Two patients presented with spinal cerebrospinal fluid (CSF) leakage manifesting as chronic disabling headache and other symptoms after motor vehicle accidents. Combined radioisotope cisternography and computed tomography myelography confirmed the presence of the spinal leaks in the lumbar spine. Radioisotope cisternography has limited spatial resolution, so there is persistent and probably unfair mistrust in its reliability. The present 2 cases confirmed the diagnosis and support the causal relationship between motor vehicle accidents and spinal CSF leakage.

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We herein describe an irregular case of toxic-shock syndrome (TSS). A previously healthy 28-year-old Japanese man developed a sudden-onset high fever. The patient was suffering from conjunctival hyperaemia, gastrointestinal symptoms such as vomiting and diarrhoea, and systemically diffused macular erythroderma. Further physical examination detected pustules on his back, which self-destructed over time. Laboratory revealed multiple organ failures. Subsequently, scalded skin on the face and desquamation in the limb extremities emerged by day 10, leading to the diagnosis of TSS, despite his stable circulatory dynamics through the course. Learning points for clinicians include that they should recall TSS as a possible disease concurrently causing high fever, systemic rash and multiple organ dysfunctions, even without being in a state of shock. The characteristic desquamations emerged in the limb extremities after hospitalisation were of help in diagnosing TSS.

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