&NA; Eosinophilic cystitis, an uncommon lesion, is rare in children; <25 cases have been reported. The intense inflammatory changes in the bladder wall associated with this lesion may produce heaped‐up excrescences, which resemble vesical rhabdomyosarcoma. Our experience with 3 patients shows that the initial diagnosis of eosinophilic cystitis may not…
&NA; Scurvy is an extremely rare complication of anorexia nervosa. Despite the poor intake of nutrients, anorexia nervosa is not commonly associated with vitamin deficiencies. We report a case of early scurvy complicating long‐standing anorexia nervosa. Anorexia nervosa appears to be increasing in incidence. Although scurvy is unusual, this case…
&NA; Chronic aortic dissection presenting as a prolonged febrile syndrome is an uncommon condition. We believe that only 22 cases have been previously reported. We present a case of a patient with an aortic dissection whose diagnosis was delayed because persistent fever, malaise, and night sweats dominated his clinical picture….
&NA; Cobalamin (vitamin B12) deficiency warrants appropriate evaluation because cobalamin is necessary in certain biochemical functions. R‐binder deficiency, which causes low cobalamin levels, is a rare and benign pseudodeficiency. If not further evaluated by determining levels of methylmalonic acid and homocysteine, however, such a patient would be given unneeded treatment….
&NA; Citalopram is the newest selective serotonin reuptake inhibitor (SSRI) available in the United States. It is currently approved by the Food and Drug Administration for the treatment of major depression. However, a number of studies have found it to be effective in the treatment of panic disorder as well….
&NA; Ischemic optic neuropathy is a rare cause of blindness reported most commonly in association with collagen‐vascular diseases, infectious processes, and systemic hypotension related to massive exsanguinating hemorrhage. We report what we believe to be the first case of posterior ischemic optic neuropathy due to perioperative hypotension in a patient…
&NA; The association of temporal arteritis and Guillain‐Barré syndrome has rarely been reported. We describe a patient who sequentially suffered from both disorders. An 81‐year‐old woman presented with headache and loss of appetite. Analysis showed anemia and an erythrocyte sedimentation rate of 94 mm/hr. Temporal artery biopsy disclosed giant cell…
&NA; Rosai‐Dorfman disease is an idiopathic histiocytic proliferative disorder characterized by sinus histiocytosis and massive lymphadenopathy. Extranodal involvement has also been reported. We report the case of a 57‐year‐old woman presenting with seizures, focal motor deficits, and leptomeningeal enhancement on magnetic resonance imaging. Meningeal biopsy revealed Rosai‐Dorfman disease. Sinus histiocytosis…
&NA; Cholelithiasis has been reported only rarely in infants. We describe a case of cholelithiasis in a 1‐month‐old infant with Klinefelter's syndrome. This association has not been previously reported.
&NA; We describe a 16‐year‐old girl who had sudden onset of cardiorespiratory arrest while at school. She had recently attempted weight loss using a low‐carbohydrate/high‐protein, calorie‐restricted dietary regimen that she had initiated on her own. During resuscitation, severe hypokalemia was noted. At postmortem examination, no other causes for the cardiac…
&NA; We describe the case of a young woman with a rapid deterioration in her cognitive status and physical functioning. An extensive laboratory and radiologic evaluation confirmed the diagnosis of neurosyphilis. Despite the reemergence of syphilis with the acquired immunodeficiency syndrome (AIDS) epidemic, neurosyphilis is often neglected in the differential…
&NA; Acute lymphocytic leukemia developed within 3 weeks after a fulminant case of varicella complicated by pneumococcal sepsis and severe bone marrow suppression in a child treated with filgrastim (human granulocyte colony‐stimulating factor).
&NA; Aeromonas hydrophila infection has been described as the cause of necrotizing fasciitis in patients with suppressed immune systems, burns, or trauma in an aquatic setting. We report a case in which severe necrotizing fasciitis involving hand, arm, chest, and lateral side of trunk, along with toxic shock, developed after…
&NA; Skeletal muscle is rarely the site of metastatic cancer, though a few such cases have been reported. Esophageal adenocarcinoma metastasic to skeletal muscle has not previously been reported in the literature. We describe the case of 71‐year‐old African American male with stage IV adenocarcinoma of the gastroesophageal junction. He…
&NA; CREST syndrome, a relatively benign, slowly progressive variant of systemic scleroderma consists of calcinosis, Raynaud's phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia. Although the association of this syndrome with primary biliary cirrhosis (PBC) is recognized in women, it has never been described in a man. We report the rare case…
&NA; We describe a case of primary aortoenteric fistula (PAEF) in a patient with upper gastrointestinal bleeding. Primary aortoenteric fistula is a rare but clinically important cause of catastrophic gastrointestinal bleeding. The diagnosis of PAEF is difficult and sometimes not made until laparotomy. Primary aortoenteric fistula should be considered in…
&NA; I report an association between Crohn's disease and bilateral phakic cystoid macular edema. A 51‐year‐old man with a diagnosis of Crohn's disease was referred for evaluation of decreased vision bilaterally. He had bilateral phakic cystoid macular edema, with a vision of 20/40 in the right eye and 20/60 in…
&NA; The patient we describe had elevated carbamazepine serum concentrations during concomitant fluconazole administration (400 mg/day), including serial concentrations both before and after antifungal therapy. Since fluconazole is a known inhibitor of the cytochrome P‐450 enzyme system, this suggests an inhibition of carbamazepine metabolism.
