Pulmonary hypertension in a patient with Schmidt syndrome.

We describe a 26-year-old patient with long-standing autoimmune hypothyroidism. She was doing well until she developed Addisonian crisis accompanied by severe metabolic acidosis, hypoglycemia, hypomagnesemia, and hypokalemia. Subsequently she developed a life-threatening cardiac arrhythmia due to QT prolongation secondary to electrolyte imbalance. The association of autoimmune hypothyroidism and adrenal insufficiency in our patient suggests the diagnosis of autoimmune polyglandular syndrome type II or Schmidt syndrome. An echocardiography that was performed detected pulmonary hypertension without apparent cardiac or lung pathology. The association of pulmonary hypertension and Schmidt syndrome is rare and may be explained by a generalized immune activation leading to pulmonary endothelial damage or dysfunction.

Haloperidol-induced neuroleptic malignant syndrome complicated by hyperosmolar hyperglycemic state.

Neuroleptic malignant syndrome (NMS) is a life-threatening neurologic emergency that may be caused by neuroleptic agents of any class. The association with hyperosmolar hyperglycemic state (HHS) is rare and carries a grave prognosis. We describe the case of a 25-year-old male patient with haloperidol-induced NMS complicated by HHS that culminated in the patient's death despite all treatment efforts. Physicians caring for diabetic psychiatric patients who are treated with neuroleptic agents should be aware of this association that may be prevented by tight glycemic control.

Eosinophilic pancreatic infiltration as a manifestation of lung carcinoma.

A 68-year-old man reported upper abdominal pain during the previous 3 months that worsened in the last 2 days. He had a history of lung squamous cell carcinoma for which he underwent right lung lobectomy 3 years earlier. Preliminary blood tests showed leucocytosis with marked eosinophilia. No evidence of recurrent malignancy was detected, but computed tomography scan of the abdomen revealed an enlarged and edematous pancreas with hyperemia and infiltration of the peripancreatic fat. Fine needle aspiration from the lesion revealed inflammatory infiltration predominantly composed of eosinophils. The diagnosis of eosinophilic pancreatitis was suggested and the patient was placed on prednisone, but without any clinical or laboratory improvement. Two months later, the patient developed severe dyspnea, chylothorax, and acute renal failure. Cytologic studies of the pleural fluid revealed malignant cells from recurrent lung squamous cell carcinoma. The disease course was characterized by rapid deterioration and a fatal outcome. To the authors' knowledge, eosinophilic pancreatic infiltration as a manifestation of lung carcinoma has not been previously reported.

Recurrent severe hypercalcemia caused by bone marrow sarcoidosis.

A 71-year-old woman with recurrent severe hypercalcemia was found to have multiple noncaseating granulomas in the bone marrow with low parathyroid hormone levels and high levels of [1,25 dihydroxycholecalciferol] that later decreased to normal levels with the normalization of calcium levels. No organ involvement other than of the bone marrow was detected, and the angiotensin-converting enzyme level was elevated. The diagnosis of bone marrow sarcoidosis is suggested.

Bartonella quintana endocarditis in east Africa.

Bartonella quintana endocarditis is characterized by sub-acute evolution and severe valvular damage, and is associated with homelessness, alcoholism, and lice infestation. We present a case of B. quintana endocarditis in an Ethiopian immigrant without known risk factors for disease acquisition. This is the first case of B. quintana endocarditis reported from east Africa.

Pure red cell aplasia and lupus.

OBJECTIVE: To review the clinical and laboratory features of all reported patients with systemic lupus erythematosus (SLE) and pure red cell aplasia (PRCA). METHODS: In addition to our patient, we identified cases reported during the years 1966-2000 by searching the MEDLINE literature (Winspirs). Clinical and laboratory features were compared with those reported in large series of patients with SLE but without PRCA. RESULTS: Twenty-three additional cases were identified. In most cases, SLE was diagnosed either before or concomitantly with the diagnosis of PRCA. The clinical and laboratory features were not significantly different from those reported in large series of patients with SLE, except for less pleuritis and a trend toward less proteinuria, hallucinations, thrombopenia, and leukopenia. The natural history of PRCA and SLE was similar to that reported for PRCA alone. The disease responded to prednisone in the majority of cases, but patients frequently remained steroid dependent. CONCLUSIONS: The association between SLE and PRCA is rare. The clinical and laboratory features of SLE in such patients are similar to SLE patients without PRCA with the exception of a decreased frequency of pleuritis. Response to treatment of PRCA in those with SLE is similar to patients with PRCA but without SLE.

Tumor lysis syndrome after hydrocortisone treatment in metastatic melanoma: a case report and review of the literature.

