Dengue viral infections are one of the most important mosquito borne diseases in the world. The dengue virus is a single stranded RNA virus belonging to the Flaviviridae family. There are four serotypes (DEN 1-4) classified according to biological and immunological criteria. Patients may be asymptomatic or their condition may give rise to undifferentiated fever, dengue fever, dengue haemorrhagic fever (DHF), or dengue shock syndrome. Annually, 100 million cases of dengue fever and half a million cases of DHF occur worldwide and 2.5 billion people are at risk. At present, dengue is endemic in 112 countries. Early recognition and prompt initiation of appropriate treatment are vital if disease related morbidity and mortality are to be limited. We present an interesting case of dengue fever with headache, skin rash and abnormal behaviour who had a massive intracranial haemorrhage with fatal outcome.

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Catastrophic antiphospholipid syndrome (APS) is caused by thrombotic vascular occlusions that affect both small and large vessels, producing ischaemia in the affected organs. The "catastrophic" variant of the antiphospholipid syndrome (cAPS) develops over a short period of time. Although patients with cAPS represent <1% of all patients with APS, they are usually life threatening with a 50% mortality rate. A strong association with concomitant infection is thought to act as the main trigger of microthromboses in cAPS. Several theories have been proposed to explain these physiopathological features. Some of them suggest the possibility of molecular mimicry between components of infectious microorganisms and natural anticoagulants, which might be involved in the production of cross-reacting antiphospholipid antibodies. We present a case of catastrophic cerebral APS characterised by massive temporal lobe infarction and subsequent haemorrhagic transformation after sudden withdrawal of warfarin.

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rom 1985 until 1992 there was a resurgence of tuberculosis in the United States that coincided with the epidemic of acquired immunodeficiency syndrome (AIDS). 1 Although the U.S. incidence of tuberculosis has since been in decline, this disease remains a major problem for much of the world, with a global prevalence of infection estimated at 32 percent. 2 Thus, the percentage of U.S. cases that occur among foreign-born persons is increasing (53 percent in 2003). 1 Extrapulmonary tuberculosis has become more common since the advent of human immunodeficiency virus (HIV) infection. 3 Extrapulmonary Tuberculosis and HIV Infection Extrapulmonary involvement can be seen in more than 50 percent of patients with concurrent AIDS and tuberculosis. 3-5 The risk of extrapulmonary tuberculosis and mycobacteremia increases with advancing immunosuppression. 6 Unique features of AIDS-associated tuberculosis include extra