'A kiss that took my legs away': a rare presentation of Epstein-Barr virus in the older population.

We present the case of a 70-year-old woman presenting with nausea, diarrhoea and a generalised rash. Initial blood tests revealed obstructive deranged liver function tests and low haemoglobin. A haemolysis screen revealed raised reticulocytes, low haptoglobin and a positive direct antiglobulin test.

Inflammatory appearance of the parietal pleura at thoracoscopy - What does it hide?

Background: Medical thoracoscopy (MT) is a well-established diagnostic procedure in cases of unexplained exudative pleural effusions. Despite the advantages of MT, challenges remain since occasionally malignancies mimic pleural inflammation.

Objectives: To assess the relationship between the macroscopic appearance of the pleura at MT, the histology of the pleural biopsy and the final diagnosis after follow up.

Lessons of the month 1: Mesenteric ischaemia secondary to infective endocarditis.

A 60-year-old woman presented with sudden-onset epigastric pain, vomiting and small volume rectal bleeding. She had a history of mechanical mitral valve replacement, for which she was on warfarin. Computed tomography (CT) angiography of the abdomen showed gallstones, a fluid-filled stomach and faecal loading.

Pneumomediastinum in COVID-19: a phenotype of severe COVID-19 pneumonitis? The results of the UK POETIC survey.

Background: There is an emerging understanding that coronavirus disease 2019 (COVID-19) is associated with increased incidence of pneumomediastinum (PTM). We aimed to determine its incidence among patients hospitalised with COVID-19 in the UK and describe factors associated with outcome.

Methods: A structured survey of PTM and its incidence was conducted from September 2020 to February 2021.

Characterization of Chronic Obstructive Pulmonary Disease Patients with a Long Length of Stay: A Retrospective Observational Cohort Study.

Objectives: Chronic obstructive pulmonary disease (COPD) exacerbation is one of the most common reasons for hospital admission. Patients with COPD with a long length of stay (LoS) occupy a disproportionately high fraction of hospital bed-days. The objective of this study was to identify associations of long LoS in patients admitted with COPD exacerbation.

Bochdalek hernia causing type II respiratory failure in an elderly patient.

Bochdalek hernias occur as a result of a congenital defect in the diaphragm enabling abdominal viscera to enter the thoracic cavity restricting lung expansion and ventilation. Bochdalek hernias, in the majority of cases, present in neonates and very rarely in adults. To the best of our knowledge, there are only four published cases of Bochdalek hernia in the adult population causing respiratory failure.

Nitrofurantoin-induced lung disease and prophylaxis of urinary tract infections.

Nitrofurantoin is commonly used for the treatment and prophylaxis of recurrent urinary tract infections (UTIs). Although relatively rare, nitrofurantoin is one of the commonest causes of drug-induced pulmonary disease, which can be potentially serious and even fatal. Knowledge of such potential adverse effects is essential to enable early recognition and withdrawal of the drug.

Lung cancer mimicking massive pulmonary embolism.

Pulmonary embolism (PE) is a common finding in patients with underlying malignancy and is the commonest cause of acute cor pulmonale. A 65-year-old woman with a background of non-small-cell lung cancer presented to the emergency department with nausea and vomiting after starting erlotinib; she was pyrexial and had raised C-reactive protein. Despite aggressive fluid resuscitation and antibiotics the patient remained tachycardic, hypotensive, profoundly hypoxic and had a persistent raised jugular venous pulse.

Severe asthma with fungal sensitization: a case report and review of literature.

There is a substantial body of evidence supporting an association between asthma severity and fungal exposure and sensitization. Fungal allergens are a recognized risk factor for severe asthma. We describe the case of a 44-year-old asthmatic whose asthma control deteriorated after moving to a new flat with walls covered in mould.

The use of ultrasonography in the diagnosis of ectopic pregnancy: a case report and review of the literature.

Ectopic pregnancy is still the most common cause of maternal deaths in the first trimester. Here we report a case of a 29-year-old pregnant woman who presented with a 2-week history of lower abdominal pain and vaginal bleeding. She was initially diagnosed as having had a complete miscarriage.