[Dysphagia and tonsillitis in a 25-year-old male patient : The nearly forgotten severe complication of a common ailment]. / Dysphagie und Angina tonsillaris bei einem 25-jährigen Patienten : Die fast vergessene schwere Komplikation einer häufigen Krankheit.

We report the case of a patient with a severe dysphagia accompanying progressive tonsillitis. The clinical examination supported the possibility of a severe septic soft tissue infection. The blood cultures revealed a largely anaerobic sepsis with Fusobacterium necrophorum. This unusual pathogen is the most common cause of Lemierre's syndrome. A duplex sonogram and magnetic resonance imaging (MRI) of the neck region and vessels suggested a thrombophlebitis of the left internal jugular vein with partial occlusion, so that Lemierre's syndrome could be diagnosed. The patient was treated with appropriate antibiotics according to the resistogram and also with rivaroxaban.

[Ectopic production of calcitriol by non-Hodgkin lymphoma as a cause of hypercalcemic crisis]. / Ektope Calcitriol-Produktion durch ein Non-Hodgkin-Lymphom als Ursache einer hyperkalzämischen Krise.

HISTORY AND ADMISSION FINDINGS: A 92-year-old woman was admitted because her general condition had deteriorated during the last two weeks and acute kidney injury had developed. Moreover, she suffered from periods of disorientation and confusion while heretofore she was autonomous. INVESTIGATION, TREATMENT AND COURSE: Clinical and biochemical evaluation revealed a hypercalcemic crisis with markedly increased serum levels of calcium (3.77 mmol/l; reference values 2.2-2.65), an acute kidney injury and neuropsychiatric disturbances. Ultrasound scan and magnetic resonance imaging of a palpable mass in the right abdomen showed a tumor in the retroperitoneal space. Histological evaluation specified the tumor as non-Hodgkin lymphoma. Further investigation revealed no other reason for the hypercalcemia but enhanced levels of calcitriol. Since serum levels of calcidiol were increased while levels of calcidiol were normal, we assumed ectopic production of calcitriol by non-Hodgkin lymphoma as the cause of hypercalcemic crises. This could been proven by the decrease of calcium and calcitriol levels during the course of lymphoma treatment. CONCLUSION: Hypercalcemia of malignancy is the most common cause of hypercalcemia in the inpatient setting. The evaluation of these cases should consider ectopic production of calcitriol a cause of hypercalcemia.

[Renal side effects of long-term lithium therapy]. / Nephrologische Nebenwirkungen einer Langzeittherapie mit Lithium.

Lithium is widely used in the treatment of bipolar disorders. Long-term administration of lithium often leads to side effects concerning the subjects: nephrology, endocrinology and surgery. This review emphasizes nephrotoxicity.Lithium treatment may disturb responsiveness to antidiuretic hormone (ADH), causing a nephrogenic diabetes insipidus. Furthermore long-term lithium therapy may trigger hyperparathyreoidism with hypercalcemia and chronic interstitial nephritis with development of microcysts. Long-term patients have an increased risk to develop impaired renal function. Lithium-induced endstage renal disease is rare. Termination of lithium treatment may decrease the risk of progression.To ensure security of lithium treatment regular controls of urine osmolarity, lithium-, creatinine- , thyroid stimulating hormone- and calcium-levels are essential. Patients with decreased renal function should be referred to a specialist early.

[Myalgia in Neuro-Behçet's disease. Medication side effects or expression of underlying disease]. / Myopathie beim Behçet-Syndrom. Medikamentennebenwirkung oder Ausdruck der Grunderkrankung?

In this report we present the 9-year course of disease in a woman of Turkish origin suffering from Behçet's disease with parenchymal CNS involvement combined with myalgia. Differential diagnoses, such as drug-induced neuromyopathy were excluded on the basis of electromyographic and bioptic tests. We were able to arrest progression of symptoms of both the myopathy and the Neuro-Behçet's disease by means of increased combined immunosuppressive therapy.

[Essential cryofibrinogenemia with generalized livedo racemosa]. / Essentielle Kryofibrinogenämie mit generalisierter Livedo racemosa.

A 45-year-old male patient presented with cold-induced generalized livedo reticularis, repeated acral ulcerations and purpura, Raynaud's phenomenon, and peripheral polyneuropathy. The patient also experienced malaise, vertigo, and transient amaurosis whenever he was exposed to low temperatures. Skin biopsies of the livedo reticularis revealed marked dilatation of the small dermal blood vessels and circumscribed leukocytoclastic vasculitis. Essential cryofibrinogenaemia was diagnosed on the basis of detection of this cryoprotein in the chilled blood plasma with increased viscosity. Pulsed therapy with dexamethasone and cyclophosphamide resulted in marked relief of the symptoms, and cryofibrinogen was no longer detectable in the patient's plasma.