The “phantom” rash of Still’s disease

An 18-year-old, female patient presented with fever, sore throat and joint pain. Laboratory tests revealed elevated inflammation markers. During her hospitalization she presented a non-pruritic, salmoncolored rash, which was appearing with the fever in the evening hours and was vanishing during apyrexia. The rash could be seen in various parts of the body, such as the limbs, the face and the neck. The diagnosis of Adult-onset Still disease (AOSD) was established, since the patient was fulfilling the relevant criteria. AOSD is a rare, systemic inflammatory disorder of unknown etiology that typically presents as a high spiking fever accompanied by systemic symptoms. Various skin lesions have been described in patients with AOSD, both typical and atypical ones. Our patient presented significant clinical improvement after initiation of corticosteroid treatment.Pan African Medical Journal 2015; 2

Fordyce angiokeratoma

A 55 year-old Caucasian man, with Diabetes Melitus type 2 history, presented to our department with complaints of multiple, dark red papules located on the scrotum. The diagnosis of Fordyce angiokeratoma was clinically established. No special treatment was recommended, apart from patient's reassurance for the benign nature of this clinical entity. Fordyce angiokeratoma or angiokeratoma of the scrotum was first described in 1896 by John Addison Fordyce. Its etiology remains unclear, while its incidence is believed to increase with age. Genetic background of the disease has not been documented. Complications are generally uncommon, however bleeding of the papules can occur. Differential diagnosis mainly includes angiokeratoma corporis diffusum, malignant melanoma and nevomelanocytic nevus. In cases of diagnostic dilemma, dermoscopy can be useful, but biopsy of the lesion is the gold standard method for the establishment of the diagnosis. Specific treatment is unnecessary, still, excision, electrodessication and laser therapy have been described in complicated cases or for aesthetic reasons

Erythema nodosum leads to the diagnosis of pulmonary tuberculosis

Erythema nodosum is a panniculitis which may have various causes, such as drugs, infections, sarcoidosis, inflammatory bowel disease, tuberculosis or can be idiopathic. We here report a case of a woman diagnosed  with pulmonary tuberculosis whose first symptom was erythema nodosum. A thorough clinical and laboratory investigation of the patient presenting with erythema nodosum is always required, in order to assess a possible systemic, underlying condition.Key words: Erythema nodosum, Tuberculosis, Hilar lymphadenopath

Severe Legionnaires’ Disease Complicated by Rhabdomyolysis and Clinically Resistant to Moxifloxacin in a Splenectomised Patient: Too Much of a Coincidence?

We here report a case of Legionnaires’ disease in a splenectomised patient, complicated by rhabdomyolysis and acute renal failure and characterized by a poor clinical response to moxifloxacin. Splenectomy is not included among the factors, typically associated with higher risk or mortality in patients with Legionellosis. However, our report is consistent with previous case reports describing severe Legionella infections in asplenic subjects. The possibility that functional or anatomic asplenia may be a factor predisposing to severe clinical course or poor response to therapy in patients with Legionella infection cannot be excluded, deserving further investigation in the future. More studies are required in order to clarify the underlying pathophysiological mechanisms that connect asplenia, immunological response to Legionella, and pathogen’s resistance to antibiotics

Unusual cardiovascular complications of brucellosis presenting in two men: two case reports and a review of the literature

Introduction: Brucellosis is a zoonosis with worldwide distribution, which is particularly endemic in many countries of the Mediterranean basin. Cardiovascular complications of this disease, such as endocarditis, myocarditis and pericarditis, are very rare, with even fewer cases of myocarditis or asymptomatic pericardial effusion in the absence of concomitant endocarditis being reported. Case presentation: We report two cases of brucellosis in two Caucasian men, aged 17 and 34 years old, with myocarditis and asymptomatic pericardial effusion, respectively. Of note, neither patient had concomitant endocarditis. The disease was confirmed serologically and by blood cultures. Both patients recovered completely after receiving appropriate antibiotic treatment without any sign of relapse during a follow-up of 12 months. Conclusion: These two cases emphasize that in endemic areas Brucella can be considered as a potentially causative agent of idiopathic pericardial effusion or myocarditis, even in the absence of concomitant endocarditis. This possibility could be taken into account particularly in cases where contraction of brucellosis is possible, such as occupational exposure or consumption of unpasteurized dairy products. © 2011 Gatselis et al; licensee BioMed Central Ltd

Another Report of Acalculous Cholecystitis in a Greek Patient with Infectious Mononucleosis: A Matter of Luck or Genetic Predisposition?

We here report a case of a young, male patient who presented with jaundice and was diagnosed with acalculous cholecystitis during the course of a primary Epstein-Barr Virus (EBV) infection. The coexistence of cholestatic hepatitis and acalculous cholecystitis in patients with infectious mononucleosis is extremely uncommon and only few cases can be found in the literature. Moreover, almost one-fourth of the total reports of this rare entity are coming from Greece. Whether this is a result of physicians’ high index of suspicion due to previous reports or a consequence of genetic predisposition is an issue that deserves further investigation in the future. More studies are required in order to clarify the pathophysiological and genetic backgrounds that connect acalculous cholecystitis and EBV infection