[A Rare Cause for B Symptoms]. / Seltene Ursache für B-Symptomatik.

A Rare Cause for B Symptoms Abstract. The 78-year-old patient was referred by her general practitioner for a tumor search after a 3-month deterioration of her general condition, B-symptomatology, persistently elevated inflammation values, progressive anemia and renal insufficiency. Given the previously discovered pulmonary nodules and microhematuria, we suspected vasculitis proven by elevated MPO-ANCA levels and a kidney biopsy. Therapy with steroids and cyclophosphamide effected remission.

[Just Anorexia?] / Alles Anorexie?

Just Anorexia? Abstract. We report the case of a 30-year-old woman presenting with fatigue, loss of weight, nausea, emesis and hyponatremia. The evaluation proved Addison's disease due to an autoimmune polyendocrine syndrome type 2 with Hashimoto thyreoiditis. Under substitution with hydrocortisone and fludrocortisone all the symptoms subsided completely.

[The Sour Patient]. / Die saure Patientin.

The Sour Patient Abstract. We report the case of a 75-year-old woman presenting with an elevated anion gap metabolic acidosis. The evaluation proved a 5-oxoprolin acidosis due to acetaminophen in therapeutic dose and concomitant risk factors such as malnutrition, chronic alcohol abuse, renal insufficiency, hepatopathy, and female sex. After stopping paracetamol medication and admission of bicarbonate and N-acetylcysteine, there was a rapid improvement in clinical symptoms and blood analysis.

[Community-acquired pneumonia in the elderly]. / Ambulant erworbene Pneumonie einer älteren Patientin.

We report the case of a 88 years old patient with cough and new onset confusion. Delirium was caused by a necrotizing Methicillin-sensible staphylococcus aureus pneumonia with bacteremia. Despite antibiotic therapy for several weeks and fall of inflammatory markers the patient died from consequences of delirium.

[A rare cause of heart failure]. / Seltene Ursache einer Herzinsuffizienz.

We report the case of a 52 years old patient with dilated cardiomyopathy. Ischemic heart disease was excluded by coronary angiography. However, bilateral hilar lymphadenopathy was present on plain chest radiography. Transbronchial biopsy showed non-necrotizing, epitheloid cell granulomas and thus sarcoidosis was diagnosed. A MRI of the heart confirmed the cardiac involvement by the sarcoidosis with corresponding structural changes.

[Therapy-resistant pneumonia]. / Therapierefraktäre Pneumonie.

We report the case of a 72 year old patient with B-symptoms and a persistent pulmonary infiltrate despite an antibiotic therapy. Buds of granulation tissue were found by transbronchial biopsy proving an organizing pneumonia. B-Symptoms and pulmonary infiltrate were improved immediately by a therapy with steroids. Even though there were reasons for a secondary organizing pneumonia due to a known chronic lymphocytic leukemia and a pneumonia treated four months before, we consider a cryptogenic organizing pneumonia as most probable.

[<> spondylodiscitis]. / «Sterile¼ Spondylodiszitis.

We report the case of a 81 year old women presenting with fever and back pain. Infectious spondylodiscitis was first supposed due to the imaging of the spine although no pathogenic agent could be proved. Antibiotic therapy was initiated. Because of the persistence of the symptoms biopsy was repeated, this time done by a surgeon. Eventually spinal gout was diagnosed. Symptomatic therapy alone removed the discomfort.

[Persistent neutropenia]. / Persistierende Neutropenie.

We report the case of a 72-old patient with persistent neutropenia diagnosed during investigation of sialadenitis. Further examination led to the diagnosis of immune neutropenia and systemic lupus erythematosus. Anamnesis and the clinical course made initial diagnosis of drug-induced lupus erythematosus implausible. Steroid trial was done, followed by maintenance therapy, with good control of symptoms.