Hypocalcaemic laryngospasm in the emergency department.

A 51-year-old African male presented to the emergency department with a sore throat, a productive cough and a striking pinched voice. Investigation revealed severe hypocalcaemia (0.97 mmol/l) with a prolonged QT interval on ECG. The authors administered intravenous calcium in the emergency department, which instantly improved the quality of the patient's voice. He was eventually diagnosed with primary hypoparathyroidism and an upper airway infection. Severe hypocalcaemia is a life-threatening condition. Identifying laryngospasm as an atypical presentation in the presence of a concomitant airway infection and prompt treatment in the emergency department are critical.

Churg-Strauss Syndrome following PTU Treatment.

Propylthiouracil (PTU) is a frequently prescribed drug in the treatment of hyperthyroidism. The use of PTU is, however, accompanied by numerous potentially serious side effects including vasculitis. PTU-related vasculitides can present as haematuria, pulmonary haemorrhage, or cutaneous lesion together with aspecific symptoms such as fever, myalgia, arthralgia, and fatigue. Cerebral involvement is seldom observed. We present a 49-year-old female with Graves' disease and asthma, who developed paresis of the proximal extremities, eosinophilia, pulmonary, and cutaneous lesions following treatment with PTU. A cerebral vasculitis consistent with Churg-Strauss syndrome (CSS) was suspected. Although cerebral involvement is seldom observed with PTU treatment, cerebral vasculitis should be considered in patients developing CNS symptoms.

Cushing's syndrome due to ectopic ACTH production by (neuroendocrine) prostate carcinoma.

Ectopic adrenocorticotropin (ACTH) secretion accounts for less than 10% of all causes of endogenous Cushing's syndrome (CS) and is usually associated with neuroendocrine tumors and small cell carcinoma of the lung. We report the case of a 62-year-old man with CS due to ectopic ACTH production by small cell carcinoma of the prostate. He presented with severe hypercortisolism and associated symptoms. Plasma neuron specific enolase (NSE) was grossly elevated. Despite performing a laparoscopic bilateral adrenalectomy, the patient died as a result of sepsis with multi-organ failure. Post-mortem immunohistochemical staining of prostate tumor tissue showed ACTH expression. ACTH staining was also performed in four additional patients with small cell carcinoma of the urinary tract without CS. None of these additional cases showed a positive staining for ACTH. Although a rare cause of ectopic ACTH production, neuroendocrine prostate carcinoma should be considered in male patients with Cushing's syndrome, in particular in those with an occult source of ACTH overproduction.

Paraganglioma of the urinary bladder.

Since paragangliomas of the urinary bladder are rare and not easily recognised, histological examination is often the only leading key to diagnosis. We report on a patient with a paraganglioma of the urinary bladder. Although the patient presented with classical signs and symptoms, these were only appreciated after histological examination of a transurethral resection specimen had elucidated the correct diagnosis.

A rare cause of haemolytic anaemia: paroxysmal nocturnal haemoglobinuria in an elderly patient.

Paroxysmal nocturnal haemoglobinuria (PNH) is an acquired haemopoietic stem cell disorder characterised clinically by chronic haemolytic anaemia with acute episodes, thrombosis and bone marrow failure. It is a rare condition, which usually occurs in younger people. Immunophenotyping and flow cytometry play a key role in diagnosing PNH. Treatment is mainly supportive. Because it is so rare, delay in diagnosis is not uncommon in patients with PNH, which has a considerable impact on patient management and prognosis. We present this case to draw attention to this rare cause of haemolytic anaemia, which should be considered in any patient, of any age, who has signs of chronic haemolysis.