Rheumatologic manifestations were noted in 24 (6.3 %) of 381 patients with symptomatic histoplasmosis who were seen during a recent epidemic in Indianapolis. Typically, these patients had rapidly additive, rather than migratory, arthritis or arthralgia, which was symmetric in 50%. Ten patients had oligo-or monarticular disease. Knees, ankles, wrists, and small joints of the hand were the most common sites affected. Eleven patients had erythema nodosum. The rheumatologic manifestations were usually mild and, in all but 2 patients, resolved without treatment or with a brief course of nonsteroidal antiinflammatory drugs. The joint disease in patients with erythema nodosum was essentially the same as that seen in patients who did not develop skin lesions. However, those without erythema nodosum more frequently exhibited systemic features, e.g., chills, fever, anemia, and elevated erythrocyte sedimentation rates. Rheumatologic complaints led 16 of the patients in this series (67%) to seek medical attenFrom the Divisions

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A retrospective analysis of 71 nongonococcal joint infections in 63 patients in reported. Staphylococcus aureus was isolated from 59% of the patients. Five patients died as a result of infections. The outcome in Gram‐n egative joint infections was similar to the overall outcome in the entire series of patients. All 11 joints with infected prostheses ultimately required removal of the prostheses. All patients were treated with appropriate parenteral antibiotics, and surgical intervention was used in 40 joints. Six patients underwent surgical treatment because of inability to sterilize the joint with antibiotics and because of repeated joint aspirations. The outcome with surgical intervention was good only in patients younger than 16 years of age. Medical therapy (parenteral antibiotics and frequent joint aspirations) led to good results in 74% of the patients. Outcome of joint infection was also influenced by factors which contribute to imparied host resistance.

Cecal resection leads to significant functional and structural changes in the adapting residual colon. Fermentation of dietary fiber by colonic flora to short-chain fatty acids is necessary, but it alone is not sufficient to mediate adaptation.

During 2 recent epidemics of histoplasmosis in Indianapolis, 7 patients with hilar adenopathy and joint complaints were identified who were initially considered to have sarcoidosis, but in whom histoplasmosis was ultimately diagnosed on the basis of a positive culture for Histoplasma capsulatum or serologic studies. Articular features were the sole presenting complaints in 3 of these patients. All had arthralgias, which were generalized or confined to the lower extremities and were additive rather than migratory. Only 1 patient had joint swelling. Two had erythema nodosum. In all but 1 patient, the articular symptoms resolved rapidly and completely with minimal therapy. The data emphasize that sarcoidosis is a diagnosis of exclusion and that granulomatous infectious diseases must be excluded in patients with hilar adenopathy and joint disease.In most areas of the United States, when a patient presents with hilar adenopathy and arthritis or arthralgia, sarcoidosis is diagnosed. Sarcoidosis, howFrom the Divisions of Rheumatology and Infectious Disease,