Abdominal NTM infection is frequently overlooked because of its rarity and nonspecific symptoms, with consequent delays in diagnosis and treatment. In immunocompromised patients with ascites from any cause (liver cirrhosis, malignant ascites, etc.), NTM peritonitis should be considered early in the differential diagnosis of symptoms including fever, abdominal pain and weight loss. The poor prognosis of abdominal NTM infection appears to be related to the severity of underlying conditions, most often malignancy.

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A 72-year-old man with a 15-year history of diabetes mellitus presented with an asymptomatic, whitish-yellow plaque on the sole of his right foot. The lesion measured 7 cm × 4.5 cm and had a verrucous surface and a peripheral hyperkeratotic collarette.See page 250 for diagnoses.Chest radiograph of a 57-year-old woman who presented with progressive dyspnea and profuse pink frothy sputum that began 6 hours after the onset of left hemiplegia.Foot radiograph of a 70-year-old man with intermittent sharp pain in his left first metatarsal.

Japanese encephalitis (JE) is an endemic disease in Taiwan. After the program to vaccinate children against JE was implemented in 1968, the incidence of JE gradually started to decrease, but it is still an important infectious disease here. Neurological manifestations in JE vary highly during the initial stage of the disease. Focal neurological symptoms, such as hemiplegia, are rarely reported. A 46-year-old male with the initial presentation of abrupt hemiplegia and fever developed mental confusion after 1 day. No bacterial pathogen was isolated from the blood or cerebrospinal fluid (CSF). A diagnosis of JE was confirmed based on the presence of JE virus-specific immunoglobulin M in the CSF and serum samples. It is necessary to consider JE when a patient presents with abrupt hemiplegia with fever followed with mental confusion and seizure, especially if the patient comes from a JE-endemic area.

hours of the day. Our experience suggests that after-hours exposures are often managed in emergency rooms or standalone clinics, and physicians in these settings may be less familiar with the approaches to exposure management and pharmacologic agents for prophylaxis.Finally, we agree with Tan et al 1 that medication cost is an important consideration, and the guidelines indicate that a more cost-efficient alternative to RAL may be required.2 Individual facilities should consider undertaking comparative cost-benefit analyses-emphasizing factors that improve PEP adherence and minimize toxicities-when updating institutional PEP policies and protocols. The guidelines list several alternative medications for PEP regimens. 2Other experts are in agreement with PHS on a preference for RAL-based occupational PEP.7 Given the limited data available on PEP administration, efficacy, and failures, some experts may disagree, and reasonable arguments can be made to support different conclusions. We echo the call for publication of relevant PEP data to inform regimen decisions. While such data are unlikely to coalesce around a single optimal regimen, electronic publication of this guideline is intended