Accepted 30 October 1996 A 37-year-old man presented with acute confusion following five days of back pain, and two days of fever and diarrhoea. On examination he had a fever of 38.7°C, jaundice, neck stiffness, conjunctival suffusion, and a purpuric rash (figures 1 and 2). His pulse was 100 beats/min and blood pressure 100/80 mmHg. The heart sounds were normal. He was tachypnoeic with scattere...

Volume 85, Number 3 www.aafp.org/afp American Family Physician 271 A 50-year-old woman presented to the emergency department with a diffuse rash that appeared four months earlier. The rash began on the upper extremities and gradually spread to her entire body. It was pruritic and associated with subjective fever and chills. Some of the lesions were pustular and crusting. She did not have a hist...

A 19-year-old woman had secondary generalized seizures for 18 months due to a calcified parietal granuloma. She was treated with phenytoin (PHT) and sodium valproate. PHT was replaced with LEV 500 mg twice daily because of a recurrence of seizures. Having taken LEV for 10 days, she developed a generalized maculopapular itchy rash which spared the mucous membranes. LEV was stopped and she was pr...

A 16-year-old boy, with a history of juvenile myoclonic epilepsy, which had been treated with valproic acid since he was 9 years of age, presented with bilateral periorbital rash. His family had found him in a stupor state after groaning early the previous morning. The patient had a history of morning myoclonic seizures and absence seizures, but no history of generalized tonic-clonic seizures. ...

anecdotally, some clinicians seem to consider LTOT to be an absolute contraindica-tion to intubation. Table 1 summarises the outcomes for intubated patients with chronic obstructive pulmonary disease (COPD) in the COPD and Asthma Outcome Study (CAOS), comparing those who were on LTOT before admission with those who were not. It can be seen that, although the two groups of patients had similar 1...