Spirocheatal shock syndrome.

In this paper we describe a clinical scenario of high grade fever, jaundice, hypotension and multi‑organ dysfunction syndrome in a 30‑year‑old homeless male without radiological biliary obstruction. He was brought to our hospital by the emergency medical service of Saudi Arabia (Red Crescent) from the street. After an initial resuscitation he proved to have Borrelia recurrentis. The clinical course during his hospital stay was not a smooth one, but the patient finally improved. After 20 days of hospitalisation, he was discharged in a stable condition. The present case underlines the need for high clinical vigilance, even in a non‑endemic area.

Acute renal failure due to leukaemic infiltration of kidneys.

Three patients with acute lymphatic leukaemia who presented with non-oliguric acute renal failure resulting from leukaemic infiltration of the kidneys are reported. Chemotherapy resulted in clinical remission of leukaemia with regression of renal size and prompt improvement in renal function in two cases. The third patient died on the second day of therapy and a post-mortem renal biopsy revealed dense leukaemic infiltration of the kidneys. Early institution of specific chemotherapy for leukaemia, maintenance of fluid and electrolyte balance, and dialytic support whenever indicated may prove helpful in prevention of serious complications associated with renal failure and in halting further ischaemic injury to the kidney.