Concurrence of sarcoidosis and systemic lupus erythematosus in three patients.

We present three cases of patients with systemic lupus erythematosus and sarcoidosis. Although both of these conditions are thought to involve autoimmune mechanisms they occur together only rarely. Our cases suggest that their concurrence may be more common than previously thought, and raise issues regarding the management of patients with SLE. We discuss the possibility that these two diseases are either causally or mechanistically related.

Cutaneous larva migrans: clinical features and management of 44 cases presenting in the returning traveller.

BACKGROUND: Cutaneous larva migrans (CLM) is the result of a nematode infection, and shows a characteristic creeping eruption. As travel to the tropics increases, many British citizens may be returning with this infection, which is often misdiagnosed or treated incorrectly. OBJECTIVES: To perform a retrospective survey of 44 cases of CLM presenting to the Hospital for Tropical Diseases in London over the last 2 years. METHODS: Cases were reviewed with regard to patient characteristics, source of infection, source of referral, clinical features and therapy. RESULTS: Most infections were acquired in Africa (32%), the Caribbean (30%) and South-east Asia (25%), but also in Central and South America. There was a history of exposure to a beach in 95% of patients and the median duration of symptoms was 8 weeks (range 1-104). Lesions mainly affected the feet (39%), buttocks (18%) and abdomen (16%), but the lower leg, arm and face were also affected. Multiple lesions were seen in seven of 44 cases (16%). Laboratory abnormalities were absent in all patients. Of 44 patients seen, four needed no treatment, 28 were cured by a single course of treatment, 11 required a second course of therapy and one patient was treated three times. Thirty-one patients received oral albendazole 400 mg daily for 3-5 days and 24 were cured (77%). Five patients received 10% thiabendazole cream topically for 10 days and four were cured (80%). Four patients received oral thiabendazole 1.5 g daily for 3 days and all required further therapy. CONCLUSIONS: In view of the range of treatment regimens recorded, a randomized controlled trial comparing topical and systemic therapies is warranted.

Production of a species specific monoclonal antibody against a 56-kDa Mycobacterium marinum antigen which is potentially useful in culture identification.

A monoclonal antibody (MoAb) designated 1H11 has been produced against a 56-kDa antigen from Mycobacterium marinum. This MoAb has been shown to be species specific by both enzyme-linked immunosorbent assay and Western blot. The relationship of this 56 kDa to other known mycobacterial antigens is currently under investigation. MoAb 1H11 recognised bacilli taken from cultures by both immunofluorescence and immunoperoxidase staining. This MoAb 1H11 may provide a simple method for rapid identification of M. marinum from cultures of clinical isolates.

Cutaneous hyalohyphomycosis caused by Paecilomyces lilacinus in a renal transplant patient.

We describe a renal transplant recipient with cutaneous hyalohyphomycosis due to Paecilomyces lilacinus and highlight the increasing importance of such opportunistic fungal infections in immunosuppressed patients.

Analysis by enzyme-linked immunosorbent assay and immunoblot of the antibody responses of patients infected with Mycobacterium marinum.

The serum antibody responses of a total of 14 patients with active or recently cured Mycobacterium marinum infections were analysed via a combination of enzyme-linked immunosorbent assay (ELISA) and the immunodevelopment of Western blots of M. marinum antigen. Normal human sera and sera from patients with active pulmonary tuberculosis were also analysed as controls. The detectable IgG response of M. marinum patients, as demonstrated by ELISA, was highly variable and did not differ significantly from normal controls. IgA and IgM levels were generally low in the M. marinum patients and were not significantly different from normal controls. Immunodevelopment of Western blots of M. marinum antigen with the sera of patients with M. marinum infections revealed that a number of antigens were recognised. Of particular note was an 18-kDa species that was recognised by 11 out of 14 patients (and by none of the normal controls). The 18-kDa antigen may be a useful serodiagnostic marker in the identification of M. marinum infections.

Mycobacterium marinum infections.

Mycobacterium marinum is a saprophytic mycobacteria capable of causing soft tissue infection in humans, usually acquired by inoculation. As with other mycobacterial infections, diagnosis may be difficult and recent developments in molecular biology are also being applied to atypical mycobacteria such as Mycobacterium marinum.

Hydroa vacciniforme presenting in an adult successfully treated with cyclosporin A.

Hydroa vacciniforme (HV) is a rare photodermatosis first described by Bazin in the mid-nineteenth century. It typically presents in childhood and resolves during adolescence. Rarely, however, symptoms may persist into adult life.2,3 We now describe a patient with this condition presenting unusually for the first time at the age of 58 years and responding to treatment with cyclosporin A.

Neutral red release from pre-loaded cells as an in vitro approach to testing for eye irritancy potential.

Many potential alternatives to the Draize eye irritation test are general cytotoxicity tests, which require modification if they are to become relevant components of an acceptable battery of tests. Preliminary studies were made on the exposure of fibroblast-like cells, pre-loaded with a vital dye (neutral red), to high concentrations of test materials for brief periods. Measurement of loss of neutral red from damaged cells provides a readily quantifiable endpoint. When the results obtained with eight detergent formulations were compared with maximum Draize eye scores, a better correlation was obtained with conjunctival and iris effects than with corneal scores or average Draize scores.

Medical reliability of advanced prehospital cardiac life support.

Records of 263 consecutive patients receiving prehospital advanced cardiac life support for dysrhythmias associated with clinical cardiac arrest were reviewed to determine 1) accuracy of diagnosis of presenting rhythm by the paramedic in the field and the medical control physician at the telemetry base station; and 2) whether the treatment rendered was appropriate. The initial rhythm was misinterpreted by the paramedic in 41 patients (16%) and by the medical control physician in 22 patients (11%). In 16 patients (8%) both paramedic and physician misinterpreted the initial rhythm. Treatment errors occurred in 120 patients (46%). Forty-seven errors (18%) resulted from failure to establish an intravenous line, 17 (6%) resulted from failure to secure a controlled airway, and 38 (14%) were medication errors from failure to adhere to protocol. We conclude that errors in management of prehospital cardiac arrest victims in our emergency medical services system result most often from mistakes in specific therapy rather than from failure to identify the precipitating dysrhythmia.