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A 38 year old Caucasian lady presented with a history of vague ill health, raised ESR and prolonged P-R interval on ECG. These features became normal within a week. Contrary to the usual presentation, this patient developed fleeting arthritis, one of the major diagnostic features of rheumatic fever, towards the end of her illness. It is important to recognise such variants of rheumatic fever, even in retrospect, for the sake of giving penicillin prophylaxis to prevent cardiac morbidity.

Recurrent pyogenic meningitis is uncommon. Its aetiology is often associated with impaired host defence mechanisms. Two such examples are discussed. Case 1 resulted from an anatomical defect and Case 2 a defect of the complement system.

A case of complete heart block is presented in a patient whose brothers were known to have ankylosing spondylitis. Uveitis and sacro-iliitis are well recognised among HLA-B27-positive siblings of ankylosing spondylitis. However, heart block is a rare occurrence as a sole presentation in siblings of patients with ankylosing spondylitis.

Cases of gastrointestinal bleeding associated with non-steroidal anti-inflammatory drugs (NSAIDs) were analysed. Forty per cent of the 92 cases admitted with gastrointestinal bleeding were found to be on NSAIDs. Sixty per cent of the cases on NSAIDs had a preceding history of dyspepsia or ulcer disease and its complications. Forty per cent presented with spontaneous bleeding. We discuss some of the aspects of the management of these cases in clinical practice.

A high index of suspicion is required to pick up cases of subdural empyema in clinical practice. CT scan may be normal in the initial stages. Early neurosurgical intervention is desirable to reduce mortality and morbidity in this condition.