A 64-year-old Japanese man presented with a 2-month history of dyspnea and 1 month of visual disturbance. Laboratory results showed anemia, low platelets, hypoalbuminemia, and elevated lactate dehydrogenase (LDH). Due to high LDH with isozyme II predominance, we suspected intravascular lymphoma (IVL) and performed random skin and bone marrow biopsies, which showed intravascular large B-cell lymphoma with hemophagocytosis. Although nonspecific symptoms are common in IVL, increased serum LDH and hypoalbuminemia are important clinical features. Performing random skin and bone marrow biopsies for Asian patients with IVL is imperative due to the high incidence of bone marrow lesions.

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A 55-year-old man with a history of bipolar disorder on lithium therapy presented with loss of appetite, tremor and ataxia. The lithium had been increased from 600 mg to 800 mg per day 3 months before. Six weeks after that, he developed a change in taste, loss of appetite and weight loss. Serum lithium and creatinine levels increased from 0.5 mEq/L and 0.8 mg/dL to 2.6 mEq/L and 1. 95 mg/dL, respectively, and chronic lithium intoxication was diagnosed. Our case emphasizes the importance of careful attention to dosing and monitoring of lithium due to its narrow therapeutic index. Clinicians should be aware of taste change as a side effect of lithium therapy because it leads to dehydration and decreased renal function, resulting in chronic lithium intoxication.

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Toxic shock syndrome (TSS) is an acute febrile illness characterized by hypotension, diffuse erythroderma, and multisystem involvement. In severe cases, TSS can cause multiple organ failure or death. TSS is associated with many clinical situations, such as menstruation, postoperative and postpartum recovery, burns, and respiratory infections. However, TSS associated with the use of wound-dressing for an abrasion has not previously been reported. Here we report a case of staphylococcal TSS associated with the inappropriate use of wound-dressing. A 21-year-old otherwise healthy man visited our hospital complaining of two days of fever, nausea, vomiting, and diarrhea. Four days prior to admission, he fell from his motorcycle and suffered a leg abrasion. The next day, a moist wound-dressing was applied. On admission, his body temperature was 39.7 °C and blood pressure 83/50 mmHg. He had diffuse erythroderma and conjunctival hyperemia. A workup revealed elevated serum creatinine and liver enzyme levels. We suspected TSS, so fluid resuscitation and treatment with antimicrobials were begun. Methicillin-sensitive Staphylococcus aureus, which produced TSST-1, was isolated from the wound exudate. A diagnosis of TSS was made. He was successfully treated through the use of antimicrobials and drainage of the infected wound. He was discharged 14 days after admission without any sequelae. This is the first report of a case of staphylococcal TSS associated with the inappropriate use of a wound-dressing for an abrasion. TSS caused by wound-dressing may be rare but should be made well-known to both health care providers and the public.

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Ovarian vein thrombophlebitis (OVT) is a potentially fatal disease occurring in the postpartum period. Although OVT can be fatal owing to complications such as pulmonary embolism or sepsis, it is often under-recognised and misdiagnosed as appendicitis or pyelonephritis owing to its rarity. Our paper describes a case of a previously healthy 35-year-old woman with postpartum right OVT. The patient presented with fever and right flank pain for a month, which started a week after an uneventful delivery. Although a gynaecologic consultant made a diagnosis of acute pyelonephritis, several imaging studies supported a diagnosis of postpartum right OVT complicated with thrombus in the inferior vena cava. We treated the patient with ampicillin-sulbactam and anticoagulation with intravenous heparin and subse- quently, oral warfarin. The patient improved without complications. Our experience underpins the importance of precisely taking the gynecological history of patients with acute abdomen and considering OVT as a possible cause of acute abdomen or fever in the postpartum period.

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