In patients who have diarrhea (without AIDS), common causative organisms are the protozoa, Giardia lamblia and Entamoeba histolytica, as well as bacterial pathogens such as Campylobacter and Clostridium difficile. Homosexual men also have a higher than expected frequency of hepatitis

B and, to a lesser extent, hepatitis C. Again, risks for these infections increase check details in those with multiple sexual partners and with anal-receptive intercourse. The susceptibility of these patients to multiple gastrointestinal and other infections is illustrated by the following report. The patient was a 55-year-old man who was admitted to hospital with jaundice, an unusual rash and rectal bleeding. Apart from jaundice, he had Transferase inhibitor small round papules on his palms and soles (Figure 1A) as well as a reddish and moist proliferative lesion around the anus (Figure 1B). Anal lesions (condylomata lata) and the skin rash were attributed to secondary syphilis and this was confirmed by serological studies. In relation to jaundice, he had a serum bilirubin of 10.9 mg/dL (186 µmol/l), a moderate elevation of alanine aminotransferase (401 u/l) and a marked elevation of alkaline phosphatase (1003 u/l). Jaundice was attributed to acute hepatitis B as he was positive for surface antigen and IgM antibody. Colonoscopy was performed because of rectal bleeding and revealed inflammation of

the rectum and sigmoid colon with edema, superficial ulceration and contact bleeding (Figure 2A). At histology, there was lymphocytic infiltration of the lamina propria and trophozoites of E. histolytica (arrows, Figure 2B). He was treated

with penicillin, metronidazole and lamivudine. He admitted to homosexual behavior including anal-receptive sexual practices. Contributed by “
“Drug-induced liver disease (DILD), ranging in presentation from mildly abnormal liver biochemistry to fulminant hepatic failure, is a serious and growing problem in modern medicine. More than 1000 medications have been Diflunisal implicated, and with the addition of new agents to formularies every year there is growing potential for further hepatotoxicity, particularly as the number of patients taking multiple medications continues to increase. In chronically or critically ill patients, co-morbidities, which may themselves be associated with deranged liver biochemistry, make determination of the role of DILD all the more difficult, yet all the more important. A systematic and organized approach to this challenging problem is keytominimizing the consequences of this all too common pharmacological complication. “
“A 39-year-old man who had 4 years previously undergone a laparoscopic appendicectomy for acute appendicitis was admitted with sudden onset severe lower abdominal pain. Initial examination revealed focal peritonism in the right iliac fossa, temperature of 39°C and tachycardia (96 bmp). White blood cell count was 16 × 109/l.