Pitfalls with anti-neutrophil cytoplasmic antibodies (ANCA).

A 39-year-old Ugandan student is described presenting with general malaise, fever and a pulmonary infiltrate. Open lung biopsy showing infarction and positive ANCA lead to a diagnosis of Wegener's granulomatosis and a treatment with immunosuppressive drugs was instituted. Five weeks after admission, however, sputum cultures turned out to be positive for Mycobacterium tuberculosis.

Tropical pyomyositis.

Two cases of "tropical" pyomyositis or bacterial abscess of striated muscle are presented. In the first patient, a Pakistani, computed tomography gave the clue to the diagnosis. The other patient never lived outside Belgium.

Emphysematous pyelonephritis.

A case of emphysematous pyelonephritis with gas formation extending into the renal vein is presented. Diagnostic procedures and aggressive surgical management are discussed.

Systemic mastocytosis, an unusual cause of osteoporosis.

A 45-year-old patient is described presenting with severe axial osteoporosis. The presence of maculopapular skin lesions and the combination of osteolytic and osteoblastic bone lesions led to the tentative diagnosis of systemic mastocytosis. This diagnosis was confirmed by measurement of urinary histamine metabolites and by bone biopsy showing increased numbers of mast cells and fibroblast-like cells.

Anteroseptal myocardial infarction complicated by right ventricular myocardial infarction.

A 73 year old man presented with an acute anteroseptal myocardial infarction. He became progressively hypotensive without signs of left heart decompensation or major rhythm disturbances. Swan-Ganz catheterisation revealed a pattern of right ventricular infarction and under appropriate treatment the patient recovered remarkably well.