patient made an uneventful recovery. We believe that the hepatic failure in our patient was secondary to the use of lamotrigine. We recommend careful monitoring of liver function when lamotrigine is administered.

Esophageal cryptosporidiosis in a child with acquired immune deficiency syndrome.

Oral Candida and Candida esophagitis are common findings in patients with the acquired immune deficiency syndrome. The intestinal protozoan, Cryptosporidium, is known to cause gastrointestinal symptoms in these patients. We report a 2-yr-old child with acquired immune deficiency syndrome, who had oral candidiasis, dysphagia, and vomiting. Upper gastrointestinal endoscopy and esophageal biopsy led to a diagnosis of esophageal cryptosporidiosis. We recommend upper gastrointestinal endoscopy as a diagnostic tool in selected patients with acquired immune deficiency syndrome. This is in contradistinction to a previous report that concludes that endoscopy is not necessary in this setting.

Salmonella typhimurium appendicitis.

A child with signs and symptoms of acute gastroenteritis developed localization of her pain to the right lower quadrant. A clinical diagnosis of appendicitis was made and an inflamed appendix was found at surgery. The postoperative period was marked by high spiking fevers and profuse nonbloody diarrhea. Cultures of the appendix and the stool revealed Salmonella typhimurium. Nontyphoidal Salmonella organisms are a rare cause of acute suppurative appendicitis. Intraoperative cultures of the appendix and peritoneal fluid as well as postoperative cultures of the diarrheal fluid were crucial in elucidating the cause of this patient's unusual course.