Primary meningococcal arthritis: case report and review of the literature.

Meningococcal arthritis is a recognized manifestation of Neisseria meningitidis infection, the presentation of which may be confusing. Although arthritis occurs in the setting of meningococcal meningitis, it may also be seen as a primary event without neurological involvement and with or without cutaneous manifestations. We describe a patient with primary meningococcal arthritis and review the literature relating to the clinical types and pathogenic mechanisms. Comparisons of patient series from 1980 to the present with those reported before 1980 are described.

Low-dose methotrexate as a risk factor for Pneumocystis carinii pneumonia.

Low-dose methotrexate is a commonly prescribed medication for the treatment of rheumatoid arthritis and other rheumatic diseases. Its effectiveness in ameliorating the clinical symptoms and findings has been well established, and adverse effects have been relatively infrequent, particularly compared to other immunosuppressive agents. Pneumocystis carinii pneumonia is most often seen in severely immunosuppressed patients related to the acquired immunodeficiency syndrome or treatment of malignancies with potent cytotoxic agents. However, P. carinii pneumonia can occur in patients receiving low-dose methotrexate concurrent with corticosteroids, nonsteroidal anti-inflammatory drugs, renal impairment, or a combination of factors. We report 1 patient and review 10 additional cases that support this relationship.

Left-sided pleural effusion secondary to splenic vein thrombosis. A previously unrecognized relationship.

The association of left-sided pleural effusion and subcapsular splenic hematoma was reported in 1980. We describe a patient in whom a left-sided pleural effusion resulted from splenic vein thrombosis, a relationship not previously reported. Splenectomy was performed, demonstrating the spleen to be enlarged and hemorrhagic. The pleural effusion did not recur after splenectomy. The three effusions due to splenic hematomas reported previously cleared only after splenectomy, suggesting splenectomy may be necessary to prevent reaccumulation. We propose possible pathophysiologic mechanisms and recommend that splenic vein thrombosis be considered in the differential diagnosis of unexplained left-sided pleural effusions.

Eosinophilia-myalgia syndrome. Recognition of a distinct clinicopathologic entity.

The eosinophilia-myalgia syndrome is a newly described disorder related to the ingestion of L-tryptophan-containing products. Its presentation may mimic other disorders characterized by eosinophilia and muscle pain and/or weakness, but can be differentiated by certain characteristic laboratory and pathologic findings. We report two such cases, describe their features, and review similar syndromes.

Acute nonlymphocytic leukemia following short-term, intermittent, intravenous cyclophosphamide treatment of lupus nephritis.

Intermittent intravenous cyclophosphamide therapy has been shown to be effective in the management of lupus nephritis. There have been no reports of malignancies associated with such treatment regimens. We describe a patient who developed acute nonlymphocytic leukemia after receiving a total dose of 4 gm of cyclophosphamide over a 1-year period.

Latrodectism--effects of the black widow spider bite.

Latrodectism-envenomation by the black widow spider, Latrodectus mactans-has been reported in virtually every state. The spider is particularly prevalent in the Southwest, Southeast and California, and symptoms from its bite are painful and may be confusing to clinicians. Prompt improvement can be expected in most cases with administration of calcium and muscle relaxant, but some patients may require treatment with antivenin. No deaths occurred in our series of 11 patients, although one case was complicated by serum sickness.

Complications of chrysotherapy: a review of recent studies.

Chrysotherapy has become a cornerstone in the treatment program of patients with rheumatoid arthritis. Unfortunately, approximately one third of these individuals will experience an adverse drug reaction at some time. Cutaneous manifestations are most commonly recognized and do not necessarily preclude reinstitution of gold after their resolution. Other complications involving the hematopoietic and renal systems are less frequent but may be severe. Recently, investigators have described serious toxic reactions involving the liver and lungs. The pathophysiologic mechanism of these untoward effects appears to be immunologic, although there are conflicting data. Treatment is primarily supportive, and the role of corticosteroids and chelating agents remains controversial. Emphasis should be placed primarily on early detection of adverse reactions through patient education and careful monitoring of blood and urine values.

Nonlethal mushroom poisoning.

The harvesting and consumption of wild mushrooms has become a popular pastime in many areas of the United States. Reports of mushroom poisonings and fatalities have been increasing since 1964. Between May 1973 and April 1978, 16 cases of mushroom poisoning were treated at our institution, including 13 within a 12-month period ending April 1978. All patients exhibited either gastrointestinal or neurologic symptoms, which responded to supportive therapy. There were no fatalities. In most cases, the clinical course can be predicted and appropriate therapy instituted if the mushroom is identified or if the interval between the ingestion and the onset of symptoms can be ascertained and certain characteristic symptoms are observed.