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AIM: A case of B cell lymphoma mimicking temporal arteritis. PRESENTATION OF CASE: A 64-year-old female, was admitted for fever, persistent headache and vision disturbances, elevated ESR and CRP 15 days ago. Lymphadenopathy was not detectable. Uppon admission, a Rheumatologic, ocular and neurologic consultation was perfomed, after a negative CT brain scan. Steroids were started and patient improved. An increased LDH was found, followed by investigation to rule out lymphoma. Chest-x-ray revealed bilateral pulmonary infiltrations. No bacterial, viral, mycobacterial infection were established. A temporal artery and bone marrow biopsy, were negative. A CT scan revealed bilateral infiltrations, interstitial pneumonitis, bilaterally increased kidneys and lesions at her spleen. A kidney biopsy was suggested, but patient denied. Another CT scan, showed resolution of pulmonary infiltrates and lesions of the spleen while been treated with prednisone. Patient had dyspnoea and respiratory failure. Spiral CT ruled out pulmonary embolism. Heart ultrasound showed pulmonary hypertension. Patient reinformed about the urgency, and had a CT guided renal biopsy. A PET-CT scan was positive for hypermetabolic lesions in kidneys, left adrenal gland, retroperitoneal lymph nodes and in the sella turcica involving the optic chiasm, (finding which explains our case).Finally, renal biopsy established Large B cell lymphoma. Patient transferred to division of hematology for chemotherapy. CONCLUSION. The illustration of this case was lymphoma masking temporal arteritis (fever, headache, loss of vision). Patient had an illness with elevated LDH, pulmonary infiltrates, hypodense lesions of the spleen and renal lesions. Differential diagnosis is broad, but, taken together, findings were most suggestive of lymphoma. [ABSTRACT FROM AUTHOR]

AIM: To report a rare form of gastritis that results from infection of the stomach wall by gas-forming organisms, emphysematous gastritis. CASE REPORT: Α 98-year-old man with a past history of diabetes presented with two days of vomiting. He had no fever. Clinical examination revealed tachycardia, crackles at lung auscultation, slight epigastric tenderness. Laboratory data : acute renal failure Cr:2.6 mg/dl, glucose:457, rhabdomyolysis, high CRP (135 mg/dl), SaO2 94% . RESULTS: An emergency endoscopy of stomach revealed thick-wall stomach with white plaques and blue coloured areas. A CT scan of chest and abdomen demonstrated gas within oesophagus wall, stomach wall, portal vein and infl iltrations in the left lung. An imaging diagnosis of emphysematous gastritis was made. Blood cultures turned up positive for Proteus mirabilis. Patient was started on empiric antibiotic treatment with metronidazole, meropenem, clindamycin, linezolide and fl uconazole. At the 2nd day linezolide was switched to tigecycline due to thrombocytopenia because of sepsis. Patient expired on the 4th day of hospitalization despite broad spectrum antibiotic treatment from septic shock. CONCLUSIONS: Immunocompromised individuals, alcohol abusers and diabetes, ingestion of corrosive substances predispose to emphysematous gastritis. Mortality is approximately 50%. Most common organisms are: Streptococci, Staphylococcus aureus, Escherichia coli, Enterobacter, Pseudomonas, Clostridium perfringens. Diagnosis rests on radiological demonstration of gas within the stomach wall. Only by prompt diagnosis and treatment with broad spectrum antibiotics can mortality be avoided. Surgery is reserved for those patients with perforation or gastric strictures. [ABSTRACT FROM AUTHOR]

AIM: The importance of high clinical suspicion for brucellosis in patients with fever of unknown origin, possible contact with Brucella or living in endemic areas. MATERIALS AND METHODS: A 55-year-old woman, farmer, was admitted because for fever up to 40 C from 40 days, myalgias, arthralgias and low back pain. She had been admitted previously in another lockal hospital and the whole workup came up negative for Brucella (Brucella agglutination test, wright, wright Coombs). CT scan of the lumbar spine was also negative. Patient was treated with quinolone with no improvement. Physical exam: hepatic enlargement, lumbar spine tenderness to palpation. Laboratory data: immunologic tests, tumor markers, Brucella agglutination test negative, elevated C reactive protein (CRP) (89.95 mg/dl), elevated ESR . RESULTS: Patient underwent a full workup for fever of unknown origin. After blood cultures, she was started on doxycycline and gentamycin with a high clinical suspicion for Brucella, but fever continued up to 8h day of hospitalization. Laboratory personnel was alerted to hold blood cultures more than 21 days and take precautions to avoid infection. Finally 4 sets of blood-culture bottles turned positive for Brucella melitensis. Rifampin was added. The patient became afebrile with normalization of infl ammation markers. MRI of lumbar spine revealed spondylodiskitis of L4-L5. A transthoracic echocardiogram to excluded endocarditis did not show any vegetations. Gentamycin was kept for 20 days, and patient continued on doxycycline, rifampin and cotrimoxazole for bone involvement, for 4 months. Patient is still on treatment, asymptomatic. A recent MRI of the lumbar spine, after 4 months, showed improvement. CONCLUSIONS: Negative Brucella agglutination test must not be exclusive for brucellosis if there is a high clinical suspicion. Laboratory personnel must be informed for keeping blood cultures for at least 4 weeks. [ABSTRACT FROM AUTHOR]

AIM: A case of Burkitt lymphoma sited only in bones, presented as fuo. METHODS: A 54 year old male, with a history of small intestine adenocarcinoma (fully treated 5 years ago) and a stent placement of aortic aneurysm was admitted for a 20days fever, malaise, fatigue. Patient was consuming unpasteurized cheese and had recently travelled to Russia. RESULTS: On admission WBCs, ESR and CRP were increased. Physical had no abnormalities. A (full investigation) was followed with blood cultures and whole body CT scan revealed two osteolytic bone lesions of the lumbar. Patient received empirical antibiotic course for contamination of the aortic stent and brucellosis. Blood cultures, Wright test and bone scan with Tc were negative. Bone-marrow aspiration was negative for hematologic disorder and cultures were negative. Patient continued having fever, despite antibiotic course after ten days and developed lethargy, nausea, vomiting and constipation. Elevated calcium was detected. Endoscopies and TEE were negative. MRI of the lumbar region revealed more lesions. A PET/CT revealed multiple bone lesions consistent with malignancy. A bone biopsy was finally done and revealed a Burkitt lymphoma. Patient was transferred to the Division of Hematology and started on chemotherapy. DISCUSSION: Burkitt lymphoma sited only in bone is extremely rare and the only way to differentiate it from other diagnoses is the characteristic pattern in PET/CT scan and biopsy of the lesions. [ABSTRACT FROM AUTHOR]