&NA; Mycobacterium kansasii is an uncommon cause of infection of the hand. Other atypical mycobacteria that cause hand infections are M marinium, M avium, M intracellularis, and M chelonei. Such infections usually occur around aquatic areas, though sometimes the source of infection is elusive. Inoculation of the atypical mycobacterium into…
&NA; Primary mediastinal large B‐cell lymphoma (PMLBCL) is a distinct disease entity that has a relatively short history. The prognosis and therapy of patients with PMLBCL is still controversial. We summarize our experience with PMLBCL at the Medical University of South Carolina between 1997 and 2000.
Background. Green tobacco sickness (GTS) is a highly prevalent occupational illness among tobacco workers. Working in wet tobacco is a major risk factor for GTS. Little is known about preventing GTS. This analysis examines possible GTS preventive measures.
Background. To help direct future educational efforts, this study was conducted to assess the knowledge and attitudes relating to child safety seat use in an urban postpartum population.
Background. Age‐specific structured encounter forms for well‐child examinations have been shown to improve thoroughness of documentation among pediatric house staff. This study evaluated the influence of such forms on completeness of documentation by practicing pediatricians.
Background. Transmission of echocardiograms via telemedicine links has allowed remote hospitals direct access to pediatric cardiology subspecialty care. This study assessed the accuracy of echocardiogram interpretation across an integrated services digital network (ISDN) telemedicine link.
Background. Identification of children with respiratory viral infections may augment infection‐control practices on inpatient units. There are clinical syndromes leading to morbidity among hospitalized children, however, in which a viral etiology of the illness might not be considered.
&NA; To achieve predictable success in managing constipated patients, it is important that underlying pathophysiologic conditions be identified objectively, so that patients amenable to aggressive medical or surgical intervention can be identified. This review considers possible causes of persistence of abdominal symptoms after surgical relief of constipation.
&NA; Obesity in adolescents has increased by 75% in the past three decades. Crosssectional and prospective surveys have shown that a large percentage of adolescents, particularly females and even those of normal weight, diet at some time. While moderate changes in diet and exercise have been shown to be safe,…
We describe a 16-year-old girl who had sudden onset of cardiorespiratory arrest while at school. She had recently attempted weight loss using a low-carbohydrate/high-protein, calorie-restricted dietary regimen that she had initiated on her own. During resuscitation, severe hypokalemia was noted. At postmortem examination, no other causes for the cardiac arrest…
CREST syndrome, a relatively benign, slowly progressive variant of systemic scleroderma consists of calcinosis, Raynaud's phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia. Although the association of this syndrome with primary biliary cirrhosis (PBC) isrecognized in women, it has never been described in a man. We report the rare case of a…
Ischemic optic neuropathy is a rare cause of blindness reported most commonly in association with collagen-vascular diseases, infectious processes, and systemic hypotension related to massive exsanguinating hemorrhage. We report what we believe to be the first case of posterior ischemic optic neuropathy due to perioperative hypotension in a patient who…
Eosinophilic cystitis, an uncommon lesion, is rare in children; <25 cases have been reported. The intense inflammatory changes in the bladder wall associated with this lesion may produce heaped-up excrescences, which resemble vesical rhabdomyosarcoma. Our experience with 3 patients shows that the initial diagnosis of eosinophilic cystitis may not be…
The association of temporal arteritis and Guillain-Barre syndrome has rarely been reported. We describe a patient who sequentially suffered from both disorders. An 81- year-old woman presented with headache and loss of appetite. Analysis showed anemia and an erythrocyte sedimentation rate of 94 mm/hr. Temporal artery biopsy disclosed giant cell…
Acute lymphocytic leukemia developed within 3 weeks after a fulminant case of varicella complicated by pneumococcal sepsis and severe bone marrow suppression in a child treated with filgrastim (human granulocyte colony-stimulating factor).
Cobalamin (vitamin B12) deficiency warrants appropriate evaluation because cobalamin is necessary in certain biochemical functions. R-binder deficiency, which causes low cobalamin levels, is a rare and benign pseudodeficiency. If not further evaluated by determining levels of methylmalonic acid and homocysteine, however, such a patient would be given unneeded treatment. We…
Mycobacterium kansasii is an uncommon cause of infection of the hand. Other atypical mycobacteria that cause hand infections are M marinium, M avium, M intracellularis, and M chelonei. Such infections usually occur around aquatic areas, though sometimes the source of infection is elusive. Inoculation of the atypical mycobacterium into the…
Rosai-Dorfman disease is an idiopathic histiocytic proliferative disorder characterized by sinus histiocytosis and massive lymphadenopathy. Extranodal involvement has also been reported. We report the case of a 57-year-old woman presenting with seizures, focal motor deficits, and leptomeningeal enhancement on magnetic resonance imaging. Meningeal biopsy revealed Rosai-Dorfman disease. Sinus histiocytosis may…
Cholelithiasis has been reported only rarely in infants. We describe a case of cholelithiasis in a 1-month-old infant with Klinefelter’s syndrome. This association has not been previously reported.
