Secondary syphilis: a rare cause of nephrotic syndrome.

A 59-year-old man with a history of type 2 diabetes and a left nephrectomy following trauma reported of malaise and weakness. He reported a penile ulcer 2 months earlier, but there had been no lymphadenopathy or fever. His speech was slurred, he was breathless on minimal exertion and there was ankle swelling. Twenty-four hours later he developed a generalised maculopapular rash. Laboratory investigation confirmed syphilis and nephrotic syndrome. He was treated with a single injection of benzylpenicillin following which there was a rapid and complete recovery. The temporal association and improvement with treatment suggest that syphilis caused his illness. The incidence of syphilis is increasing and doctors should remain alert to syphilis as a possible cause of the nephrotic syndrome.

Phenytoin-induced Lyell's syndrome.

Lyell's syndrome or toxic epidermal necrolysis (TEN) is a rare dermatological disease that causes serious morbidity and mortality. It is most commonly drug induced. The authors report the case of a 57-year-old woman who was admitted to our hospital with severe rash all over the body. She had been previously submitted to brain surgery for total resection of a large meningioma and medicated with phenytoin for seizures prophylaxis. During this treatment, erythematous lesions and blisters were observed first on her face and trunk and then spreading to the entire body. Detachment of the skin, as well as mucous involvement especially of mouth and conjunctiva, was also observed. TEN was diagnosed, and phenytoin was discontinued. Intravenous fluids, systemic steroids and tightened infection control measures were implemented. After 10 days, skin recovery and re-epithelialisation were established, temperature decreased and mucosal complications stabilised. The patient was discharged after 1 month of hospitalisation.

Caffeinated energy drink intoxication.

In recent years an increasing number of different energy drinks have been introduced to provide an energy boost. They contain high levels of caffeine and other additives that act as stimulants. Several recent studies present that energy drinks could increase the risk of seizures, acid-base disorders and cardiovascular events. The authors report a 28-year-old man who was brought to the emergency room after sudden onset of tonic-clonic seizures and metabolic acidosis after drinking several cans of a caffeinated energy drink. The authors believe that this clinical picture was caused by caffeine intoxication from an energetic drink causing a syndrome of catecholamine excess. The patient was discharged within a week with no complaints and no neurological signs. Finally, recognising the features of caffeine intoxication and its potential health consequences may be especially relevant when treating younger persons who may be more likely to consume energy drinks.