An 86-year-old woman was referred to our Clinic because of a new onset of anaemia. She was under treatment with warfarin for chronic atrial fibrillation. The INR at admission was 4.1. Her caregiver excluded hematemesis or melena, and assured no NSAID had been taken. She appeared pale and was haemodynamically stable. A wellmarked, reddish-brown, netlike discoloration of the skin, with clear-cut margins was present on the anterior and medial surfaces of both thighs (Fig. 1). This kind of lesion was not present in any other body areas. Physical examination was otherwise normal.Routine blood examination revealed the presence of a microcytic anaemia (haemoglobin 7.8 g/dL; mean corpuscular volume 60.8 fL) with iron deficiency (serum iron 20 lg/ dL; serum ferritin 30 lg/L). The erythrocyte sedimentation rate appeared high (75 mm/h). Lupus anticoagulant panel, antinuclear antibodies, Coombs tests, cryoglobulins and anti-HCV antibodies were normal. Haptoglobin levels were normal. Esophagogastroduodenoscopy showed a sliding hiatal hernia with erosive esophagitis.The patient reported that the skin discoloration had appeared on her thighs many years before, and was chronic and stable. She added she would usually keep a hot water bottle on her thighs. It is to be noted that the extension of the lesion corresponded to the surface of the water bottle.Therefore, the skin discoloration and anaemia likely had no relationship. In fact, the anaemia was secondary to erosive esophagitis, and was treated with iron supplementation and proton pump inhibitors. DiscussionErythema ab igne appears as a reticulated, erythematous, hyperpigmented eruption that may occur after prolonged and repeated skin exposure to mild heat or infrared radiation, but under the threshold of thermal burn [1]. It can be also characterized by skin atrophy, telangiectasia and subepidermal bullae, and it is usually asymptomatic. Distribution and contour of the skin lesions depend on the direction of the incident radiation, and the interposition of clothing.

An 88-year-old man was referred to our Unit for a bowel obstruction. The past history included a diagnosis of chronic obstructive pulmonary disease (COPD) with cor pulmonale treated with anti-cholinergic and glucocorticoid inhalation therapy, as well as prostate cancer. At admission he was periodically drowsy and confused. Arterial gas analysis demonstrated a mild respiratory failure with hypercapnia and normal arterial O 2 -saturation. The EKG showed a sinus rhythm. A few hours later atrial fibrillation began, and the patient was treated with an intravenous infusion of amiodarone, with recovery of a sinus rhythm. An amiodarone oral maintenance regimen was then started.The bowel obstruction resolved after adequate intravenous fluid infusion and enemas.A few days thereafter, the patient underwent CT scan of head, thorax and abdomen with contrast media enhancement (iopromide--Ultravist 370, Bayer HealthCare Pharmaceuticals, 100 mL), as suggested by the patient's oncologist.On return from the Radiology Unit, the patient appeared restless and dyspneic. Physical examination showed tachypnea (respiratory rate 34 breaths/min), reduction of normal vesicular breath sounds and diffuse wheezing. The blood pressure was 140/80 mmHg, with a heart rate of 94 beats/min, and in a sinus rhythm. The pulse oximetry saturation was 83% while inhaling 2 L of oxygen/min by nasal cannula. Oxygen therapy was promptly increased to 8 L/min via pharyngeal cannula; anti-cholinergic drugs, glucocorticoids and short-acting b2-adrenergic agonists were given via aerosol. Arterial gas analysis parameters showed severe respiratory acidosis (pH 7.17, pCO 2 78 mmHg, pO 2 129 mmHg, SaO 2 99%). Intravenous glucocorticoids (hydrocortisone 1 g), histamine H1 antagonists (chlorphenamine maleate, 20 mg), furosemide (80 mg) and nitrates (17 gamma/min) were administered. As even adrenaline administration was considered in the concern for an iodinated contrast media adverse reaction, the radiologist called in, to inform about the presence of an unusual finding in the patient's CT scans of the thorax: an oval image, strongly radio-opaque, looking

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