[Severe pneumonitis as a complication of low-dose methotrexate therapy in psoriasis-associated polyarthritis]

A 71-year-old woman with psoriasis-associated rheumatoid arthritis had for 15 months been treated with methotrexate (5 mg/week orally). Four weeks before admission she had developed dyspnoea and cough. On admission her axillary temperature was 38.2 degrees C, the white cell count was normal. Erythrocyte sedimentation rate (50/90 mm), lactate dehydrogenase activity (449 U/l) and the creatinine level (1.33 mg/dl) were all elevated. Blood gas analysis revealed partial respiratory impairment (pO2 52 mm Hg), and the chest X-ray demonstrated bilateral interstitial-alveolar changes. Despite antibiotics the temperature continued to rise, and on the 11th day a blood eosinophilia of 4% was noted. The bronchial mucosa was normal on bronchoscopy, and transbronchial biopsy showed only minor interstitial fibrosis, occasional macrophages and lymphocytes. Cultures of the lavage-fluid were negative. As methotrexate pneumonitis was suspected the drug was discontinued and prednisolone administered (50 mg daily for 3 days, gradually reducing over 7 days). The symptoms quickly improved, and blood gas analysis and the X-rays became normal. The patient was discharged symptom-free after 30 days.

Which pathologic characteristics influence echographic patterns of retinoblastoma?

Disagreement still exists regarding the influence of rosette formation, pseudorosettes, necrotic changes, vascularity, and calcification on the echographic characteristics of retinoblastoma. To further evaluate the echographic pattern of retinoblastoma confirmed by tissue diagnosis, we studied 11 consecutive cases of retinoblastoma and correlated pathologic findings with A- and B-scan echographic findings. In five patients with heavily calcified tumors, the A-scan echograms were more accurate in documenting reflectivity and revealed an extremely highly reflective pattern attenuating the ultrasonic beam substantially and casting characteristic shadows on the sclera. The B-scan echogram revealed a mass attenuating the ultrasound beam. This mass had dense focal echoes persisting at lower sensitivity within the tumor. In five patients with mild calcification on pathological examination, the A-scan echogram showed a highly reflective pattern. In one case with no calcification, the A-scan echogram revealed a medium reflective pattern. The B-scan echogram revealed a well-defined mass in each case. The degree of rosette differentiation, pseudorosettes, or necrosis failed to correlate with A-scan echographic pattern specific for retinoblastoma. No case showed a cystic appearance on B-scan echogram regardless of the degree of necrosis seen in the pathologic specimen. The echographic findings in retinoblastoma depend primarily on the degree of calcification and are not influenced independently by other specific pathologic characteristics of the tumors.

Familial porphyria cutanea tarda in a patient with retinitis pigmentosa

The patient in this report had typical retinitis pigmentosa which apparently was of recessive inheritance. In addition, she had an exacerbation of porphyria cutanea tarda (PCT) while taking oral contraceptives. In view of the lack of evidence for hereditary transmission of PCT it is also of interest that the patient's mother had an exacerbation of PCT while taking estrogenic medication.

Conjunctival biopsy in the diagnosis of sarcoidosis

The diagnosis of sarcoidosis with ocular involvement is often difficult and accompanied by a certain measure of uncertainty due to a paucity of additional physical signs. In the ophthalmic literature, it is controversial as to whether biopsy of a clinically normal conjuctiva should be done if sarcoidosis is suspected. Many authors advocate biopsy only in the presence of conjunctival follicles or nodules. However, a positive biopsy from a clinically normal-appearing conjunctiva has been reported. Recently, we saw a patient with bilateral uveitis, evanescent cranial nerve palsies, and other clinical manifestations suggesting central nervous system and ocular sarcoidosis. Random biopsy of a normal-appearing conjunctiva revealed a noncaseating granuloma consistent with sarcoidosis. Since conjunctival biopsy is a simple office procedure with minimal morbidity, this diagnostic tool should be considered for patients with clinically suspected sarcoidosis, even in the absence of conjunctival follicles or nodules.

Swimmer's goggles for keratoconjunctivitis sicca

Swim goggles with a moist chamber effect have been used successfully in seven patients with severe keratoconjunctivitis sicca unresponsive to the conventional means of therapy including artificial tears, mucolytics, and occlusion of the puncta. The longest follow-up is three years, the shortest six months. There have been no complications, and in all cases the patients have been subjectively and objectively improved.

Neuro-ophthalmological study of late yaws and pinta. II. The Caracas project

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Seronegative dementia paralytica: report of a case

Dementia paralytica may present diagnostic difficulties when routine serological test using a non-treponemal antigen is non-reactive. We present an illustrative demented patient who initially had negative VDRL test both in his serum and cerebrospinal fluid. However, the brain biopsy specimen showed active meningoencephalitis. By special staining technique, a spiral organism was found in the brain exhibiting morphology perfectly compatible with treponema pallidum. Later in the course, the VDRL became reactive in the blood but remained non-reactive in the cerebrospinal fluid. On the basis of the experience of other workers in the field and ours with this patient, we advise the use of FTA-ABS test as a screening procedure in patients with neurological problems of possible syphilitic origin. We urge further research in this field.

A neuro-ophthalmologic study of late yaws and pinta

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A new modification of the Krajian silver stain for Treponema pallidum

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Late syphilis in the primate

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Presence of spirochaetes in paresis despite penicillin therapy

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Recovery of spirochagetes in the monkey by passive transfer from human late sero-negative syphilis

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