A 69-year-old man presented with protracted necrotizing pharyngitis requiring prolonged antibiotic therapy. During immunologic evaluation he was found to have IgA multiple myeloma, low complement component C1q and extrinsic defect of neutrophil chemotaxis. The severity of his pharyngitis correlated with myeloma activity implying a causal relationship. The characteristics of the illness strongly suggest that it is related to the acquired defect in neutrophil chemotaxis. This case represents a previously undescribed infectious complication of multiple myeloma.

Aged↗

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Measles associated hepatobiliary disease: an overview.

In this report the literature on all cases of documented measles with hepatobiliary disease was reviewed to describe the characteristics of measles associated hepatitis. We found 27 patients described. Their age ranged from 9 to 59 years. Male to female ratio excluding military facilities was 1:1. The clinical and laboratory presentation appeared to follow one of two patterns. The first was suggestive of hepatocellular dysfunction characterized by aminotransferase elevation. It was encountered in 24/27 cases, seven of them with atypical measles. This form of liver disease tended to be asymptomatic. It appeared early and resolved in a few days. The second pattern was characterized by cholestasis and jaundice. It was described in three cases. This type of hepatitis became apparent when measles began to recede and persisted for two weeks or longer. The variation in time of appearance of the two types of liver disease may imply distinct pathogenetic mechanisms.

Adolescent↗

PubMedDate not supplied

Delayed hepatobiliary disease and eosinophilia in atypical measles.

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Adult↗

PubMedDate not supplied

Spontaneous gangrenous myositis induced by Streptococcus pyogenes: case report and review of the literature.

A 54-year-old man presented with gangrenous myositis caused by Streptococcus pyogenes. A review of the literature disclosed 10 similar cases. Their presenting manifestations were spontaneously occurring, localized, excruciating pain; mottling suggestive of ischemic changes; and signs of sepsis. The duration of illness ranged from two to six days, and the outcome was uniformly fatal. This rare but distinct entity resembles clostridial myonecrosis except that it lasts slightly longer and does not involve gaseous crepitus. A definitive diagnosis of myonecrosi scan be established by surgical exploration; early, radical debridement plus penicillin therapy should be undertaken after diagnosis in an attempt to alter the usual devastating outcome.

Gangrene↗

PubMedDate not supplied

Acute epiglottitis in adults.

We treated four adults whose upper airway was compromised due to acute epiglottitis. We also reviewed the English literature for all reports of this condition in adults (18 years and older). Among the 158 cases, the infectious etiology was identified in 29 (H. influenzae 20, Streptococcus pneumoniae six, H. parainfluenzae two, Streptococcus pyogenes one). In the remaining cases, the etiology was uncertain. Bacteremia was documented in 23/32 patients (71.9%), but extra-epiglottic infections were strikingly rare (X = six). The clinical manifestations were sore throat (100%), fever (88%), dyspnea (78%), dysphagia (76%), anterior neck cellulitis or tenderness (27%), hoarseness (21%), pharyngitis (20%) and anterior cervical lymphadenopathy (9%). Complete airway obstruction ensued in 23 out of the 119 subjects (18.3%) who had respiratory difficulty. Overall mortality rate was 17.6% but it was 6.4% among the patients who were semi-electively tracheostomized or endotracheally intubated. These findings illustrate that antibiotics therapy active against H. influenzae is required in the treatment of acute epiglottitis in adults. Additionally, airway patency should be established when inspiratory stridor appears assuring uncomplicated recovery.

Acute Disease↗