Parotid gland sarcoidosis with renal failure

Sarcoidosis is a multisystem granulomatous disorder of unknown etiology. Although any organ can be involved in sarcoidosis, significant renal involvement is rare, mostly due to nephrocalcinosis. Renal impalrment in the absence of nephrocalcinosis is uncommon and is usually due to glomerulonephritis or granulomatous pathology in the interstitium. Bilateral parotid swelling with renal impairment, as a presenting feature of sarcoidosis, as in this case, has never been reported before

Candida albicans myocardial abscess

A case report of an 88 years old male is presented who had past medical history of aortic valve replacement twice, first in 1984 and second in 1998, acute congestive heart failure with aortic insufficiency due to bioprosthetic degeneration and aortic root dilation and aortic dissection [status-post aortic root repair and ascending aorta replacement with Hemashield aortograft in 1998], infrarenal 4.8 cm abdominal aortic aneurysm, myocardial infarction in 1999, peripheral vascular disease, hemicolectomy due to colonic polyps, benign prostatic hyperplasia, status post transurethral prostatectomy in 1990, chronic renal insufficiency, and rheumatic fever. He was transferred from a nursing home to the acute care in July 1999 with a history of fever, 101.7oF, lethargy, mild confusion, shortness of breath and chest pain. On physical examination, the patient was found to have distended neck veins, a III/VI systolic ejection murmur at the left 2nd intercostals space and a diastolic murmur at the apical region, and bibasilar crackles on respiratory examination. The chest radiograph revealed right middle lobe infiltrates and prominent bronchial markings and cardiomegaly with an unfolding aorta. Electrocardiograph showed atrial fibrillation, left axis deviation, and an old septal infarct. On initial laboratory work-up, the patient had a total leukocyte count of 12.4 t/cu mm, [polymorphs 81.4%, lymphocytes 8.2%, monocytes 10.3%], with a platelet count of 94 t/cu mm and normal cardiac enzymes. The initial blood urea nitrogen, creatinine and electrolytes were within normal range. Vancomycin, Rifampin and Gentamicin were started empirically. On third day of hospitalization, transthoracic and transesophageal echocardiography were done which did not show any vegetation or myocardial abscess. Two blood samples were drawn for cultures and were found to be positive for Candida albicans. Continued