Infective endocarditis caused by Streptococcus mutans. A complication of idiopathic hypertrophic subaortic stenosis.

Three patients with endocarditis caused by Streptococcus mutans were seen during a six-month period. All had clinical features of subacute bacterial endocarditis, including fever, heart murmurs, and positive blood cultures. One had underlying aortic insufficiency and two had idiopathic hypertrophic subaortic stenosis. All patients were treated with parenteral antibiotics and were cured. Streptococcus mutans is a pleomorphic, microaerophilic organism that is associated with dental caries and plaque. Differentiation of S mutans from enterococcal endocarditis is important because the former condition can be treated for a shorter period of time with penicillin alone, without the addition of aminoglycoside antibiotics.

Adverse dermatologic reactions from antiarrhythmic drug therapy.

Undesirable cutaneous reactions to drugs may occur early or late in the course of treatment. The ingestion of drugs may also aggravate existing dermatologic conditions. The adverse dermatologic reactions from antiarrhythmic drug therapy are reviewed. The exact incidence of dermatologic side effects from cardiovascular drugs has been difficult to estimate because of sporadic reporting. In this review, the cutaneous side effects are discussed according to drug class and the type of dermatologic reaction.

Increasing dose of naproxen in rheumatoid arthritis: use with and without corticosteroids.

A group of 50 patients with rheumatoid arthritis (half of whom received prednisone for 12 weeks before and then during the study) participated in a double-blind trial evaluating the efficacy and safety of 3 dosages of naproxen (125, 250, and 500 mg b.i.d.). Increasing dosages of naproxen were associated with increasing levels of therapeutic response and increasing serum levels of naproxen with no evidence of toxicity. Corticosteroid patients did not exhibit the same pattern of increasing levels of efficacy. The study demonstrates a dosage-related increasing pattern of efficacy for naproxen up to 1,000 mg/day, a pattern not yet demonstrated for the other non-steroidal antinflammatory drugs.

Steroid-induced mesenteric lipomatosis.

A patient undergoing chronic corticosteroid therapy presented with mesenteric lipomatosis that simulated malignant masses. Computerized tomography was instrumental in identifying these apparent tumors as benign fatty deposits. The spectrum of lipomatous abdominal lesions amenable to diagnosis by computerized tomography is reviewed.