Typhoid fever as a rare cause of hepatic, splenic, and bone marrow granulomas.

During the course of typhoid fever, the usual histologic finding of the liver is "nonspecific reactive hepatitis." Hepatic granuloma (HG) is a rare complication of typhoid fever. We present two cases of typhoid fever with HG and review the relevant literature. Case 1 (a 53-year-old female) was found to have both hepatic and splenic granulomas. This is the first case of typhoid fever with splenic granulomas in the English language literature. Case 2 (a 66-year-old male) developed granulomas in the bone marrow in addition to HG. It should be considered that typhoid fever may lead to granulomas in several organs.

Neutrophilic pleocytosis in cerebrospinal fluid: adult-onset Still's disease.

We describe a unique patient whose clinical and laboratory findings fulfill diagnostic criteria of adult onset Still's disease and at the same time, this case was complicated by aseptic meningitis with neutrophilic pleocytosis in cerebrospinal fluid, as well as sensorineural hearing loss. The symptoms of the patient improved greatly with prednisolone therapy. Some studies in the literature suggest that this disease may lead to aseptic meningitis with neutrophilic pleocytosis.

The diagnosis of brucellosis by use of BACTEC 9240 blood culture system.

The diagnosis of brucellosis is generally made when a standard tube agglutination titer of 1/160 or more for anti-Brucella antibodies in the presence of compatible clinical signs and symptoms. However isolation of the organism from blood or bone marrow is the proof of the disease. In this study we aimed to describe the rate and duration of isolation of Brucella spp. from blood and bone marrow by use of automated blood culture system (BACTEC 9240). Between 1997 to 2001, 23 adults were diagnosed as brucellosis. Blood culture was obtained in all and simultaneous bone marrow culture in 18 and both specimens were cultured by BACTEC 9240. Brucella was isolated from blood and bone marrow cultures in 19 (82.6%) and 13 (81.2%) respectively. All positive blood cultures yielded within 7 days and bone marrow cultures in 4 days. We concluded that automated BACTEC culture systems can isolate Brucella spp. in a fast and efficient way.

Epileptic seizure: an atypical presentation in an adolescent boy with neurobrucellosis.

Brucellosis is an infectious disease with multisystemic involvement caused by the genus Brucella. Neurological complications, including meningitis, meningoencephalitis, myelitis-radiculoneuritis, brain abscess, epidural abscess and meningovascular syndromes, are rarely encountered. We present a patient with epileptic seizures and aggressive mood due to chronic neurobrucellosis of 2.5 y duration, which was misdiagnosed as bacterial meningitis and epilepsy. This form of presentation has not previously been reported in the English language literature. We conclude that the diagnosis of neurobrucellosis should be considered in patients presenting with recurrent or chronic meningitis syndromes with or without seizure from endemic areas for brucellosis.

Hyperpigmentation due to pyrimethamine use.

Pyrimethamine is used for the treatment of toxoplasmosis and the prophylaxis of malaria. Among the well-documented side effects are megaloblastic anemia, leukopenia, thrombopenia, rash, vomiting, and diarrhea. Hyperpigmentation is a very rare side effect. In some patients, associated HIV infection makes it difficult to distinguish the reasons for the etiology. We herein describe an HIV-negative patient who developed hyperpigmentation after pyrimethamine use.

Losartan-induced hepatic injury.

Losartan, an angiotensin II receptor antagonist, is widely used for the treatment of hypertension. Clinical experience with this drug has demonstrated that it is safe. Losartan-induced hepatic toxicity is extremely rare. We report a case of severe hepatic toxicity and fibrosis caused by losartan use, and we review four previously reported cases. Drug-induced hepatic injury may be seen during the treatment of hypertension by losartan and the clinician should be aware of this toxicity, especially during the initial phase of treatment.

The role of antibiotic treatment alone for the management of Brucella endocarditis in adults: a case report and literature review.

Endocarditis is a rare complication of brucellosis but it is the main cause of the mortality in this disease. The accepted treatment for Brucella endocarditis (BE) is a combination of valve replacement and antibiotics. Conservative antibiotic treatment alone is not recommended by most of the authors as it is considered ineffective and increase the risk of fatality. In our literature search, we found 14 adult patients with BE treated only with antibiotics with a favorable outcome. In this report, we described a patient treated with antibiotics alone and reviewed the literature. Depending on the data from the growing literature and our patient we suggest that in selected patients with BE who do not have congestive heart failure, valvular destruction, abscess formation, or a prosthetic valve, conservative antibiotic treatment may be a valid alternative to surgery.