Isolated Pulmonary Cryptococcosis in an Immunocompetent Patient Presenting with Right Shoulder Pain: A Case Report and Review of the Literature

Cryptococcosis is an important systemic fungal infection occurring predominantly in immunocompromised patients. We report a case of isolated pulmonary cryptococcosis in an ambulant middle-age lady who presented to the emergency department with right shoulder pain. The clue to lung pathology was right apical haziness best seen in the apical lordotic radiograph. The diagnosis was established by transbronchial lung biopsy. She did not have underlying immunosuppression or extrapulmonary disease. She was closely observed without anti-fungal therapy, and showed radiographic improvement during the five-month period of follow up.

A Rare but Potentially Fatal Bacterial Infection in a Patient with Poorly Controlled Diabetes Mellitus: Emphysematous Pyelonephritis

Emphysematous pyelonephritis, a necrotizing infection of the renal parenchyma caused by gas-producing organism, is a rare but life-threatening condition. The initial presentation could be non-specific. We report a case of emphysematous pyelonephritis in a patient presenting with poorly controlled diabetes mellitus and severe sepsis. Its pathogenesis and management are briefly discussed.

Sequential non-traumatic femoral shaft fractures in a patient on long-term alendronate

Fractures associated with osteoporosis are common among elderly people and postmenopausal women. Bisphosphonate is an effective anti-resorptive drug commonly used for the prevention and treatment of osteoporosis. There are, however, concerns about potential side-effects during long-term treatment with alendronate. We report a case where an 82-year-old woman who had been taking alendronate for 10 years presented with two episodes of non-traumatic femoral shaft fracture. An iliac bone biopsy showed severely suppressed bone turnover, suggestive of adynamic bone disease. We suspect the bone turnover suppression was related to the prolonged use of alendronate.