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THE RADIOLOGICAL demonstration of a diffuse pulmonary infiltrate presents a difficult diagnostic problem to the physician initiating an extensive clinical study. Ultimately, pulmonary biopsy is required and may or may not reveal the definitive nature of the lesion. The only possible diagnosis is often "diffuse pulmonary fibrosis." In the course of evaluation of such a patient we have uncovered the unusual association of pulmonary hemosiderosis without anemia, interstitial pulmonary fibrosis, pulmonary concretions, cryoglobulinemia, and rheumatoid arthritis. Although this association of diseases may be fortuitous, a strikingly similar case was reported by Karlish in 1962.1 The present case was studied in some detail and the results of these investigations are presented. REPORT OF A CASE A 42-year-old Negro man was noted to have abnormal findings on chest x-ray in 1959 in the course of a routine medical examination (Fig 1). He failed to report for further examination. In 1962 he

Idiopathic pulmonary hemosiderosis (essential brown induration of the lungs), first described by Virchow1 in 1864, has been reported in 52 adult patients.After Virchow's description, there was no further report of the disease until Ceelen2 published autopsy findings in 2 children in 1931. The first adult cases were reported by Waldenstrom3 in 1940, who described the clinical and roentgenologic findings in a 16-year-old girl, and Borsos-Nachtnebel4 in 1942, who described the findings in a 38-year-old man. Since Browning and Houghton5 reported 3 adult cases in 1956, there have been 156,15,49,50 additional adult cases described in the American literature.Despite its characteristic nature, idiopathic pulmonary hemosiderosis is probably still poorly recognized and surely incompletely understood. Because the disorder is rare the following case is described in detail and the literature reviewed. REPORT OF A CASE A 19-year-old soldier was first hospitalized on Jan. 21, 1960,

Idiopathic pulmonary hemosiderosis (IPH) has generally been associated with a persistent hypochromic anemia.1 During the protracted course of the disease, particularly during clinical remission, the hematologic abnormalities may be minimal.2 A complete restoration of normal hemoglobin levels is unusual, and most observers have alluded to a chronic anemic state during periods of clinical remission.3 The classic case comes to the attention of a physician because of symptoms related directly or indirectly to anemia. We have had the opportunity to study two cases of adult pulmonary hemosiderosis in which there was no evidence of anemia over a period of years despite a persistent pulmonary infiltration. It is the purpose of this report to compare the clinical and pathologic observations in these two patients to those made previously in IPH. REPORT OF CASES CASE 1. —A 29-year-old Negro male was referred to the hospital because of bilateral pulmonary infiltrates

Since the clinical syndrome of meningococcemia without meningitis was initially described by Salomon,1 numerous reports of chronic meningococcemia have appeared in the American literature.2-10 Benoit's 11 recent report constituted a review of the entire literature to date. It is the purpose of this report to re-emphasize some of the clinical features of the disease and to record distinctive features of the histopathology of the skin lesions. The skin lesion of chronic meningococcemia appears to differ from that of acute meningococcemia. These differences will be reviewed and a possible explanation offered. REPORT OF A CASE A 26-year-old airman gave a history of good health until July 17, 1962, when he noted the acute onset of fever with chills. On the third day a rash appeared on the feet and hands which was described by the patient as "little red spots." Because of these symptoms he was detained at a

Since Ellman and Ball1 first described the occurrence of widespread pulmonary lesions in rheumatoid arthritis, there have been a number of reports of interstitial pulmonary fibrosis in "rheumatoid disease." The purpose of this paper is to report two cases in which pulmonary lesions appeared as significant manifestations of the disease and to record the many unusual features presented by each of these patients. CASE 1. —A 67-year-old white woman was admitted to the hospital in January 1958 because of complaints of cough and chest pain of six months' duration and increasing dyspnea for three months. The patient had been in good health most of her life. She was hospitalized 15 years previously for repair of a rectal prolapse, and 5 years previously she had had an episode of herpes zoster. In April 1956, she was admitted to another hospital because of numbness of the left cheek and hands. There

The editorial committee for the Annual Review has carefully selected in-depth monographs on subjects of present medical interest for presentation. The text is divided by specialty and includes clinical pharmacology, genetics, obstetrics, psychiatry, and public health, in addition to the traditional subdivisions of internal medicine. Because of this diversity and the very specific nature of each review, it is necessary for the reader to scrutinize the contents carefully in order to choose for study those subjects of pertinence to his specific needs. I find it difficult to believe that a single reader will have an in-depth interest in both "Estimation of Gestational Age in the Fetal State" and "Endogenous Carbon Monoxide Metabolism." In recognition of this selectivity by the reader, the editorial committee has indexed each contribution by a number aligned in the margin of the title page for use in the direct order of reprints of the specific review.