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Adult onset Still's disease is an inflammatory disorder characterized by daily spiking high fevers, arthritis and an evanescent rash. It is a rare disease of unknown aetiology and can be life-threatening. We present a case of adult onset Still's disease associated with myocarditis requiring the use of invasive ventilation, in which the patient responded well to systemic steroids.

A 28-year-old girl suffering from lysinuric protein intolerance was referred on account of severe chronic respiratory failure. Since childhood she had failure to thrive with chronic hyperammonaemia and interstitial lung disease but normal respiratory function. At the age of 21, she experienced haemoptysis and worsening of the respiratory disease. CT scan of the chest showed bilateral, symmetrical ground glass opacities and subpleural cysts. At the age of 25, nocturnal non-invasive ventilation was initiated. Lysinuric protein intolerance is an exceptional genetic cause of interstitial lung disease.

Hypercalcaemia occurs in less than 15% of lymphomas but is associated with a poor prognosis. A patient known to have a testicular lymphoma was admitted because of asthenia and weight loss. Hypercalcemia and high serum level of calcitriol were found. A high-grade lymphoma attesting a Richter's syndrome was diagnosed. Palliative treatment consisting in corticosteroids and pamidronate was instituted. Hypercalcaemia in lymphoma has a poor prognosis and is often attributed to an acquired uncontrolled vitamin D 1-alpha-hydroxylase activity by the macrophages close to the lymphomatous cells. Influences of TNFalpha, interleukine 6 and PTHrp are also reported.