Frederick B. Rose

Capnocytophaga canimorsus sepsis with purpura fulminans and symmetrical gangrene following a dog bite in a shelter employee.

The authors describe a fatal case of purpura fulminans with symmetrical peripheral gangrene and sepsis caused by Capnocytophaga canimorsus in a 45-year-old, previously healthy woman who was bitten by a dog at an animal shelter where she was employed. Absent in this patient were the usual risk factors, including immunosuppression, alcohol abuse, corticosteroid therapy, and splenectomy. The patients presentation to the emergency room late in the course of the infection probably effected her death. C canimorsus should be strongly suspected in any case of septicemia following a dog bite. Prompt therapy may influence the potentially fatal course of systemic infection. Employees and/or volunteers who work in animal shelters should be cognizant of the potential risks of a dog or cat bite and follow recommended procedures when such an incident occurs.

Recurrent Mycobacterium xenopi infection in a patient with rheumatoid arthritis receiving etanercept.

A case of recurrent Mycobacterium xenopi infection presenting as Potts disease in a patient receiving etanercept for severe rheumatoid arthritis is described. A 49-y-old Caucasian male had received a total of 11 months of anti-mycobacterial therapy for hip infection acquired 15 months earlier; he presented with progressive back pain, which was diagnosed as Potts disease. He had been treated with etanercept in addition to his prior immunosuppressive agents after the diagnosis of hip infection.

Family outbreak of fatal yersinia enterocolitica pharyngitis

A family outbreak of fatal Yersinia enterocolitica pharyngitis is reported. Two members of a family were hospitalized for pharyngitis and posed a diagnostic dilemma until cultures of throat, blood, and stool revealed Y. enterocolitica. Neither patient responded to erythromycin therapy. The first patient died, and her husbands life-threatening illness seemed to respond to aminoglycoside and trimethoprim/sulfamethoxazole therapy. Y. enterocolitica should be considered as an etiologic agent in the differential diagnosis of a patient with pharyngitis whose condition deteriorates during erythromycin or penicillin therapy.

Tuberculosis of the hip as the presenting sign of HIV and simulating pigmented villonodular synovitis

Abstract. A 36-year old man, with no prior known exposure to human immunodeficiency virus (HIV) or tuberculosis, presented with monoarticular pain and a decreased range of motion in his left hip. Radiography and magnetic resonance imaging revealed bony erosive lesions, juxta-articular cysts, a large effusion, and juxta-articular edema. The initial clinical and radiographic diagnosis was pigmented villonodular synovitis (PVNS) of the left hip. However, what was initially felt to be a chronic proliferative inflammatory process was later determined to be tuberculous arthritis. This case emphasizes the importance of including tuberculous arthritis in the differential diagnosis of patients with monoarticular destructive joint disease radiologically suggestive of PVNS.

Cricoarytenoid arthritis presenting as cardiopulmonary arrest

We describe a patient with a long history of rheumatoid arthritis who presented in full cardiopulmonary arrest. He was given intracardiac epinephrine. Fibroptic laryngoscopy determined the cause of the arrest to be upper airway obstruction from cricoarytenoid joint ankylosis, a complication of long-standing rheumatoid arthritis. The patient underwent a tracheostomy, recovered uneventfully, and was doing well nine months later. The literature is reviewed, and the pathophysiology, clinical findings, presentations, and treatment of this potentially fatal entity are described.

Disseminated Histoplasmosis and Asplenia

Excerpt To the editor: We read with interest the article by Wheat and associates concluding that age greater than 54 years and immuno-suppression were the only risk factors for disseminated or fata...

Genital herpes. How to relieve patients' physical and psychological symptoms.

Genital herpes simplex virus is being encountered at an increasing rate by the primary care physician. Recurrences of this disease create not only medical but psychological and social problems, of which the physician must be aware. Although acyclovir (Zovirax) has become a useful palliative tool, compassion, sensitivity, and understanding are essential in the treatment of this disease. Physician-provided education is still currently the thrust for prevention.