Acute generalized exanthematous pustulosis with multiple organ dysfunction syndrome.

Acute generalized exanthematous pustulosis is a rare condition characterized by sterile pustules on erythematous and edematous tissue. Mostly drug induced, this condition can also be caused by other factors. Cases due to vancomycin are rare. A 67-year-old woman with cellulitis of the left lower extremity was admitted with marked bilateral lymphedema of the lower extremities and diffuse erythema of the left lower extremity from foot to knee. She was given clindamycin and then vancomycin. On day 5, her condition worsened, with erythema involving the entire back. Although treatment with clindamycin and vancomycin was discontinued, acute generalized exanthematous pustulosis developed. After successful treatment of other complications, the skin condition improved. Because vancomycin is frequently used, clinicians should be aware of the possibility of acute generalized exanthematous pustulosis. Because the pustulosis decreases after withdrawal of the causative drug, being able to diagnose and differentiate the abnormality from other conditions is prudent.

A rare presentation of a rare disease: pulmonary lymphomatoid granulomatosis.

A 70-year-old female presented with a 4-week history of dry cough and wheezing. Chest radiograph showed a 10.5 cm mass-like density in the anterior mediastinum which had not been previously visualized. Computed tomography scan (CT) of the chest showed a right hilar mass encasing and narrowing right upper lobe bronchus and right mainstem bronchus and secondary atelectatic changes. Biopsy was consistent with a diagnosis of lymphomatoid granulomatosis Grade 3. She responded well clinically and radiologically to therapy. Lymphomatoid granulomatosis is a rare EBV-associated disorder which is considered a lymphoproliferative disease. The most common radiographic feature is multiple lung nodules. An isolated hilar mass is an exceptionally rare presentation of this rare disease.

Emerging paradigms in the management of malignant pleural effusions.

Malignant pleural effusions (MPE) are a common clinical problem in patients with neoplastic disease. The development of MPEs in advanced malignancies can cause significant morbidity and mortality. Predominant symptoms of dyspnea, cough, and chest discomfort are usually debilitating. Given the poor prognosis of majority of these patients, palliation is more desirable than cure of an individual complication. Despite multiple new therapies placement of chest tube with sclerotherapy remains the standard of care. The purpose of this article is to review the emerging therapeutic options for MPE management.