Successful Use of Continuous Veno-Venous Haemodialysis in a Case of Potential Lethal Caffeine Intoxication.

Here we describe the case of a potentially lethal caffeine intoxication after the reported ingestion of 10 g of caffeine. Due to hemodynamic instability with tachycardia and hypertension with an insufficient effect of continuous labetalol infusion, the patient was started on continuous veno-venous haemodialysis (CVVHD). After successful treatment for 15 h, CVVHD could be discontinued, and the patient was discharged home the next day. This case report is the first to report the use of CVVHD as a haemodialysis modality in the case of caffeine intoxication and illustrate the effect on caffeine clearance. We stress the importance of an early recognition of caffeine intoxication, so that haemodialysis can be considered in the case of a potentially lethal intoxication.

[A woman with complaints after an injection of diclofenac]. / Een vrouw met klachten na een diclofenac-injectie.

A 61-year-old woman came to the Emergency Department with a skin lesion located at her right upper leg. At the site of the lesion a subcutaneous injection of diclofenac had been administered for pain from nephrolithiasis. CT revealed a large infiltrate proximal in the right upper leg; histologic evaluation of the tissue showed an acute necrotizing inflammation. These findings are typical for Nicolau syndrome.

The immune response to schistosome antigens in formerly infected travelers.

We investigated the type and strength of the immune response to schistosome antigens in a group of 20 Dutch travelers who had been infected with Schistosoma spp. during a group visit to Mali in 1991 and 8 non-infected controls. At the time, 9 had Katayama syndrome (KS), and 11 remained asymptomatic. All had been treated with praziquantel. Eight years later, serology remained positive in all 20 formerly infected travelers. The lymphocyte proliferative responses and cytokine responses (interleukin 13 [IL-13], IL-10, and interferon [IFN-γ] responses to soluble egg antigens and the IL-13, IL-10, and IL-5 response to adult worm antigen) were stronger in the travelers than in the controls and tended to be stronger in those with KS compared with those who had remained asymptomatic. In conclusion, Schistosoma infection induced a memory immune response, and people who experienced KS tended to have a stronger immune response to schistosome antigens than their asymptomatic counterparts.