Legionella micdadei infection presenting as severe secretory diarrhea and a solitary pulmonary mass.

Sixty percent of infections with non-pneumophila species of Legionella are caused by Legionella micdadei. Although diarrhea is a common symptom of legionellosis, including that due to L. micdadei infection, severe, life-threatening diarrhea is rare. We describe a patient with profound secretory diarrhea (secretion rate, up to 8 L/day) that was secondary to culture-proven L. micdadei pneumonia. In addition, a 3-cm pulmonary nodule was detected, which completely resolved after proper treatment for Legionella infection. Resolving pulmonary nodules have been previously reported in association with treatment of L. micdadei infections.

Lung hernia as a sequela to limited-access mitral valve surgery.

We report a case of a 36-year-old man who developed a lung hernia after a minimally invasive mitral valve repair. Lung hernias are uncommon. Most are acquired and may be classified as traumatic, spontaneous, pathologic, or postoperative. In theory, minimal-access surgical techniques should decrease the likelihood of herniation, in comparison with open thoracotomy. Our review of the literature revealed only 2 reports of this sequela in association with this surgical procedure. Repair was performed due to persistent symptoms, including pleurisy and dyspnea, and interference with the patient's daily activities. Surgical repair led to complete resolution of these problems.

Corticosteroid responsive fludarabine pulmonary toxicity.

Fludarabine monophosphate is a purine nucleoside antimetabolite with efficacy in the treatment of lymphoproliferative disorders and chronic lymphocytic leukemia. It is the 2-fluoro, 5' phosphate derivative of 9-beta-D-arabinofuranosyl adenine (ara-A, vidarabine) and the mechanism of action is through inhibition of DNA synthesis and the cytolytic effects through the induction of endonuclease-independent apoptosis.

Fulminant ischaemic colitis with atypical clinical features complicating sickle cell disease.

Clinically significant ischaemic bowel injury is an exceedingly rare complication of sickle cell disease. It manifests as acute surgical abdomen and may respond to conservative treatment. An unusual fatal case of ischaemic colitis with minimal abdominal findings in a young male during a sickle cell vaso-occlusive pain crisis is described. This case demonstrates that an acute surgical abdomen should be considered in such patients who fail to respond to conservative management as untreated this condition may be fatal.

Legionnaire's disease associated with acute encephalitis and arrhythmia.

OBJECTIVE: To report an unusual, life-threatening combination of neurologic, cardiac, and gastrointestinal symptoms in the presence of a community-acquired pneumonia. DESIGN: Case report. SETTING: University hospital. PATIENT: Previously healthy young male. INTERVENTION: Diagnostic fiberoptic bronchoscopy, lumber puncture, magnetic resonance imaging of the brain, and institution of systemic antibiotics. MAIN RESULT: Gradual clinical improvement of a multiple-system illness. CONCLUSION: Legionellosis should be considered in the differential diagnosis of patients presenting with neurologic, cardiac, and gastrointestinal symptoms, particularly in the presence of radiographic pneumonia. Furthermore, Legionella meningoencephalitis may present with findings on magnetic resonance imaging previously thought to be characteristic of herpes encephalitis.