[The Waterhouse-Friderichsen syndrome]

Item does not contain fulltextBACKGROUND: The Waterhouse-Friderichsen syndrome (WFS) is a serious illness associated with a high mortality rate and characterized by septic shock and signs of adrenocortical insufficiency. CASE DESCRIPTION: A 33-year-old male was seen in the emergency department with severe abdominal and back pain with diffuse mottled skin and rapidly progressive petechiae all over his body. Laboratory results showed severe lactate acidosis with renal dysfunction and indications of diffuse intravascular coagulation. Because he had signs of progressive septic shock, the patient was admitted to the ICU. There he subsequently developed hypoglycaemia (glucose < 0.1 mmol/l) and CPR had to be performed twice - the patient died shortly afterwards. Autopsy showed bilateral necrosis and haemorrhage of the adrenal glands, indicative of the diagnosis of WFS. Streptococcus pneumoniae was identified. CONCLUSION: In case of sepsis, with fever, rapidly expanding petechiae and purpura the Waterhouse-Friderichsen syndrome should be considered. Intensive therapy with antibiotics, fluids, vasopressors, and corticosteroids should be initiated immediately

A dutch patient with diffuse panbronchiolitis successfully treated with clarithromycine

A case report of a 26-year-old caucasian male with a medical history of chronic sinusitis and a “difficult to treat” asthma bronchiale is described. After a period of 6 years intensive medical treatment and diagnostic procedures, a diffuse panbronchiolitis (dpb) was diagnosed, confirmed by histological examination. This case report describes the successful outcome of macrolide treatment in this patient. Despite the low incidence of dpb in western countries, physicians must be aware of this orphan disorder in order to provide adequate therapy

Long-term intratracheal lipopolysaccharide exposure in mice results in chronic lung inflammation and persistent pathology

Long-term intratracheal lipopolysaccharide exposure in mice results in chronic lung inflammation and persistent pathology. Vernooy JH, Dentener MA, van Suylen RJ, Buurman WA, Wouters EF. Department of Pulmonology, Maastricht University, Maastricht, The Netherlands. Lipopolysaccharide (LPS), a major proinflammatory glycolipid component of the gram-negative bacterial cell wall, is one of the agents ubiquitously present as contaminant on airborne particles, including air pollution, organic dusts, and cigarette smoke. Chronic exposure to significant levels of LPS is reported to be associated with the development and/or progression of many types of lung diseases, including asthma, chronic bronchitis, and progressive irreversible airflow obstruction, that are all characterized by chronic inflammatory processes in the lung. In the present study, pathologic effects of long-term LPS exposure to the lung were investigated in detail. To this end, a murine model in which mice were exposed to repeated intratracheal instillation of Escherichia coli LPS was developed. We show that long-term LPS instillation in mice results in persistent chronic pulmonary inflammation, characterized by peribronchial and perivascular lymphocytic aggregates (CD4(+), CD8(+), and CD19(+)), parenchymal accumulation of macrophages and CD8(+) T cells, and altered cytokine expression. Furthermore, airway and alveolar alterations such as mucus cell metaplasia, airway wall thickening, and irreversible alveolar enlargement accompanied the chronic inflammatory response. Interestingly, the observed inflammatory and pathologic changes mimic changes observed in human subjects with chronic inflammatory lung diseases, especially chronic obstructive pulmonary disease (COPD), suggesting that this murine model could be applicable to dissect the role of inflammation in the pathogenesis of these disease conditions

[Massive rectal blood loss after colonoscopy]

Item does not contain fulltextA 70-year-old man presented with acute lower gastrointestinal bleeding. A colonoscopy performed one and a half months prior had revealed diverticulosis in the sigmoid colon; a small polyp located 10 cm from the anal margin had been removed at that time. The presenting patient was haemodynamically unstable and there was a significant amount of rectal blood loss. Gastroscopy revealed no abnormalities. During angiography, the patient died as a result of haemorrhagic shock. The post-mortem examination revealed a rectal perforation, which had most likely resulted from the polypectomy, and a secondary haematoma located between the common iliac artery and the rectum. The source of the gastrointestinal bleeding was the rupture of the haematoma directly into the rectal perforation. Colonoscopy is a relatively safe procedure; however, this case illustrates that potentially lethal complications from colonoscopy can be expressed, even after a few months