Common presentation: Rare disease: Adult Langerhans cell histiocytosis.

A 19-year-old boy presented with signs of a granulomatous lung disease. Sputum testing for tuberculosis was negative. After a year, he returned with generalised lymphadenopathy. Though a clinical diagnosis of tuberculosis was then made and treatment was commenced, a lymph node biopsy revealed Langerhans cell histiocytosis. We are not aware of any other such case described in the Pacific.

Simple leg ulcers: difficult diagnosis.

Chronic leg ulcers in children in tropical developing countries are common. They are difficult to diagnose clinically and to manage. Our case illustrates that even in areas where yaws is endemic and point of care testing is available, the diagnosis remains difficult.

Tropical leg ulcers in children: more than yaws.

The management of yaws has changed in recent years. Mass treatment with oral azithromycin has replaced intramuscular benzathine benzylpenicillin. Treponemal and non-treponemal serology (equivalent to TPHA and RPR) point-of-care blood testing is now available. In addition, recent studies in yaws endemic regions have shown that a significant number of leg ulcers in children which are clinically suggestive of yaws are caused by Haemophilus ducreyi. It is noteworthy that the World Health Organization has also set the ambitious goal to eliminate yaws by 2020.

SLE and dental erosion: a lethal cocktail.

A 13-year-old Pacific Island girl presented complaining of fever, joint pain and dry mouth. She was using limes to relieve her dry mouth. On examination, the most striking clinical finding was severe dental erosion and caries. Autoimmune serology confirmed a diagnosis of systemic lupus erythematosus (SLE) with possible Sjögren's syndrome. The case illustrates the devastating consequence of excessive consumption of acidic citrus juice in sicca syndrome.

The impact of housing first and peer support on people who are medically vulnerable and homeless.

OBJECTIVE: The purpose of this study was to assess the impact of a local initiative, Project H3, which used housing first, harm reduction, and peer support models to provide housing for 47 homeless people who were medically vulnerable. METHOD: Comparisons of interviews with participants who were housed at the day of their move-in, and 6-months and 12-months after their move-in, were conducted. RESULTS: Ninety-eight percent of the participants remained in housing after 12 months. Individuals who were housed reported significant increases in their access to and utilization of planned health care services and quality of life, and reductions in their involvement in the criminal justice system. CONCLUSION AND IMPLICATIONS FOR PRACTICE: Housing first, harm reduction, and peer support models demonstrate effectiveness in decreasing substance use and improving the quality of life of people who are homeless over time.

Resurgence of yaws in Tanna, Vanuatu: time for a new approach?

Recent reports from the island of Tanna in Vanuatu suggest that yaws has resurged. We carried out a serological and clinical survey to determine the prevalence and clinical presentation of yaws on the island. A total of 306 random serum samples were tested for rapid plasma reagin and rapid diagnostic determine syphilis: 31.04% were positive for one or both tests; 39.8% of children surveyed in three schools had skin lesions consistent with yaws; and there were only two cases of secondary yaws osteitis and no cases of tertiary yaws. These results confirm that the disease has resurged but appears to be attenuated. Intramuscular benzathine penicillin is the currently recommended treatment for yaws. We suggest that a stat dose of oral azithromycin would be a more accessible treatment as it could be prescribed by village health workers and therefore enable yaws control to be more easily incorporated into other primary health-care programmes.