Renal insufficiency due to an orthohantavirus infection in the north of the Netherlands.

We describe a patient with an orthohantavirus infection in the north of the Netherlands. Orthohantavirus cases in the Netherlands are rare and most cases occur in the east of the Netherlands. Orthohantavirus infections should be included in the differential diagnosis in travellers and non-travellers, and patients from areas other than the east of the Netherlands if flu-like symptoms and acute renal insufficiency are present.

A fatal case of metastatic squamous cell carcinoma in a patient with myositis ossificans traumatica.

Myositis ossificans traumatica is a rare disease associated with chronic wounds and fistulae. Chronic ulcers, fistulae and wounds can transform into squamous cell carcinoma, the so-called Marjolin's ulcer. We describe a rapid, progressive and fulminant course of a metastatic squamous cell carcinoma arising from a chronic wound in a patient with myositis ossificans traumatica.

[Gastrointestinal symptoms with meningococcal infection. Emergence of Neisseria meningitidis serogroup W.] / Gastro-intestinale klachten bij meningokokkeninfectie.

BACKGROUND: Meningococcal disease usually presents as meningitis and/or septicaemia, but can also present as pneumonia or arthritis. Since 2000, a worldwide increase in meningococcal disease is reported which is caused by a new virulent clone of serogroup W (MenW:cc11). This subtype is more likely to give an atypical clinical presentation and results in high mortality rates. CASE DESCRIPTION: A 68-year-old woman with polymyalgia rheumatica, managed with prednisone, developed an acute gastrointestinal syndrome of nausea, diarrhoea, vomiting, fever and chills. She presented at the Emergency Department and was admitted to intensive care for septic shock. Blood cultures revealed MenW:cc11 infection. She received antibiotic treatment and left the hospital in good condition 8 days after admission. CONCLUSION: MenW:cc11 is associated with gastrointestinal symptoms and sepsis. Recognition of this atypical clinical presentation is important for a timely and adequate treatment and for antibiotic prophylaxis of family members and close contacts.

Granulocytosis and thrombocytosis in renal cell carcinoma: a pro-inflammatory cytokine response originating in the tumour.

BACKGROUND: In up to 20% of patients with renal cell cancer (RCC) an inflammatory response consisting of low-grade fever, weight loss and an elevated ESR and CRP may occur with modest granulocytosis and thrombocytosis. Clinical and experimental data suggest a pathogenic role for tumour-derived cytokine production, especially interleukin-6. CASE REPORT: A 79-year-old female with RCC presented with low-grade fever, weight loss and overt granulocytosis and thrombocytosis. Radiological examination revealed a right-sided renal tumour. During nephrectomy a gradient between the IL-6 levels in the renal artery and vein was demonstrated, providing direct evidence for in vivo production of IL-6 by the tumour affected kidney, which was confirmed by the demonstration of IL -6 in the tumour cells by immunohistochemical staining and in the supernatant of the homogenised tumour. Cytogenetic examination revealed complex abnormalities including a gain of chromosome 7. In addition we demonstrated production of IL-1alpha, IL-1beta, IL-8 and ICAM-1 in the tumour with systemic elevated levels of IL-6 and IL-8 with secondary increased serum G-CSF and TPO levels. CONCLUSION: We have provided direct evidence for the production of pro-inflammatory cytokines by renal cancer cells in a patient with RCC and a profound inflammatory response, with a central role of IL-6, probably due to a gain of chromosome 7. The extreme granulocytosis and thrombocytosis may have resulted from the secondary systemic production of G-CSF and TPO.