[Pancreatitis ascribed to the use of itraconazole]

A 50-year-old woman was treated intermittently with itraconazole (Trisporal) due to onychomycosis. After the initial period of 7 days and after the first 9 days of the second period she experienced abdominal complaints. In the second episode, pancreatitis was diagnosed. No known risk factors for acute pancreatitis were present. The pancreatitis may have arisen due to the use of itraconazole. As far as we know, this side effect of itraconazole or other triazole derivatives has not previously been reported in the literature. It seems to be a rare side effect, for which the pathogenesis has yet to be elucidated.

[High levels of carcinoembryonic antigen in a woman with hypothyroidism]

A 53-year-old woman was referred to the outpatient clinic for Internal Medicine, due to an elevated serum concentration of carcinoembryonic antigen (CEA). Hypothyroidism was diagnosed. Following replacement therapy with levothyroxin, the serum concentrations of thyroid stimulating hormone (TSH) and CEA decreased to near-normal levels. No malignancy was found during the remainder of the treatment period. A decreased hepatic clearance of CEA seemed to be the most likely explanation for the observed high CEA concentration in this patient with hypothyroidism. An increased CEA concentration may occur in association with certain malignancies, as well as with non-neoplastic disorders, such as hypothyroidism. As CEA has a low tumour specificity, routine assessment of CEA is not advocated for diagnostic evaluation.

Echocardiographic follow-up of Chlamydia psittaci myocarditis

Chlamydia psittaci myocarditis has been infrequently reported. A case of serologically confirmed C psittaci myocarditis with dilated left ventricle and severely impaired left ventricular function is described. Serial echocardiograms demonstrated complete recovery after therapy. An early diagnosis has important prognostic implications.

Wilkie's syndrome, a rare cause of vomiting and weight loss: diagnosis and therapy

Wilkie's syndrome is a rare disease that should be considered in the differential diagnosis of upper abdominal discomfort and weight loss. Compression of the inferior part of the horizontal duodenum by the superior mesenteric artery may result in high intestinal obstruction with postprandial or positional discomfort, vomiting and weight loss. The diagnosis is based on clinical presentation and confirmed by radiographic studies during a symptomatic period. Therapy of first choice is conservative. Nevertheless, surgical intervention with duodenojejunostomy is often required.

Bilateral brachial plexus neuritis following parvovirus B19 and cytomegalovirus infection

A man, 23 years of age, had a typical erythema infectiosum, complicated by a severe bilateral brachial plexus neuritis. Motor function recovered slowly and only partially after 6 months. An infection by human parvovirus B19 was demonstrated, with strongly positive and gradually declining IgM antibodies and viral DNA detectable in serum for more than 3 months. There was also clear evidence of a recent infection by cytomegalovirus. The interaction between these two viruses could be responsible for this rare and severe complication of common infections in this patient.

[Hepatitis attributed to the use of terbinafine]

A 71-year-old woman was admitted to our hospital with jaundice after she had been using terbinafine for a few weeks. The liver function tests showed a mixed cholestatic-hepatocellular pattern. A liver biopsy revealed large amounts of intracellular bile pigment. Causes of the liver disorder other than the use of the aforementioned antimycotic drug were excluded. Ten months after cessation of the drug the patient had recovered completely. The Netherlands Inspectorate for Health Care received 20 reports of liver enzyme elevations due to terbinafine in 1991-1994.

Acute thyroiditis caused by Moraxella nonliquefaciens

A 43-year-old woman presented with thyroiditis caused by Moraxella nonliquefaciens. Antibiotic therapy resulted in complete recovery. The literature on M. nonliquefaciens and acute bacterial thyroiditis is reviewed. This is the first documented case of a thyroiditis caused by M. nonliquefaciens.

[Accessory spleens as a cause of recurrent idiopathic thrombopenia]

A female aged 62 yr developed a recurrence of chronic idiopathic thrombocytopenia 7 years after splenectomy. Two accessory spleens were identified and removed surgically. An increase in platelet count was seen. An analysis of the literature shows that extirpation of accessory spleens was successful in over 60% of the patients (32/52) with recurring idiopathic thrombocytopenia after splenectomy.