A 45-year-old woman presented at the outpatient department of a center for tropical diseases with fever, diarrhea, headache, myalgia, malaise, and an itchy papular rash. She had been on holiday with her family for 11 days in a mountain village in northern Cyprus. The place was infested with a lot of small, stinging flies or mosquitoes. She and her family became sick after they returned home. The physical examination was normal apart from the rash on the inside of the extremities. Significantly elevated transaminases and a slightly increased C‑reactive protein level were found in the blood examination. Considering the country of travel, the report of the "stinging flies" and the clinical presentation, sandfly fever was also taken into account as a differential diagnosis for the hepatitis. Antibodies to the sandfly fever Sicilian virus (SFSV) were detected. They showed the typical dynamics during the course of the illness and thus "pappataci fever" was diagnosed. The case report and a short review of up-to-date literature is meant encourage consideration of phlebovirus infection as a possible differential diagnosis in travelers or refugees suffering from severe febrile hepatitis and rash or aseptic viral meningitis after their stay in the Mediterranean area.

Zusammenfassung Anamnese und klinischer Befund Wir berichten über einen 22-jährigen Patienten, der sich mit Abgeschlagenheit, Gewichtsverlust und Verfärbung der Haut vorstellte. Eine Hashimoto-Thyreoiditis war bekannt. Die Hormonsubstitution mit L-Thyroxin war bereits erhöht worden. Allerdings persistierten die Beschwerden. Diagnostik Die körperliche Untersuchung zeigte eine gelblich-graue Verfärbung der Haut. Zudem fielen laborchemisch eine Hyponatriämie und eine Hyperkaliämie auf. Kortisolspiegel, Antikörperbestimmungen sowie ein ACTH-Stimulationstest bestätigten die Diagnose eines Morbus Addison. In Zusammenschau mit der bekannten Hashimoto-Thyreoiditis ergab sich das Bild eines Schmidt-Syndroms. Therapie und Verlauf Es erfolgte die Substitution mit 20 mg Hydro- und 0,1 mg Fludrokortison täglich, worunter es innerhalb einer Woche zur Beschwerdebesserung und Normalisierung der Laborparameter kam. Folgerung Die Erkrankungen und Symptome, die im Rahmen einer autoimmunen Polyendokrinopathie vorliegen können, erschweren häufig eine schnelle Diagnose. Daher sollte bei Patienten mit bereits bekannter Autoimmunerkrankung an die Möglichkeit einer autoimmunen Polyendokrinopathie gedacht werden.

No abstract

We report the case of a 57-year-old patient initially seen with stool irregularities and malignant ascites. Through further examinations we diagnosed a long standing untreated ulcerative colitis with endoscopic signs of a massive chronic inflammation of the entire colon. The origin of the malignant cells in the ascites remained unknown despite the exhaustion of all diagnostic means available. As an ultima ratio we performed a colectomy and an advanced adenocarcinoma of the appendix was found. The patient's condition deteriorated very fast so that chemotherapy wasn't an option. Following his wishes he received palliative care in his home environment. Patients with an inflammatory bowel disease have a higher risk of developing colorectal cancer. This is a well-known fact. But an adenocarcinoma of the appendix is still a rarity. Here we illuminate the possible link between the appendix and ulcerative colitis.