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Exertional heat stroke (EHS) is a medical emergency characterized by life-threatening hyperthermia and central nerve system dysfunction during or directly after exercise. Early recognition and aggressive cooling reduces morbidity and mortality of patients with EHS. Therefore, all health care professionals involved in acute care should immediately recognise EHS and start cooling with cold water immersion as soon as possible. Most EHS occur in young and healthy individuals without a medical history, such as athletes or soldiers. We report the case of EHS in a 26-year-old man without a medical history. He suffered from EHS during a military admission test. A few years later he had a second EHS during military training. This time, the EHS was complicated by compartment syndrome, rhabdomyolysis, acute kidney injury and epilepsy. He fully recovered from both EHS episodes. Muscle histology, whole exome sequencing and heat tolerance tests did not show any abnormalities.

Background: In view of the diminished number of CD4+ lymphocytes, the co-existence of an HIV infection and sarcoidosis seems paradoxical. Immune reconstitution inflammatory syndrome (IRIS) may be observed in response to anti-retroviral therapy (ART). According to the conventional definition, this is caused by an overwhelming immune response to an already present or to a new agent., Case Description: We describe the case of a 47-year-old HIV-positive patient, who presented with an exacerbation of his sarcoidosis nine months after initiation of ART. Based on the time course and the dynamics of the CD4+ lymphocyte count, this presentation of disease can be placed in the context of IRIS., Conclusion: The presentation or exacerbation of sarcoidosis after initiation of antiretroviral therapy in HIV-positive patients with a low CD4+ count at start of therapy can be placed in the context of IRIS.

Background: Bone resorption inhibitors such as denosumab may induce symptomatic hypocalcaemia if a vitamin D deficiency is present. Amongst other causes, this type of deficiency may arise following bariatric surgery., Case Description: We describe a 51-year-old woman who, a few years after undergoing bariatric surgery, developed symptomatic hypocalcaemia after she started taking denosumab., Conclusion: An adequate calcium and vitamin D status is a general condition before prescribing medication to treat osteoporosis. Therefore we recommend that before starting treatment with a bone resorption inhibitor that not only the calcium but also the vitamin D status should be determined, and if necessary, optimised.

Mesenteric panniculitis is a non-specific inflammation of the mesenteric adipose tissue, with varying degrees of fibrosis and fat necrosis. It can be associated with varying diseases and conditions, such as autoimmune disease and cancer. Many doctors are not familiar with this disease or do not know how to interpret the signs and symptoms. Here, we describe three patients illustrating the variety of clinical course, diagnostics, prognosis and treatment. A 44-year-old woman suffering from episodic abdominal pain was diagnosed with uncomplicated mesenteric panniculitis. The disease was stable while maintaining a conservative approach. In a 43-year-old woman, mesenteric panniculitis was complicated by autoimmune haemolytic anaemia. After treatment with corticosteroids, she made a full recovery from both disorders. Finally, a 73-year-old man was diagnosed with mesenteric panniculitis and auto-immune haemolytic anaemia, which both appeared to be consequences of an angioimmunoblastic T-cell lymphoma.