Robert Sweet first described acute febrile neutrophilic dermatosis (Sweet's syndrome (SS)) in 1964 affecting eight women. They had four cardinal features: fever, neutrophilia, tender plaques and dermal infiltrate of neutrophils histologically.1 SS is rare and occurs worldwide with no racial predilection.2 Associations include infections, drugs, malignancy, inflammatory bowel disease and pregnancy.2 We present a case of SS in a patient with biliary sepsis.
A 54-year-old Caucasian man developed pyrexia, leukocytosis with neutrophilia and raised C-reactive protein one day after transhepatic biliary stent insertion. Intravenous piperacillin/tazobactam (Tazocin, Pfizer, USA) was started for presumed biliary sepsis. He remained pyrexial 2 days later. The antibiotic was changed to meropenem. He remained unwell with swinging pyrexia while his leucocytosis, neutrophilia and C-reactive protein worsened over the following 5 days. Two days after he became unwell, …
There is no consensus on the pharmacological treatment of alcoholic hepatitis. The Glasgow alcoholic hepatitis score (GAHS) has been shown to be more accurate than the modified Maddrey's discriminant function (mDF) in the prediction of outcome from alcoholic hepatitis. This study aimed to determine whether the GAHS was able to identify those patients who would benefit from corticosteroids.
Methods:
225 patients with an mDF greater than or equal to 32 from five hospital centres in the United Kingdom were reviewed. Patient survival relative to the GAHS and the use of corticosteroids was recorded.
Results:
144 patients with an mDF greater than or equal to 32 (64%) also had a GAHS greater than or equal to 9. There was no difference in survival between untreated or corticosteroid-treated patients for those with a GAHS less than 9. For patients with a GAHS greater than or equal to 9 the 28-day survival for untreated and corticosteroid-treated patients was 52% and 78% (p = 0.002), and 84-day survival was 38% and 59% (p = 0.02), respectively.
Conclusions:
Among patients with an mDF greater than or equal to 32, there was no appreciable benefit from treatment with corticosteroids in patients with a GAHS less than 9. Patients with a GAHS greater than or equal to 9 have an extremely poor prognosis if they are not treated with corticosteroids, or if such treatment is contraindicated.
To evaluate the existing evidence on the diagnosis and management of septic arthritis in native joints.Systematic review.Cochrane Library, Medline, Embase, National Electronic Library for Health, reference lists, national experts.Systematic review of the literature with evaluation of the methodological quality of the selected papers using defined criteria set out by the Clinical Effectiveness and Evaluation Unit of the Royal College of Physicians.3291 citations were initially identified. Of these, 189 full text articles were identified for potential selection. Following review of these full text articles, 80 articles were found to fulfil the inclusion criteria and were included in the final list. Conclusions were drawn on the diagnosis, investigation and management of septic arthritis.Little good quality evidence exists to guide the diagnosis and management of septic arthritis. Overall, no investigation is more reliable in the diagnosis of septic arthritis than the opinion of an experienced doctor. Aspiration and culture of synovial fluid is crucial to the diagnosis, but measurement of cell count is unhelpful. Antibiotics are clearly required for a prolonged period, but there are no data to indicate by which route or for how long. Key unanswered questions remain surrounding the medical and surgical management of the infected joint.
Scope and purpose of the guidelinesThe clinical presentation of a hot swollen joint is common and has wide differential diagnosis.The most serious is septic arthritis, with a case fatality of 11%.Delayed or inadequate treatment leads to joint damage.These guidelines focus on the diagnosis and management of septic arthritis.Hot swollen joints commonly have other underlying diagnoses, including crystal arthritis, reactive arthritis and a monoarticular presentation of polyarthritis.
Crit Care 1999, 3 3 ( (s su up pp pl l 1 1) ):P1 I In nt tr ro od du uc ct ti io on n: : Critically ill patients requiring intensive care are at risk of iatrogenic ocular damage.Studies have reported an incidence of eye problems of up to 40% in critically ill ventilated patients.We conducted this study to assess the incidence of ocular complications in our intensive care unit where all patients are cared for according to an eye care standard.M Me et th ho od ds s: : All ventilated patients over a 2 month period were included.Ophthalmic assessment was performed on admission and repeated every other day during the period of ventilation.At each assessment the average Ramsey sedation score over the previous 24 h, the presence of tracheal secretions and the presence of ventilation associated pneumonia was noted.Eye care performed was recorded.R Re es su ul lt ts s: : Sixty patients were included.One patient developed corneal exposure keratopathy.No patient developed conjunctivitis or corneal ulceration.Further advice on appropriate measures of eye care was given in five cases (8%).Nine patients (15%) had large amounts of respiratory secretions with positive microbiological results.C Co on nc cl lu us si io on n: : This study confirms that the use of an eye care standard is associated with a low incidence of ocular surface complications.The incidence of ocular complications in this group of patients is far lower than previously described.
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