Aeromonas hydrophila infection has been described as the cause of necrotizing fasciitis in patients with suppressed immune systems, burns, or trauma in an aquatic setting. We report a case in which severe necrotizing fasciitis involving hand, arm, chest, and lateral side of trunk, along with toxic shock, developed after the…
We describe the case of a young woman with a rapid deterioration in her cognitive status and physical functioning. An extensive laboratory and radiologic evaluation confirmed the diagnosis of neurosyphilis. Despite the reemergence of syphilis with the acquired immunodeficiency syndrome (AIDS) epidemic, neurosyphilis is often neglected in the differential diagnosis…
The patient we describe had elevated carbamazepine serum concentrations during concomitant fluconazole administration (400 mg/day), including serial concentrations both before and after antifungal therapy. Since fluconazole is a known inhibitor of the cytochrome P-450 enzyme system, this suggests an inhibition of carbamazepine metabolism.
I report an association between Crohn’s disease and bilateral phakic cystoid macular edema. A 51-year-old man with a diagnosis of Crohn’s disease was referred for evaluation of decreased vision bilaterally. He had bilateral phakic cystoid macular edema, with a vision of 20/40 in the right eye and 20/60 in the…
Citalopram is the newest selective serotonin reuptake inhibitor (SSRI) available in the United States. It is currently approved by the Food and Drug Administration for the treatment of major depression. However, a number of studies have found it to be effective in the treatment of panic disorder as well. While…
Skeletal muscle is rarely the site of metastatic cancer, though a few such cases have been reported. Esophageal adenocarcinoma metastasic to skeletal muscle has not previously been reported in the literature. We describe the case of 71-year-old African American male with stage IV adenocarcinoma of the gastroesophageal junction. He had…
Chronic aortic dissection presenting as a prolonged febrile syndrome is an uncommon condition. We believe that only 22 cases have been previously reported. We present a case of a patient with an aortic dissection whose diagnosis was delayed because persistent fever, malaise, and night sweats dominated his clinical picture. These…
Scurvy is an extremely rare complication of anorexia nervosa. Despite the poor intake of nutrients, anorexia nervosa is not commonly associated with vitamin deficiencies. We report a case of early scurvy complicating long-standing anorexia nervosa. Anorexia nervosa appears to be increasing in incidence. Although scurvy is unusual, this case shows…
We describe a case of primary aortoenteric fistula (PAEF) in a patient with upper gastrointestinal bleeding. Primary aortoenteric fistula is a rare but clinically important cause of catastrophic gastrointestinal bleeding. The diagnosis of PAEF is difficult and sometimes not made until laparotomy. Primary aortoenteric fistula should be considered in any…
Background.Identification of children with respiratory viral infections may augment infection-control practices on inpatient units. There are clinical syndromes leading to morbidity among hospitalized children, however, in which a viral etiology of the illness might not be considered.
Background.To help direct future educational efforts, this study was conducted to assess the knowledge and attitudes relating to child safety seat use in an urban postpartum population.
Primary mediastinal large B-cell lymphoma (PMLBCL) is a distinct disease entity that has a relatively short history. The prognosis and therapy of patients with PMLBCL is still controversial. We summarize our experience with PMLBCL at the Medical University of South Carolina between 1997 and 2000.
Background.Green tobacco sickness (GTS) is a highly prevalent occupational illness among tobacco workers. Working in wet tobacco is a major risk factor for GTS. Little is known about preventing GTS. This analysis examines possible GTS preventive measures.
Background.Transmission of echocardiograms via telemedicine links has allowed remote hospitals direct access to pediatric cardiology subspecialty care. This study assessed the accuracy of echocardiogram interpretation across an integrated services digital network (ISDN) telemedicine link.
Background.Age-specific structured encounter forms for well-child examinations have been shown to improve thoroughness of documentation among pediatric house staff. This study evaluated the influence of such forms on completeness of documentation by practicing pediatricians.
To achieve predictable success in managing constipated patients, it is important that underlying pathophysiologic conditions be identified objectively, so that patients amenable to aggressive medical or surgical intervention can be identified. This review considers possible causes of persistence of abdominal symptoms after surgical relief of constipation.
Obesity in adolescents has increased by 75% in the past three decades. Cross- sectional and prospective surveys have shown that a large percentage of adolescents, particularly females and even those of normal weight, diet at some time. While moderate changes in diet and exercise have been shown to be safe,…
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