Acute suppurative thyroiditis (AST) is a rare inflammatorycomplication in patients with hematological malignancy.Infection spreads to the thyroid from a distant site throughthe bloodstream or the lymphatics. Defects such as persistentthyroglossal duct and pyriform sinus fistula are associatedwith the development of AST. Ultrasonography, bariumswallow testing, CT, and fine-needle aspiration are usedfor diagnosis. Treatment includes the administration ofparenteral antibiotics, drainage, and excision. We describea patient with aplastic anemia and bacteremic AST.[Infect Med. 2008;25:339-342]

A 45-year-old Hispanic man who acquired HIV infection in April 2003 presented with a 24-hour history of worsening right lower quadrant pain accompanied by fever, decreased appetite, nausea, and vomiting. The pain was described as sharp, constant, and nonradiating. He denied any accompanying diarrhea, constipation, urinary frequency, dysuria, dyspepsia, reflux symptoms, or previous episodes of abdominal pain. There was no history of recent travel. His current CD4+ cell count was 239/?L. In May 2003, he had a CD4+ cell count nadir of 133/?L. His HIV RNA level has remained undetectable at less than 50 copies/mL since starting firstline antiretroviral therapy in June 2003. Therapy consists of coformulated zidovudine/lamivudine/abacavir and efavirenz. He has never had opportunistic infections or other major medical illnesses.

Drug-induced aseptic meningitis should be included in thedifferential diagnosis of viral/aseptic meningitis. Cliniciansshould use historical clues in patients presenting with signs andsymptoms of viral meningitis to aid in the differentiation ofdrug-induced aseptic meningitis from other causes of asepticmeningitis. Viruses are the most common cause of asepticmeningitis, with enteroviruses being the most common amongviruses in cases presenting as aseptic meningitis. Ibuprofen iscurrently the most common cause of drug-induced asepticmeningitis. Drug-induced aseptic meningitis is a benign conditionwithout long-term sequelae. The diagnosis of druginducedaseptic meningitis is made by establishing a causalrelationship between the use of the drug and the onset of signsand symptoms, supported by negative tests for infectiouscauses of symptoms and rapidity of resolution after the drugis discontinued. [Infect Med. 2008;25:331-334]

Over the past 2 decades, there has been an alarming increase in opportunistic fungal infections with an associated rise in morbidity and mortality. This trend has been attributed to the growing number of patients who are immunocompromised because of bone marrow or solid organ transplant, immunosuppressive drugs, AIDS, and hematological malignancies. Advances in trauma and critical care medicine that lead to longer survival of more patients with immunocompromising conditions also play a role.

Since the licensure of the heptavalent pneumococcalconjugate vaccine (PCV7) in 2000, the prevalence ofinvasive pneumococcal disease (IPD) among childrenin the United States has decreased significantly. Theincidence of IPD caused by pneumococcal serotypes associatedwith PCV7 among children younger than 5 yearsdecreased from 80 cases per 100,000 population in 1998 to1999 to 4.6 cases per 100,000 population in 2003.1 Variousstudies have demonstrated that nasopharyngeal colonizationwith pneumococcal serotypes covered by thevaccine also has decreased. However, several studies suggestthat in some settings, these bacterial populationshave been replaced with Streptococcus pneumoniae serotypesnot covered by the vaccine.2,3

Kawasaki syndrome (KS) is a common and serious disorderthat most often affects children aged 1 to 8 years but mimicsa range of other diseases of childhood. Diagnosis of KS isbased on physical examination findings coupled with theexclusion of other causes. To provide optimal care for patients,it is important to be aware of the differential diagnosis of KS.We report a case of a 4-year-old boy who presented withpersistent fever and cervical lymphadenitis; later, mucousmembrane changes, rash, and conjunctival injectioncharacteristic of KS developed. [Infect Med. 2008;25:320-322]

The CDC's Advisory Committee on Immunization Practices (ACIP) recommends that all persons older than 60 years be immunized against the varicella-zoster virus that causes herpes zoster with a single dose of the live, attenuated virus vaccine Zostavax (Merck & Co, Inc, Whitehouse Station, NJ). Furthermore, it urges clinicians to offer the vaccine on the first available clinical encounter.

We present a case of a 20-year oldman with massive hemoptysisresulting from pulmonarysequestration that involved 2lobes (the right lower and middlelobes). Preoperative embolizationand subsequent surgicalbilobectomy were performed.Although the patienthad a difficult and prolongedpostoperative course, he eventuallyhad a full recovery.

