Kawasaki syndrome in an adult: case report and review of the literature in adolescents and adults.

Kawasaki syndrome in adults is very rare, with fewer than 50 cases reported in the English-language literature. We describe the case of a physician with Kawasaki syndrome and summarize the clinical features and treatment of 11 patients in the literature since the last review in 1994. Our patient presented with high fever, conjunctivitis, and arthralgias, then developed progressive toxicity with oral lesions, cervical adenopathy, and desquamation of the fingers and toes. No exanthematous rash or coronary artery aneurysms were found. Recovery was rapid after therapy with aspirin and intravenous immunoglobulin (IVIg). The diagnosis of Kawasaki syndrome depends on clinical criteria and the exclusion of other diseases. This diagnosis can be challenging to make in an adult, particularly when it presents without all typical features. Kawasaki syndrome must be considered nonetheless in an adult with unexplained fever of more than 5 days duration, because early diagnosis and combination therapy with aspirin and IVIg can prevent the life-threatening complication of coronary artery aneurysms.

Giant Cell Arteritis in AJ Americans.

Giant cell arteritis is often considered less common in African Americans. In 1985, we reviewed 34 African American patients with biopsy-proven temporal arteritis. We report on 9 additional biopsy positive patients seen at the Washington Hospital Center (WHO between 1988 and 1996.Clinical presentations were similar to those reported in previous series, with the exception that only one patient had polymyalgia rheumatica. Two patients had visual symptoms, but only one patient had permanent monocular visual loss. In combining our 9 new patients with 41 biopsy-proven, well characterized, published patients and comparing them with a representative Caucasian group, we found statistically significant differences. Male gender, anemia, and visual loss were overall more common in African Americans, whereas constitutional symptoms and polymyalgia rheumatica were less common. The detection rate of temporal artery biopsies at WHC was lower than rates reported in other studies, but they did not differ by race.We conclude that giant cell arteritis should be pursued as a diagnosis in all patients presenting with appropriate clinical features, regardless of race, and that earlier recognition may account for the lower incidence of permanent visual loss.

A swinging heart in limited systemic sclerosis.

We describe a 3rd patient with limited cutaneous systemic sclerosis (ISSc) complicated by a pericardial effusion sufficient to cause hemodynamic compromise. Although more commonly appreciated as a complication of diffuse systemic sclerosis, the recognition of hemodynamically compromising pericardial effusion presenting in the limited form of ISSc can be lifesaving.

Gonococcal pericarditis with tamponade in a patient with systemic lupus erythematosus.

Pericarditis is one of the most frequent manifestations of systemic lupus erythematosus; however, purulent pericarditis and tamponade are rare. We describe a patient with systemic lupus erythematosus and culture-proven gonococcal arthritis who developed purulent pericarditis with intracellular gram-negative diplococci. Evidence of tamponade was seen on echocardiography. There has not been a reported case of Neisseria gonorrhoeae in pericardial fluid or tissue since the introduction of antibiotics.

Olmec civilization, veracruz, Mexico: dating of the san lorenzo phase.

Archeological excavations at San Lorenzo Tenochtitlan, Veracruz, show that the Olmec sculptures of this zone are associated with the San Lorenzo phase, which can be placed in the Early Formative period (1500-800 B.C.) on the basis of ceramic comparisons. Five of six radiocarbon dates for the San Lorenzo phase fall within the 1200-900 B.C. span. The San Lorenzo phase therefore marks the beginning of Olmec civilization, and the sites forming the San Lorenzo Tenochtitlan group represent the oldest civilized communities known in Mexico or Central America.