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Infectious mononucleosis (EBV infection), in its classical presentation, consists of the clinical triad of fever, pharyngitis, and cervical lymphadenopathy. Because of uncommon presentation, clinical manifestations are less well described in older age [1]. We present the case of a 53-year-old woman who was admitted to our hospital due to epigastric pain. Esophagogastroduodenoscopy revealed only gastritis. On the second day, the patient was febrile. WBC count was 11400 (neutrophils: 86.5%), ESR 86 mm/h, and CRP 187 mg/L. Chest X-rays, followed by a CT scan, showed a gradually growing irregular opacity with an air bronchogram sign in the right lower lobe with small bilateral infiltrates and pleural effusions. Consequently, IV antibiotic administration was started. At the same time, anemia occurred (Ht: 21.8%, Hb: 7.1 g/L while, on admission, Ht was 31% and Hb 10.5 g/L). A diagnosis of autoimmune hemolytic anemia was made, taking into account a positive Coombs test and an increased reticulocyte count. Moreover, cold agglutinins could not be detected. Prednisolone was initially administered at 50 mg/day and then increased to 75 mg/day, and a gradual improvement was noticed. On the 9th day, the patient became afebrile and the

The use of herbal remedies continues to increase in developed countries. Ma-huang is a Chinese herbal product that is often used for weight loss and energy improvement. One of the adverse effects of Ma-huang is hepatotoxicity. We present the case of an adult with acute hepatitis due to Ma-huang. A previously healthy 28-year-old man was admitted to our department complaining of epigastric pain and nausea. He was jaundiced. He reported no recent unusual travel, exposure to hepatitis, or alcohol or drug abuse. Further inquiry revealed the use of Ma-huang for bodybuilding during the previous 2 months. The patient stopped taking Ma-huang on the day of his admission. Liver biochemistry on admission was indicative of hepatitis, while serology for hepatitis B, C, herpes viruses, and HIV were negative. Antinuclear antibodies were present at a titer of 1:80 and anti-smooth muscle antibodies were negative. Abdominal ultrasound and computed tomography were normal. Nine days later, the patient's liver biochemistry was normal, antinuclear antibodies were negative, and his clinical condition had improved. The active component in Ma-huang is ephedrine. Dilated cardiomyopathy, arrhythmias, headache, insomnia, and nervousness are some of Ma-huang's known adverse effects. Hepatotoxicity resulting from the use of Ma-huang is quite rare, with only a few cases of acute hepatitis having been reported [1]. Without specific clinicopathological findings, the diagnosis of hepatitis is based on the temporal sequence of clinical events associated with its use and on the exclusion of other causes of hepatitis. The mechanism for liver injury seems to be either immune-mediated or idiosyncratic. The purpose of our report is to indicate that physicians should always consider herbal medicines as a possible cause of unexplained hepatitis. Given that its distribution remains unsupervised, patients should be asked specifically about their use. The immediate cessation of Ma-huang when hepatitis is diagnosed is mandatory; otherwise, irreversible liver injury may occur [2]. References

Pasteurella multocida infection is a rare zoonosis that often occurs in immunocompromised patients. Close contact with, or exposure to, domestic animals is a considerable risk factor. Respiratory infection is the second most common type of Pasteurella infection, after skin and soft tissue. We present the case of a non-immunocompromised elderly man with bilateral bacteremic pneumonia due to P. multocida. An 85-year-old man with a history of epilepsy and venous insufficiency was admitted to our hospital for hematemesis. On the first day of hospitalization he manifested fever and sepsis. The patient mentioned having had close contact with cats, but he could not recall being bitten or scratched. There was a 5 8cm clean ulcer on his left foot, without any sign of local infection, due to chronic venous insufficiency. He had mild anemia, an elevated WBC count, and highly elevated ESR and CRP. Chest CT showed bilateral basal consolidations and mild pleural effusions. P. multocida was isolated in blood cultures. The patient was treated with amoxicillin/clavulanic acid for 20days and became afebrile on the 15th day of the treatment [1]. Endoscopy revealed that hematemesis was attributed to a bleeding ulcer of the stomach.