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The usual presentations and manifestations of systemic lupus erythematosus (SLE) are well known. We describe a patient with SLE that was discovered in the course of evaluation of an abscess, found to be associated with non-0:1 Vibrio cholerue.Systemic lupus erythematosus (SLE) is a common rheumatic disease which has a variety of presentations and manifestations, including the welldescribed malar ''butterfly rash," arthritis, nephritis, serositis, and alopecia. This is the first reported case of SLE presenting as a subcutaneous abscess secondary to non-0: 1 Vibrio cholerue. CASE REPORTThe patient, a 29-year-old woman from the Dominican Republic, presented to the emergency department of a New York City hospital with fever, left hip pain, and pleuritic left chest pain. The medical history was significant for anemia, for which she claimed to be receiving treatment, consisting of "vitamin injections" in the left hip, in the Dominican Republic. The needles and syringes were not disposable and were "cleaned with sea water." On physical examination the patient appeared to be in a toxic condition. The vital signs were as follows: oral temperature 103"F, pulse 101 beatdminute, blood pressure 90/60 mm Hg. There was alopecia, a malar rash, and a maculopapular rash over the torso and extremities. A mild synovitis was present in the left wrist. The left buttock had a 20-cm area of induration, which was Submitted for publication December 1, 1993; accepted in revised form May 11, 1994. firm, red, warm, and tender. The chest radiograph demonstrated a small left pleural effusion. The white blood cell count was 25,300/mm3 with a left shift. The hemoglobin level was 6.4 gm/dl, hematocrit 18.6 gm/ dl, mean corpuscular volume 85.1 pm3, mean cell hemoglobin 29.2 pg/cell. The patient was admitted to the hospital for cellulitis, and empiric treatment with intravenous nafcillin (500 mg every 6 hours) was begun.A left gluteal abscess developed, which drained spontaneously 5 days after admission. The Gram stain demonstrated gram-negative bacilli, which also grew from cultures of blood obtained prior to the initiation of antibiotic treatment. The organism was thought to be V cholerue and was sent to the Public Health Department for serotyping. The antibiotic regimen was changed to intravenous ampicillin (1 gm every 6 hours) and gentamicin (80 mg every 8 hours), and the leukocytosis, cellulitis, and abscess resolved within 10 days.Laboratory evaluation revealed the following: antinuclear antibody (ANA) titer 1 :320 (speckled pattern), anti-RNP antibody titer 1 :512, negative rheumatoid factor, negative anti-Sm antibody, erythrocyte sedimentation rate (ESR) 142 m d h o u r (normal 0-20), C3 51.9 mg/dl (normal 85-193), C4 8.7 mg/dl (normal 12-36 mg/dl), rapid plasma reagin negative. A diagnosis of hemolytic anemia was established based on a reticulocyte index of 3.9%, haptoglobin level of 243 mg/dl (normal 13-163), and Coombs' antibody positivity. The serum creatine level was 4.1 mg/dl, and urinalysis demonstrated persistent proteinuria (>3...

Dr. Jacques Forestier was a strong man, intellectually and physically. He was one of the founders of modern rheumatology; his name is synonymous with the rheumatology of our times.He died at a time which was symbolic-the day after he delivered the Keynote Address to the 50th Anniversary Celebration of the foundation of the French League Against Rheumatism, of which he had been Secretary for the entire first half of its existence.The long family tradition of medical practice in Aix-les-Bains dating from the early nineteenth century through his father, the founder of the International League Against Rheumatism (with Dr. Van Breemen and Jacques), is continued today by his son, who represents the fifth generation of illustrious physicians.Jacques Forestier studied in Paris and was associated thereafter with the pioneering of a rheumatology clinic at the famous Hopital Cochin. His early investigations included studies of contrast radiography with iodized oil. In the field of rheumatologic therapeutics he introduced gold salts in the treatment of rheumatoid arthritis. This gained him particular reknown. He also perfected a variety of balneologic techniques (hydrologic and radioactive) and developed the early use of balneotherapy as part of the rehabilitation process after reconstructive orthopedic surgery.In the field of diagnostic rheumatology, which bears great names of French medicine such as Charcot and Pierre Marie, he distinguished from ankylosing spondylitis the condition that is now named for him, Forestier's disease, or ankylosing vertebral hyperostosis. He also wrote a pioneer clinical description of what is now called polymyalgia rheumatica (pseudo-polyarthrite rhisomelique) among many other publications on ankylosing spondylitis, chronic rheumatism, and goat.During my specialization in rheumatology at the hospitals Lariboisiere and Cochin in Paris from 1956-

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We describe a patient with adult-type osteopetrosis presenting as carpal tunnel syndrome. Radiographs demonstrated sclerosis of the carpal bones, bone biopsy revealed wide bone spicules containing areas of cartilage, and electrophysiologic studies confirmed the diagnasis of median nerve entrapment in the carpal tunnel. Any condition which alters the size or shape of the carpal canal or its contents may result in median nerve compression.Osteopetrosis is a rare bone disease, caused by disequilibrium between the normally balanced process of bone formation and bone resorption (1). In this report, we present a case of adult-type osteopetrosis in which the patient presented with carpal tunnel syndrome. The clinical, radiologic, and histologic features of the disease, including the electrodiagnostic findings, are discussed.Case report. A 52-year-old woman was admitted to the hospital because of numbness and a tingling sensation in her left hand. The sensation was more pronounced at night. Seven years prior to admission she had renal colic, and subsequently a calculus was removed from her right kidney. A skeletal survey at that time revealed a diffuse increase in bone density.Dysesthesia in the median nerve distribution of the left hand was noted at her physical examination. Tinel's sign, blood pressure cuff test, and Fhalen's wrist-flexion test results were positive. Laboratory findings, including levels of parathyroid hormone, hydroxyproline, alkaline phosphatase, and a thyroid profile were all within normal range. The patient was advised to undergo surgical release of the carpal tunnel, she refused, and the condition persisted.A posteroanterior view of the wrist, a radiograph of the spine, and the results of a bone biopsy are shown in Figures 1, 2, and 3, respectively.Results of electrodiagnostic tests (Figure 4) were as follows: reduced amplitude of sensory-evoked potentials of the median nerve, marked prolongation of the distal sensory latency (6.0 ms; normal <3.7), and increased motor distal latency of the median nerve (4.9 ms; normal c4.3). Nerve conduction velocities of the median nerve were normal (50 metershecond) (2).Discussion. Osteopetrosis, also known as Albers-Schonberg disease or marble bones disease, is a rare osseous disorder. Its etiology is not completely understood (3).The disease is characterized by a general increase in bone mass. Current opinion is that osteopetrosis is a disease of the osteoclast. Numerous osteoclasts may be present, but do not appear to be engaged in the resorption of bone. Two forms are recognized. The severe form is inherited as an autosomal recessive trait (4).