Fatal Scedosporium prolificans infection in a leukemic patient

AIM: To establish normative values for the anterior segment in premature infants in relation to postconceptional age and birth weight. METHODS: Anterior segments were measured in 39 premature infants, 25 to 39 weeks' gestational age by use of ultrasound biomicroscopy and a muscle hook with topical anaesthesia. RESULTS: Anterior chamber depth, trabecular-iris angle, angle opening (trabecular-iris) distances at 250 and 500 microns from the scleral spur, and the thickness of the thickest part of the iris showed linear increases in relation to postconceptional age and birth weight. CONCLUSIONS: Ultrasound biomicroscopy is a powerful tool for obtaining precise images and measurement of the anterior segment in preterm neonates. Normative values were established for anterior segment dimensions in relation to postconceptional age and birth weight.     

Fatal hyperammonemia in a patient with systemic lupus erythematosus

We treated a 31-year-old woman with systemic lupus erythematosus, renal failure with nephrotic syndrome, and a long-standing seizure disorder, who developed severe hyperammonemia with a fatal outcome. Blood chemistry examination did not indicate liver disease, and amino acid concentrations did not suggest a defect in the urea cycle. Discontinuation of anticonvulsant treatment with valproic acid (VPA) failed to bring about improvement. We speculated that hyperammonemia in this case was induced by VPA, and the existence of other underlying factors, including the administration of aspirin and cimetidine, hypoalbuminemia, and renal failure might elevate the concentration of the serum free fraction of VPA.     

Fatal Campylobacter jejuni infection in a patient splenectomised for thalassaemia

A 35 year old man with a fatal Campylobacter jejuni infection is described. He had HbE/beta zero thalassaemia and had undergone splenectomy nine months previously for hypersplenism; he also had chronic hepatitis C infection. He presented with high grade fever but no gastrointestinal symptoms and rapidly progressed to septicaemic shock and hepatic encephalopathy despite treatment with penicillin, gentamicin, and, later, chloramphenicol and ceftazidime. Only one case of Campylobacter jejuni septicaemia occurring post-splenectomy has been reported previously, also in an iron overloaded thalassaemia patient. Unusual Gram negative bacilli must be covered by the chosen antibiotic regimen when splenectomised thalassaemic patients present with high grade fever.     

Fatal myocardial infarction in a young patient due to coronary arteritis

This paper has introduced a child management protocol which incorporates better facial seal of the relative analgesic nosepiece together with rubber dam control which effectively allows the operator to concentrate on the precise delivery of the restorative option. The benefits of immediate treatment must be weighed up against the potential psychological distress of not having benefited from the luxury of behavioural management intervention.     

Fatal myelofibrosis following fludarabine administration in a patient with indolent lymphoma

We report a case of fulminant myelofibrosis after administration of fludarabine in a patient diagnosed as having refractory low-grade lymphoma, progressing fatally. Myelofibrosis in the setting of an indolent lymphoma is very rare; this fact, and the short period between drug administration and fibrosis suggest an etiopathogenic link, although this potential and severe adverse effect of fludarabine has not been previously reported in the literature.     

Fatal bronchiolitis obliterans in a patient with juvenile rheumatoid arthritis receiving chrysotherapy

Bronchiolitis obliterans has been described in adults with rheumatoid arthritis, particularly in association with D-penicillamine treatment, but to our knowledge has not been reported in juvenile rheumatoid arthritis (JRA). We describe a 12-year-old girl with JRA who developed bronchiolitis obliterans after a 6-month course of intramuscular gold. She presented with severe obstructive airway disease (FEV1, 17% predicted) unresponsive to bronchodilators, without obvious pathology on chest radiograph. Despite aggressive immunosuppressive therapy and eventual lung transplantation, she died 3 1/2 years after her initial diagnosis of JRA. Although rare, bronchiolitis obliterans must be considered in the differential diagnosis of respiratory distress in children with JRA.     

Locked-in syndrome in an adolescent patient with pneumococcal meningitis

The effect of Heart-protecting Musk Pill (HMP) on blood perfusion of the ischemic myocardium by intravenous dipyridamole 99mTc-MIBI single photon emission computerized tomography (SPECT) in 17 patients with coronary heart disease was observed. Results showed that sublingual administration of HMP prior to injection of dipyridamole could remit the cardiac symptoms induced by dipyridamole, such as angina, chest distress, etc. With a remission rate of 85%. HMP could also improve the SPECT image defect significantly, 8 of 11 cases with reversible image defects and 4 of 6 irreversible image defects were improved. It suggested that HMP could improve the blood perfusion of the ischemic myocardium, the total effective rate was 70.6%. No adverse reaction was found.     

Fatal varicella zoster infection in a severe steroid dependent asthmatic patient receiving methotrexate

A case is described of fatal haemorrhagic varicella zoster in a steroid dependent asthmatic patient concurrently receiving methotrexate. The future management of patients on immunosuppressive steroid sparing drugs is discussed.     

Intravenous immunoglobulin administration to a patient with systemic lupus erythematosus and pneumococcal septicemia

A case history is presented of a woman with systemic lupus erythematosus, sepsis and pneumonia caused by Streptococcus pneumoniae. Conventional treatment was supplemented with intravenous human immunoglobulin with remarkable effect. The treatment is discussed.     

Fatal interstitial pulmonary disease in a patient with dyskeratosis congenita after allogeneic bone marrow transplantation

Local control rate by radical radiation therapy was analyzed in 33 patients with a piriform sinus cancer. Twenty-five patients (76%) were in stage T3 + T4. Local recurrence-free survival at 3 years was 49% in T1 + T2 and 25% in T3 + T4 (p = 0.01). In T1 + T2 lesions, a biologically effective dose for an acute reaction over 80 Gy and total treatment time less than 70 days appeared to improve local control. In T3 + T4 lesions, good radiation response assessed by the regaining of laryngeal mobility affected local control favorably. An esophageal involvement and destruction of the laryngeal cartilage as well as soft tissue extension precluded the possibility of local control by radiation therapy alone. In addition to the T-stage, other tumor factors should also be considered for predicting local control with radiation therapy.     

Fatal pulmonary infection with Mycobacterium celatum in an apparently immunocompetent patient

Mycobacterium celatum is a recently described mycobacterium isolated from patients who have suppressed cell-mediated immunity, such as AIDS. We present here, to our knowledge, the first report of a fatal pulmonary infection caused by M. celatum in a 73-year-old immunocompetent female patient. The mycobacterium was identified by a 16S rRNA sequence analysis.     

Occult pneumococcal septicemia and pneumococcal pneumonia complicating pneumatoceles in a previously healthy child

1. The effect of in vitro glycation on delta-aminolevulinic dehydratase (ALA-D) under several experimental conditions was investigated. When preincubated with 500 mM glucose at 37 degrees C for 20 hr, ALA-D was 80% inactivated and glycated hemoglobin levels were increased more than fourfold. 2. Thiobarbituric acid species were not modified during glycation; therefore ALA-D inactivation cannot be attributed to glucose autoxidation. 3. Acetyl salicylic acid was effective in preventing both hemoglobin glycation and ALA-D inactivation by glucose. 4. A method has been developed for measuring protein glycation in vitro, in a crude preparation of red blood cells, which can also be applied to sugars other than glucose.