Virilization associated with choriocarcinoma.

We demonstrate here two autopsy-proven cases of virilization associated with choriocarcinoma. The first patient was a 27-year-old woman with a 7-year history of metastatic choriocarcinoma who presented with left hemiparesis and virilization. Serum testosterone concentration was 18 nmol/l, free testosterone 471 pmol/l, dehydroepiandrosterone sulphate (DHEA-sulphate) 1.7 mumol/l, sex hormone binding globulin 12.3 nmol/l, estradiol (E2) 1,843 pmol/l, and hCG 1.6 x 10(5) IU/l. The second patient was a 21-year-old virilized woman with metastatic choriocarcinoma who presented in semicomatose state. Limited endocrine investigation revealed serum testosterone 27 nmol/l and hCG 2.7 x 10(5) IU/l. Both patients died despite chemotherapy and radiation therapy. Autopsy findings revealed choriocarcinoma with brain and multiple organ metastasis in both. Pathology of the ovaries of both patients demonstrated hyperplasia of luteinized theca cells and lutein cells. We postulate that an association of virilization and choriocarcinoma resulted from long-standing stimulation of ovary by hCG causing theca cell hyperplasia with subsequent hypertestosteronemia and virilization.

Eosinophilic myelomeningoencephalitis caused by Angiostrongylus cantonensis: a report of three cases.

Three members of a family developed eosinophilic myelomeningoencephalitis following ingestion of Pila snails. They were father, daughter and son and had similar clinical presentations. Two days after ingestion of snails, they developed a generalized itchy maculopapular rash followed by myalgia, marked paresthesia, fever and headache. Two days later there was weakness of the extremities which was progressive in severity involving the legs more than the arms. They later developed urine retention and cloudiness of consciousness. Two patients progressed to coma, one of whom died after 3 weeks and the other died at home 9 months after the onset. Autopsy of the fatal case revealed multiple tracks and cavities with the presence of Angiostrongylus cantonensis in the brain and various levels of the spinal cord.

Primary amoebic meningoencephalitis in Thailand: report of a case and review literatures.

Primary amoebic meningoencephalitis (PAM) which is caused by free-living amoeba, Naegleria fowleri, is a rare disease. We report the fifth case in Thailand in order to add more information. The patient was a previously healthy 4 1/2-year-old girl from Nakhon Pathom province. For several weeks before this illness she had swum in a water supply canal. She developed high fever with change in consciousness. Her cerebrospinal fluid contained numerous Naegleria fowleri which grew in culture media and mice inoculation. She did not respond to treatment with intravenous and intraventricular amphotericin B, and oral rifampicin. She died on the fifth day of illness. Water sample from the canal also grew N. fowleri. All five reported cases in Thailand were reviewed. It was found that none of them had been exposed to a common source. Four of the five cases were male, and four cases occurred during the summer months, March to May. These findings agree with worldwide information.

Neurological manifestations of gnathostomiasis.

Neurological features of 24 patients with nervous system gnathostomiasis were reviewed. The commonest presenting features were radiculomyelitis or radiculomyelitis terminating with encephalitis, and subarachnoid haemorrhage. A primary encephalitic form was noted in 2 patients. The salient feature of the disease was a sudden onset of extremely severe radicular pain and/or headache followed by paralysis of the extremities and/or the cranial nerves. Migration signs were also the hallmark of nervous system gnathostomiasis. No single area of the nervous system was inaccessible to the highly invasive gnathostome lava. Multiplicity and/or rapid progress of lesions beyond the degree of cerebral oedema could only be explained by further migration of the parasite. Death occurred in 6 patients from direct extensive involvement of vital centres in the brain stem or from complications such as pneumonia or septicaemia. Multiple cranial nerve palsies were usually bad prognostic signs.