The late effects of chemotherapy on immunologic parameters in AIDS-related non-Hodgkin lymphoma (NHL) have not been described.

The aim of this study was to review the impact of infliximab therapy on children with treatment-resistant Crohn's disease. Treatment resistance was defined as clinically active disease despite >4 months of immunosuppressive therapy. The outcome variables were time to first remission, duration of remission and the need for surgery. 24 children received 90 infusions of infliximab (16 boys; median 10.3y, range 1.0-14.4y); all had three infusions as an induction course. 17 (70.8%) achieved clinical remission, with 14/17 (82.3%) relapsing within 4 months of the third infusion. 6/7 in the non-responding group and 8/17 of the responders required surgery with an insignificant difference in the median time to surgery (p=0.49). Four remain dependent on regular infliximab. Infliximab is well-tolerated and highly effective in achieving clinical remission in children with refractory Crohn's disease but may only delay and not avoid the need for surgery. Failure to achieve clinical remission by the 3rd infusion significantly increases the risk of surgery.

IntroductionEpstein-Barr virus (EBV) is detected in the cerebrospinal fluid (CSF) in people with HIV infection who develop primary cerebral lymphoma (PCL). However, EBV may also be detected in the CSF of patients without PCL, and here the significance is uncertain. MethodsNinety-eight HIV-positive patients had lumbar punctures performed and polymerase chain reaction (PCR) for EBV was undertaken on the CSF. Thirty-eight patients had non-Hodgkin's lymphoma (NHL), including four with PCL. Sixty patients had a CSF examination for other indications. The clinicopathological details, symptoms, diagnosis, CSF and neuroimaging findings and therapy at time of CSF were recorded and correlated with CSF EBV PCR results. ResultsEBV was detected in the CSF in three of four patients (75%) with PCL, one of three (33%) with systemic lymphoma and meningeal involvement, and four of 31 (13%) with systemic lymphoma and no meningeal disease. Seven of 60 patients (12%) without lymphoma were CSF EBV-positive. There were no differences in immunological, clinical, biochemical or radiological parameters between patients with and without EBV in the CSF. After a median follow-up time of 30 weeks (maximum 102 weeks), none of the seven CSF EBV-positive patients has developed PCL. ConclusionEBV was detected in up to 12% of patients with neurological symptoms but without lymphoma. A positive result did not correlate with more advanced immunosuppression or a particular neurological diagnosis. Patients with EBV in their CSF did not appear to be at increased risk of developing PCL in the short term.

Deficiency of vitamin D is usually caused by dietary deficiency and/or lack of exposure to sunlight in dark skinned individuals living at northern latitudes. Simple vitamin D deficiency is commonly treated by prescribing a vitamin D containing calcium supplement. This report presents a patient who rejected this approach and instead, after researching alternative treatment options independently, opted to self-treat by consuming UVB-irradiated mushrooms. The beneficial effect of this on the patient's plasma biochemical markers is shown. Further research into the beneficial effect of consuming UVB-irradiated mushrooms is required.

A 61 year old white homosexual man complained of profound fatigue, proximal lower extremity weakness, myalgias, and fever of two days' duration. He also complained of a worsening rash over his proximal upper extremities, trunk, and back for the past month. Two months earlier he had been diagnosed with seronegative rheumatoid arthritis when he presented with bilateral hand and wrist pain. He denied cough, shortness of breath, photosensitivity, Raynaud's phenomenon, dry mouth or eyes, recent travel, pets, morning stiVness, penile discharge, or genital ulcers. He tested HIV negative three months before admission. His past medical history was significant for hypertension, gastro-oesophageal reflux disease, and obstructive sleep apnoea. He had been taking prednisone 15 mg and cimetidine 400 mg daily.On examination, the patient looked acutely ill and uncomfortable. He was febrile at 102.4°F, his blood pressure was 148/80 mm Hg, and his pulse was 90 beats/min. He had confluent erythematous and purpuric plaques on his back, anterior trunk, and proximal upper extremities (see fig 1); some were in a polycyclic arrangement but without scale. No muscle tenderness or weakness was detected. There was no appreciable arthritis or synovial thickening. He had a II/VI systolic murmur throughout his precordium without radiation. The remainder of his physical examination was without abnormalities.The initial evaluation is listed in box 1. A skin biopsy showed superficial and deep perivascular infiltrates with extensive interface damage. Immunofluorescence revealed strong granular C3 and trace granular IgG and IgM at the dermal-epidermal junction.