Renal cell cancer diagnosed at endoscopy.

A 59-year-old lady was referred for an open-access endoscopy with a history of dyspepsia. The endoscopy showed a 5 mm sessile nodule in the fundus of the stomach. The histology report suggested that this represented a metastatic deposit from renal cell carcinoma (RCC). Following this, a computerised tomography (CT) of the abdomen showed an 18 × 15 cm RCC. Here we provide a short review on gastric metastases.

Lemierre's syndrome secondary to Fusobacterium necrophorum infection, a rare cause of hepatic abscess.

An 18-year-old male was admitted to the Accident & Emergency department with complaints of abdominal pain, vomiting and diarrhoea. He was clinically jaundiced and further CT scan suggested liver abscess. Later on blood cultures showed gram-negative bacilli and a further liver aspirate culture confirmed the presence of the rare Fusobacterium necrophorum. A diagnosis of hepatic abscess secondary to Lemierre's syndrome was made and patient was treated with appropriate antibiotics. Lemierre's syndrome, although a rare condition, may be associated with serious life-threatening complications. Early recognition and treatment is essential in successfully treating this rare condition. A review of Lemierre's syndrome is presented. We recommend clinicians to be aware of this condition (Lemierre's Syndrome) especially when dealing with young patients with sore throat and jaundice. It is important for primary care physicians to be aware of this condition as they are discouraged from prescribing antibiotics for young patients with sore throat. Although it is a rare condition, it is associated with severe life threatening complication like liver abscesses.

Castleman's disease in a patient with celiac disease.

A 72-year-old man with celiac disease was doing well on gluten-free diet. Five years later, he developed dyspepsia, fever and weight loss. CT scan and laparoscopic biopsies of small mesenteric lymph nodes clinched the diagnosis of Castleman's disease. He was started on chlorambucil; unfortunately he died few months after the diagnosis was made.

A case of acute infectious mononucleosis presenting with very high ferritin.

Hepatitis is an important but uncommon manifestation of acute Epstein Barr infection. Infectious mononucleosis is usually a disease of young adults. We report a case of infectious mononucleosis in a 72-year old jaundiced gentleman with ferritin level of 2438 that normalised on clinical improvement.