Tumor lysis syndrome (TLS) is 1 of the complications that usually follows chemotherapy treatment of myelo-lymphoproliferative diseases. Corticosteroids (CS) could also induce TLS in this type of malignancies. On the other hand, TLS in solid tumors is less frequent, and CS treatment was never reported to be associated with TLS in solid tumor. Here we report the first case of TLS in a solid tumor (melanoma) after CS treatment.

Unilateral pulmonary edema: a rare presentation of congestive heart failure.

The authors present a case of an 85-year-old woman known to suffer from severe congestive heart failure who presented with dyspnea and a unilateral infiltrate in the right lung on chest x-ray. Following clinical judgment, she was diagnosed with unilateral pulmonary edema and was treated accordingly, with rapid improvement of symptoms and disappearance of the infiltrate within 12 hours. The patient had been hospitalized many times during the previous years with pulmonary edema affecting both lung fields. Unilateral pulmonary edema is an unusual clinical condition that has been reported as a manifestation of left heart failure, mostly affecting the right lung. The authors emphasize the possible presentation of unilateral pulmonary edema in a patient with heart failure and recurrent bilateral pulmonary edema.

Sweet's syndrome affecting the external auditory canal and tympanic membrane.

We report a patient who developed left ear pain, dry cough, and fever. The external auditory canal was tender, swollen, erythematous and full of debris. Later the patient developed widespread tender and red skin nodules and pustules that subsequently coalesced to form plaques. Identical lesions developed also in the external auditory canal and the tympanic membrane of the affected ear. Skin biopsy showed dermal neutrophilia, compatible with the diagnosis of Sweet's syndrome. Rapid improvement was achieved with prednisone after the failure of antibiotics.

Systemic lupus erythematosus among Arabs.

BACKGROUND: The prevalence of clinical manifestations and laboratory parameters in systemic lupus erythematosus differ among various ethnic groups. Few studies have reported on SLE in Arabs. OBJECTIVES: To summarize the demographic, clinical and laboratory features of Arab SLE patients and to compare them with other series from different Arab countries. METHODS: We reviewed the charts of all Arab SLE patients who had been seen at the Carmel Medical Center in Halfa, the Nazareth Hospital and the Holy Family Hospital in Nazareth, and a professional clinic (a referral outpatient clinic of the largest health maintenance organization in Israel) in Acre--all cities in northern Israel. Only patients with symptoms of more than one year were included. Demographic, clinical and laboratory parameters were documented and compared with those of four series from different Arab countries. RESULTS: The study group comprised 34 patients. The majority of the patients was Moslem; there were a few Druze and one Christian. There was no statistical difference between our patients and any of the other Arab series in terms of arthritis, neuropsychiatric manifestations and VDRL. The presence of serositis and mucocutaneous manifestations was significantly lower in our series compared to some of the other series. However, there was significantly less renal involvement in our patients compared to each of the other series. CONCLUSIONS: The prevalence of most clinical and laboratory parameters in Israeli Arab SLE patients is comparable to that of other series of SLE patients from different Arab countries. The prevalence of renal involvement in Israeli Arab SLE patients seems to be lower than in SLE patients from different Arab countries.

[Contralateral hemothorax: a late complication of subclavian vein catheterization].

Central venous catheterization is extensively used in unstable patients who need hemodynamic monitoring and in patients who require prolonged treatment such as, chemotherapy, antibiotics therapy, parenteral nutrition, or temporary hemodialysis. Subclavian vein catheterization is the preferred approach for hemodialysis, especially as it does not restrict the patient. Most of the complications related to this procedure are insignificant, however, occasionally they may be life threatening and require surgical intervention. We present a case study of a 77-year-old woman suffering from chronic renal failure. A subclavian catheter was inserted, and the patient started hemodialysis. Three weeks later, during hemodialysis, she complained of right upper abdominal and right chest pain. Chest X-ray showed a moderate to large right pleural effusion, with pleurocentesis confirming the presence of hemothorax.

Sweet's syndrome after pneumonectomy.

We report the case of a 38-year-old woman in whom typical skin lesions of Sweet's syndrome developed 2 days after undergoing left pneumonectomy, which was done because of severe bronchiectasis related to remote chemotherapy and radiotherapy given for lung sarcoma at the age of 8 years. Later fever and leukocytosis appeared, and biopsy results of the skin lesions showed neutrophilic infiltration of the dermis compatible with the diagnosis of Sweet's syndrome. Postoperative Sweet's syndrome has been reported only twice in the world literature. These other two cases and possible pathogenic mechanisms are reviewed.