We present a rare case ofCushing syndrome resultingfrom thymic carcinoid of thelung. Although Cushing syndromeis not usually associatedwith respiratory muscleweakness or restriction, ourpatient had reduced lung volumesand expiratory muscleweakness. His reduced lungvolumes could not be completelyexplained by respiratorymuscle weakness, parenchymallung disease, or obesity.Six months after removal ofthe carcinoid tumor, the patient'sgrowth hormone leveland the lung volumes improvedsignificantly, and hebecame asymptomatic.

ABSTRACT: Although the organisms that cause community-acquiredpneumonia are similar in diabetic and nondiabetic patients,those who have diabetes mellitus (DM) may have moresevere disease and a poorer prognosis. Elevated blood glucoselevels are associated with worse outcomes in patients withpneumonia, and the mortality risk may be as high as 30% in patientswith uncontrolled DM. Thus, appropriate treatment-and possibly prevention-of bacterial pneumonia should includeaggressive efforts directed at glycemic control. Other respiratoryinfections, such as influenza, tuberculosis, and fungalpneumonia, also are associated with greater morbidity in patientswith DM. Diabetic patients with tuberculosis are morelikely to present with bilateral lung involvement and pleural effusions.(J Respir Dis. 2008;29(7):285-293)

ABSTRACT: Pulmonary manifestations, such as pleural effusions,interstitial lung disease (ILD), and rheumatoid nodules, arecommon in patients with rheumatoid arthritis (RA). For thosewith pleural effusions, diagnostic thoracentesis is usually necessaryto rule out other causes. Larger effusions that cause dyspneamay require therapeutic thoracentesis or other interventions.The presentation of ILD is characterized by graduallyprogressive dyspnea on exertion and cough. An isolated decrementin carbon monoxide–diffusing capacity is often the earliestabnormality seen on pulmonary function testing. HighresolutionCT is an important tool for detecting ILD; commonfindings include ground-glass opacities and reticulation. It isimportant to keep in mind that in RA-associated ILD, morethan one pathological process-often several-may be seen inthe same patient. (J Respir Dis. 2008;29(7):274-280)

de Jong YP, Uil SM, Grotjohan HP, et al, Isala Klinieken, Zwolle, and University Medical Center Gronigen, the Netherlands. Oral or IV prednisolone in the treatment of COPD exacerbations. A randomized, controlled, double- blind study. Chest. Dec 2007;132:1741-1747.

Since the introduction of highly active antiretroviral therapy in the mid-1990s, antiretroviral therapy (ART) options have expanded considerably to include simpler, safer, and more tolerable regimens.

Aspergillus species are ubiquitous molds to which humans are commonly exposed. Of approximately 180 species, it is estimated that 34 are medically significant. Most persons who come in contact with the fungus remain asymptomatic.

Symptomatic primary HIV infection occurs in an estimated 50% to 90% of patients. A constellation of symptoms that most closely resembles those of acute infectious mononucleosis characterizes the syndrome.

In the preface to the third edition of this comprehensive reference on AIDS therapy, the editors proclaim that their book is a “one-stop resource for busy clinicians in busy practice settings.” And this textbook serves that purpose well. But first, you will need to lift it. This hardcover edition weighs in at a hefty 7 pounds!

Kaposi sarcoma (KS), AIDS-related non-Hodgkin lymphoma (AIDS-NHL), and anal squamous cell carcinoma/anal intraepithelial neoplasia (SCC/AIN) are malignancies that commonly involve the GI tract in patients who have HIV/AIDS.1 Oncogenic viruses have been implicated in the etiology of each of these neoplasms-specifically, human herpes virus 8 (HHV8) in KS, Epstein-Barr virus (EBV) in AIDS-NHL, and human papillomavirus in SCC/AIN.

A 23-year-old man's right chest shows a common congenital muscle anomaly-partial absence of the pectoralis major muscle. The abnormality was noted during a routine preemployment physical examination. The clavicular origin seemed to be intact. There was no apparent decrease in shoulder internal rotation or adduction strength, and the patient had not noticed any shoulder weakness or limitation in motion.

When diagnosing vitamin B12 deficiency, we routinely include a measurement of the methylmalonic acid (MMA) level in all patients whose B12 values are under 400 pg/mL. An elevated MMA level confirms B12 deficiency.

A patient of mine recently had an extensive allergy workup after a rash developed, apparently following exposure to wheat products.