Importance. Infections can cause leukocytoclastic vasculitis. Observations. We report the case of a patient with a left ventricular assist device who presented with acute kidney injury and biopsy proven leukocytoclastic vasculitis. Blood cultures grew Listeria monocytogenes. The patient's rash improved with treatment of the underlying Listeria infection. Conclusion. Clinicians should be aware that there are a number of broad categories of disease associated with the histologic finding of vasculitis, including infection. It is important to keep in mind the risk factors of a particular patient when formulating a differential diagnosis. This is the first reported case of Listeria bacteremia causing leukocytoclastic vasculitis.

Disseminated gonococcal infection (DGI) is a rare complication of primary infection with Neisseria gonorrhoeae. Cardiac involvement in this condition is rare, and is usually limited to endocarditis. However, there are a number of older reports suggestive of direct myocardial involvement. We report a case of a 38-year-old male with HIV who presented with chest pain, pharyngitis, tenosynovitis, and purpuric skin lesions. Transthoracic echocardiogram showed acute biventricular dysfunction. Skin biopsy showed diplococci consistent with disseminated gonococcal infection, and treatment with ceftriaxone improved his symptoms and ejection fraction. Though gonococcal infection was never proven with culture or nucleic acid amplification testing, the clinical picture and histologic findings were highly suggestive of DGI. Clinicians should consider disseminated gonococcal infection when a patient presents with acute myocarditis, especially if there are concurrent skin and joint lesions.

Importance. Rituximab was not effective in ameliorating the hearing loss in a patient with atypical Cogan's syndrome. Observations. We report the case of a patient who developed acute bilateral uveitis and sensorineural hearing loss. A diagnosis of atypical Cogan's syndrome was made. The patient's hearing loss did not improve despite high dose steroids and azathioprine. Rituximab was administered given a recent report of its efficacy in a patient with refractory disease; however, our patient's hearing loss did not improve. Conclusion. Hearing loss in Cogan's syndrome is difficult to treat. Though rituximab was ineffective in our case, earlier administration in the disease course could be effective for future patients.

A 26-year-old previously healthy woman developed sudden-onset hypoxaemic respiratory failure 3 days post partum. During pregnancy, the patient had displayed haematuria (26-50 red blood cells/highpower field on urine dipstick) and proteinuria (30 mg/dL on urine dipstick), which at the time was not further investigated. The pregnancy and vaginal delivery were otherwise uncomplicated. On the morning of planned discharge from the maternity ward, the patient developed sudden dyspnoea, tachypnoea, tachycardia and severe hypoxaemia (PaO 2 of 48 mm Hg on room air) accompanied by 5 mL of bright red haemoptysis. Chest auscultation was normal. ECG showed sinus tachycardia with an S 1 Q 3 T 3 pattern and urgent bedside echocardiogram showed evidence of right heart strain. Christian BeckerRespiratory insufficiency in the peripartum period has many potential causes, including PE, amniotic fluid embolism, pulmonary oedema due to tocolytic therapy and peripartum cardiomyopathy. Venous thromboembolism (VTE) is approximately 80 times more common in the first week post partum when compared with the general population 1 and PE is a leading cause of maternal mortality in the developed world (whereas postpartum haemorrhage is the most common cause of death in the developing world 2 ). Haemoptysis in the setting of PE occurs in about 5% of patients, and represents pulmonary infarction. 3 Given the acute onset of symptoms and echocardiographic findings, PE is the initial concern for this patient.

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