[Blood culture negative endocarditis: a diagnostic challenge]. / Endocardites a hémocultures négatives: un défi diagnostique.

Blood culture negative endocarditis (BCNE) account for about 5% of all cases of endocarditis. Diagnosis and initiation of antimicrobial therapy may be delayed, with a negative impact on clinical outcome. The most common cause of BCNE is antimicrobial drug therapy before blood sampling. Other common causes include slow growing and non cultivable organisms. Identification of the etiologic agent is critical in the management of BCNE and molecular tools such as broad range 16SrRNA PCR technique followed by direct automated sequencing and microorganism-specific PCR are promising. Some authors have proposed to include these techniques among major Duke's criteria for the diagnosis of BCNE.

[Pseudo-(venocuran-)lupus--a minor episode in the history of medicine]. / Pseudo-(Venocuran-)Lupus--eine kleine Episode Medizingeschichte.

Pseudolupus is a syndrome characterized by recurrent fever arthralgia, myalgia, involvement of lung and heart, high sedimentation rate, leukocytosis and lymphopenia. The diagnosis is established by the presence of circulating antimitochondrial antibodies. In 1975 it was found that the disease was due to prolonged treatment with Venocuran, a drug against venous disorders composed of phenopyrazone (pyrazolone derivative), horse-chestnut extract, and Miroton (glycosides extracted from white squill [Urginea maritima], convallaria, oleander and adonis). The drug was then withdrawn. No new cases have come to our attention since then. 15 patients with severe pseudolupus known to us in 1975 have now been followed up. In 6 of the patients all symptoms disappeared within weeks or a few months after withdrawal of the drug. However, the other 9 patients had at least 1 and often 2--3 relapses in the following months to years. In some patients, symptoms remained as long as 4--5 years. Antimitochondrial antibodies persisted in 4 patients for more than 3 years and in 1 patient are still detectable now. The pathomechanism of pseudolupus has not been elucidated.