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Chronic hepatitis patients undergoing immunosupressive or cytotoxic treatment may develop acute hepatitis or fulminant hepatitis due to reactivation of hepatitis B virus (HBV) and these patients may lose their lives after their treatments are discontinued. Lamivudine which was the first oral drug developed against chronic hepatitis in 1999 is a nucleoside analogue, and it shows its effect by inhibiting reverse transcriptase enzyme. Lamivudine has also been shown to be relatively safe for its side effects when compared with the interferon treatment. In this article we reported the HBV reactivation in four cases of HBV carriers with lymphoma to whom chemotherapy was applied, and the effectiveness and safety of the lamivudine treatment.

A non-Hodgkin’s Iymphoma case with actinomycosis of the tongue in a forty-three years old male patient is described in this article. The patient hospitalized because of NHL relapse and ifosphamide, methotrexate, bleomycin, prednisolone and intrathecal methotrexate were given as chemotherapy. In the course of the hospital stay, fungemia has been documented and an isolated lesion has emerged in the tongue. Wedge biopsy was performed yielding the diagnosis of actinomycosis. The case is reported from the point of its rare localization and clinical presentation, diagnostic methods, differential diagnosis and treatment. Actinomycosis should be beared in mind in immunocompromised patients with oral lesions.

Fever of unknown origin is defined as fever above 38.3°C in several episodes in 3 weeks period, in the absence of specific diagnosis established by the end of 1 week inpatient evaluation. Sixtytwo patients, fitting the criteria of fever of unknown origin, followed in our clinics between 1993-1997 were investigated retrospectively. Minor or major invasive procedures were applied to 46 (74%) (7 laparotomies) patients. A specific diagnosis has been established in 55 (89%) patients. Infections, connective tissue diseases, neoplasms and other diseases were diagnosed in 31(50%), 13 (21%), 7 (11%) and 4 (6%) cases respectively. Among all, infections were the leading cause. When the infections were considered; tuberculosis (12 cases 19%) was the first in rank followed by endocarditis (7 cases 11%). Disseminated tuberculosis was the most frequent tuberculosis form. Still’s disease (5, 8%) and lymphomas were the leading forms of connective tissue diseases and neoplasms respectively. No diagnosis has been established in 7 (11%) out of 62 patients. Laparatomy had direct contribution to diagnosis in 6 cases making the diagnostic value of the procedure 86%. In the circumstances of our country, infections are the leading cause of fever of unknown origin and beyond tuberculosis; endocarditis and brucellosis should be beard in mind.

Fever of unknown origin (FUO) is described as documented fevers above 38.3°C, for more than three weeks of duration and lack of a specific diagnosis after one week of investigation. The most common causes of FUO in adult patients are infections, neoplasms and collagen vascular diseases. In adults, the most common causes of FUO are infections. Also in our country, more than half of the reported cases are caused by infections. Infective endocarditis is reported as the cause of 0-8% of FUO cases in developed countries, and 0-3.8% in our country. In this study, we established the diagnosis of infective endocarditis in 11.2% (7 patients) of 62 FUO patients. We discussed the diagnostic difficulties, probable predisposing factors, clinical and laboratory findings of infective endocarditis and the role of infective endocarditis in FUO cases in our cauntry by reviewing these seven patients with infective endocarditis.