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A 54-year-old African American male with systemic lupus erythematosus and chronic alcoholic hepatitis presented with recurrent fever, pancytopenia, transaminitis, weight loss, and widespread violaceous tender plaques. Skin biopsy revealed hemophagocytic histiocytes leading to a diagnosis of cytophagic histiocytic panniculitis in the setting of lupus panniculitis. During workup, an axillary lymph node biopsy mimicked Kikuchi-Fujimoto's disease. Treatment with tapering high-dose glucocorticoids, mycophenolate mofetil, and hydroxychloroquine induced remission of the disease. We believe the comorbid conditions of Kikuchi-Fujimoto-like pathology and cytophagic histiocytic panniculitis have not been documented in the literature to date in a patient with systemic lupus erythematosus.

Aims, Objectives and BackgroundRecent guidelines for Acute Coronary Syndrome have recommended rapid diagnosis based on repeat sampling at 2 hours from admission. We investigated the feasibility and diagnostic equivalence of repeat measurement at 2 hours by comparing the diagnostic classification achieved by measurement at 0 and 2 hours with a delta value of <=3 between samples to measurement at 0 and 3 hours and a delta of <=7ng/L between samples.Method and DesignFrom August to November 2021 all patients with chest pain where a diagnosis of acute coronary syndrome (ACS) was considered had a diagnostic protocol of measurement of cardiac troponin T (cTnT) on admission and at 2 and 3 hours from admission. Requests and results were extracted from the laboratory information system including date and time of result. Data was transferred to a relational database (Access, Microsoft corp) for analysis. Non-parametric statistics were used throughout using the Analyse It.(www.analyse-it.com) add in for Excel.Cardiac troponin T (cTnT) was measured by the Roche high sensitivity cardiac troponin T assay hs-cTnT (Roche diagnostics), range 3 – 10,000ng/L, 10% CV 13ng/L, 99th percentile 14 ng/L.Results and Conclusion728 sets of serial samples where obtained on 711 patients, 40.1% female median age 61.8 years,(interquartile range 50.6–75). Comparison of classification is shown in table 1. Overall agreement was good but there were 6 cases where a positive 3 hour delta occurred with a 2 hour delta of 3 or less. 4 had values exceeding the 99th percentile on the admission sample so would have been retained for further investigation. The remaining 4 patients had co-existing clinical conditions that required further investigation.Abstract 1704 Table 1ClassificationDelta ≤3 at 2 hDelta >3 at 2 hDelta ≤7 at 3 hours55837Delta >7 at 3 hours635Abstract 1704 Figure 1ConclusionThe routine use of serial sampling at admission and 2 hours was clinically safe and resulted in the same clinical decisions in the context of the busy ED environment for the population served by the hospital.

This essay is a response to Michael Kreyling's article analyzing the state of new southern studies. Kreyling argues that in many of the new texts, there is too much "calculated amnesia" and wants to see more awareness of past texts and criticism. My response agrees with Kreyling in this charge but suggests that the combining of new and old is a tricky business because you must determine which old you want to preserve and value. I suggest that the texts that place the mixing of old and new at the heart of their examinations are the most successful. The articles in the special issue of American Literature on the new southern studies do not negotiate that tricky combination of old and new. The Prentice-Hall anthology, The South in Perspective, includes a nice mix of canonical and non-canonical texts, but diverts attention by unnecessarily separating texts into "upper south" and "lower south" categories. I end with a discussion of Houston Baker's Turning South Again and Baker's description of being haunted by the southern past. I suggest that to avoid the problem Kreyling addresses of forgetting the past we should listen to the ghosts.

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