Bartonella henselae endocarditis in an immunocompetent adult

We describe a case of aggressive Bartonella henselae endocarditis in an immunocompetent man who owned a cat. Aortic valve replacement was required, and his infection was diagnosed by histology, serology, and polymerase chain reaction analysis. The manifestations of his disease included mediastinal lymphadenopathy, glomerulonephritis, myocarditis, and a petechial rash; the unusual finding of a positive titer of c-antineutrophil cytoplasmic antibodies was noted. Serological titers were markedly elevated for > 1 year despite clinical improvement.

Bronchiectasis in HIV disease

An increased frequency of bacterial pneumonia occurs in HIV-infected individuals: however the development of bronchiectasis is not well recognized. We describe seven patients with HIV infection who developed chronic symptomatic lung disease, six with troublesome recurrent infective exacerbations. Bronchiectasis was demonstrated by computed tomography in five patients, and bronchial wall thickening was shown in a further two patients. The characteristics of the patients are described, and possible aetiological factors are discussed. As measures become available which prolong the later stages of HIV disease, bronchiectasis may become an increasing problem in this patient population. Early recognition and appropriate management may significantly alter morbidity in advanced HIV disease.

Central pontine myelinolysis in a patient with AIDS

Images

Orf of the pinna

A case of orf affecting the pinna is discussed. This is an unusual presentation of an infection that is common in farming communities. At the initial presentation the diagnosis was not suspected, the management therefore was inappropriate and probably gave rise to the secondary infection that ensued. The history described is classical. Orf affecting the external auditory canal has been reported once, but orf affecting the pinna has not been described before.

Spontaneous rupture of the spleen in Legionnaires' disease

A case of Legionnaires' disease is described in a 63 year old man who presented with pneumonia and confusion. Eleven days after admission he became acutely hypotensive and attempts at resuscitation failed. Post-mortem examination revealed spontaneous splenic rupture and massive hepatocellular necrosis--an outcome that has not previously been associated with Legionnaires' disease.