[Unusual use of nutmeg]. / Een ongebruikelijke toepassing van nootmuskaat.

A 20-year-old woman with borderline personality disorder was referred to the emergency department by a psychiatric clinic. After taking 10 g of nutmeg she complained of stomach ache and dizziness. A physical examination showed mild hypothermia and sinus tachycardia. She was admitted for observation and discharged after 24 h to the psychiatric clinic without sequelae. Nutmeg is a spice. Relatively unknown are the hallucinogenic and euphoric effects for which it is used by drug abusers and students. Symptoms appear 6 h after ingestion of at least 10 g of nutmeg and are related to its effects on the central nervous system. Use of the drug can lead to anxiety and feelings of doom and even to psychosis. Dry mouth, nausea and dizziness may also occur. A physical examination may show hypothermia, tachycardia or hypertension or, in rarer cases, hypotension and shock. Symptoms disappear without sequelae after 24-48 h. Treatment consists of supportive measures. In the event of haemodynamic instability, cardiovascular monitoring is indicated.

[Acrodermatitis chronica atrophicans: late manifestation of Lyme borreliosis]. / Acrodermatitis chronica atrophicans: late manifestatie van lymeborreliose.

A 71-year-old man was referred to our outpatient clinic because of arthralgia and swelling of his right hand. He also showed a subcutaneous nodule on his left knee. A second patient, a 57-year-old woman, was referred because of painful skin of her legs. Dermatologic examination revealed erythematous livid discoloration on both feet and legs. There were reticular varices, corona flebectatia paraplantaris medialis and minimal pitting oedema. Serology tested positive in both patients for Borrelia and they both recalled tick bites. A third patient, a 73-year-old woman, was referred because of erythema and maculae located at her lower legs and positive Borrelia serology. Pathologic examination was typical for acrodermatitis chronica atrophicans, a late skin manifestation of Lyme borreliosis. In all patients, symptoms improved after treatment with doxycycline for four weeks. A lack of familiarity with this skin condition may lead to unnecessary vascular investigations and considerable delay in adequate treatment.