West Nile virus in a patient with Good's syndrome.

We describe the association between thymoma and hypogammaglobulinemia (Good's Syndrome) and a fulminant, seronegative West Nile Virus neuroinvasive infection confirmed by nucleic acid amplification. Diagnostic difficulties are emphasized and historical minutiae are highlighted.

The nerve of legal entrapment.

Chordomas are a rare type of bone tumor that arises from the embryological remnant of the notochord. They originate at any point along the axial spine with the sacrum and the skull based region being the most commonly affected sites. Chordomas are slowly growing, indolent tumors, presenting insidiously, but also carry a high recurrence rate with a tendency to invade contiguous structure making their treatment challenging. The current standard of care for localized chordoma is aggressive cytoreductive surgery followed by high dose adjuvant radiotherapy. We present a unique case of a 72-year-old lawyer with a skull base chordoma invading into the hypoglossal canal and causing isolated hypoglossal nerve paralysis.

Multiple coronary aneurysms in a young adult with acquired immunodeficiency syndrome.

HIV infection can cause multiple deleterious effects on the cardiovascular system. Emerging evidence has supported a direct association between HIV infection and accelerated atherosclerosis. The mechanism for atherosclerosis in HIV-positive patients is multifactorial, an interplay between conventional risk factors, HIV itself and highly active antiretroviral therapy. The case described is a 29-year-old man with HIV, non-adherent to antiretroviral therapy and with few cardiovascular risk factors, who presented with chest pain and non-ST elevation myocardial infarction. Cardiac catheterization revealed multiple coronary artery aneurysms in the left main coronary artery and the right coronary artery. Aneurysmal formation may develop from vasculitis, HIV itself, accelerated atherosclerosis, congenital formation or medications (e.g. protease inhibitors). The researchers provide a review of coronary artery disease, aneurysmal formation and vasculitic processes in the context of HIV. As this clinical entity becomes more apparent, alternative therapeutic options may need to be explored.

Current Insights in Whipple's Disease.

Therapy for Whipple's disease should be continued for a minimum of 1 year, and the regimen should include an agent or agents that achieve acceptable concentrations in the central nervous system, given the likelihood of recurrence at this site. Clinical follow-up of proven cases of Whipple's disease should be conducted for a minimum of 10 years after discontinuation of therapy, given the potential for late relapses. Polymerase chain reaction analysis is preferred rather than endoscopy when evaluating for disease recurrence.