CHONDROMALACIA OF THE PATELLA: AN UNUSUAL PRESENTATION

A 38–year–old male with a 10–year historyof recurrent ruptured popliteal cyst at the right knee was diagnosedat arthroscopy to have chondromalacia patellae. After shavingof the affected area he had no further symptoms on follow–up18 months later.     

A RISE IN THE GLOMERULAR FILTRATION RATE AS THE CAUSE OF A'PARADOXICAL'INCREASE IN URINARY FREE CORTISOL DURING DEXAMETHASONE SUPPRESSION IN A PATIENT WITH AN ADRENAL ADENOMA: A CASE REPORT

A 57-year-old woman who presented with depression and hypertension for which she had received anti hypertensive therapy including diuretics was found to have Cushingoid features. All medication was stopped and subsequent investigation demonstrated markedly elevated urinary free cortisol (UFC) levels. An increase in UFC occurred in response to the low dose dexamethasone suppression test and a further increase was noted during the high dose test. Plasma cortisol levels did not change significantly. Detailed examination of the data revealed that over the 6-day testing period the plasma creatinine had fallen from 1·4 mg/dl to 0·7 mg/dl while the creatinine clearance had doubled—presumably due to withdrawal of the diuretic. When the UFC was expressed per 100 ml of plasma filtered, there was no difference between any of the daily excretions. We conclude that a concurrent increase in glomerular filtration rate is one mechanism by which a'paradoxical'increase in UFC in response to dexamethasone suppression may occur.     

RELAPSING POLYCHONDRITIS: AN UNUSUAL CAUSE OF PUO IN AN ASIAN LADY

A case of pyrexia of unknown origin (PUO) in a 54-year-old Asianlady is described. She subsequently developed ocular and auralinflammation suggestive of relapsing polychondritis (RP) withimmediate clinical improvement following steroid therapy. PUOis an unusual presenting feature of RP. The literature is reviewedand the clinical features of RP are discussed KEY WORDS: Pyrexia of unknown origin (PUO), Scleritis, Auricular chondritis.     

A FATAL CASE OF LEGIONNAIRES' DISEASE IN AN IMMUNOCOMPROMISED PATIENT

A 65-year-old woman presented with an autoimmune hemolytic anemia and was subsequently diagnosed as having malignant lymphoma. Cytotoxic chemotherapy was followed by the development of fatal Legionnaires' disease, confirmed by isolation of L. pneumophila serogroup 6 from pleural and lung aspirate specimens. This is believed to be the first reported isolation of serogroup 6 L. pneumophila in Australia. (Aust NZ J Med 1984; 14: 59–60.)     

ILEITIS AS A MAIN RECURRENT LESION IN A PATIENT WITH ULCERATIVE COLITIS: REPORT OF A CASE

We report a case of ulcerative colitis complicating ileitis that endoscopically and histologically resembled a colonic lesion. Eight years prior to the time of writing, the patient had undergone proctosigmoidectomy and ileocecal resection because of severe hemorrhagic lesions of ulcerative colitis. A month prior to the time of writing, bleeding from the stoma occurred. Endoscopy revealed erosions on easy‐bleeding mucosa in the ileum but no active inflammatory lesions in colonic mucosa except for small erosions in the descending colon beneath the stoma. Histologic findings of biopsy specimens from the ileal mucosa showed marked inflammation including neutrophile infiltration and crypt abscesses. This is a rare case of ulcerative colitis showing ileitis as a main recurrent lesion, suggesting that careful observation of the small intestine will be required after ileocecal resection in ulcerative colitis patients.