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Post-kala-azar dermal leishmaniasis (PKDL) is a complication of visceral leishmaniasis (VL) observed mainly in Sudan and India where it follows treated VL in 50% and 10% of cases, respectively. We report a 46-year-old patient with acquired immune deficiency syndrome who, 7 months after diagnosis of VL, developed PKDL and uveal leishmaniasis following HAART-induced immune recovery. In southern Europe PKDL seems to be an emerging clinical presentation among human immunodeficiency virus (HIV)-infected patients experiencing HAART-induced immune recovery after a previous diagnosis of VL. The best treatment among HIV-infected patients remains to be determined.

Adrenal gland haematoma is often a complication of traumatic events. The case is reported of a 45 year old man with unilateral non-symptomatic adrenal gland haematoma caused by a trauma during martial arts practice.

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We read with interest the article by Norwood and colleagues. 1 The management of femoral artery pseudoaneurysm has evolved in recent years and percutaneous ultrasound guided thrombin injection is now recommended as the standard of care. Its efficacy is highlighted by successful pseudoaneurysm thrombosis in 96% of cases and good patient tolerance. 2,3 As described by Norwood, potential reasons for a change in femoral artery pseudoaneurysm incidence may be related to an increased number of interventional cardiological procedures performed coupled with the newer anti-platelet agents now employed.We have recently undertaken a review of 87 patients with 89 iatrogenic pseudoaneurysm treated at our centre between January 1997 and June 2002. 4 Thrombin injection was introduced as a treatment modality from July 1999. Prior to this, compression therapy and conventional operative repair were utilised in the management of pseudoaneurysm. In the two years (1997)(1998) before the introduction of thrombin therapy, 17 (89%) of 19 lesions were repaired surgically. In the two years (2000)(2001) after its introduction, 21 (41%) of 51 required operation. While there was no significant increase in the total number of arterial catheterisations, there were significantly more pseudoaneurysms treated after July 1999; the point at which thrombin injection was introduced as a treatment option.Findings of an increased number of pseudoaneurysms referred and treated together with a constant incidence of surgical repair for pseudoaneurysm suggest that a lower threshold for treatment by thrombin injection exists; and may account for the increased incidence seen in our series and that of Norwood and colleagues.