We present the case of a 33-year-old lady who was diagnosed with disseminated Kaposi’s sarcoma and HIV infection. The patient improved on highly active antiretroviral therapy (HAART), however, nine days into treatment, she became febrile and dyspnoeic and developed tender cervical and axillary lymphadenopathy. Despite treatment for suspected sepsis and immune reconstitution, she died in intensive care. Lymph node biopsies revealed coexistent Castleman’s disease and Kaposi’s sarcoma. Initiation of HAART can be rarely associated with unmasking and rapid progression of Castleman’s disease, a phenomenon called immune reconstitution. Urgent investigation and treatment with agents such as steroids and cytotoxic drugs can be life-saving.

Untreated biliary cholestasis such as in the case of choledocholithiasis with biliary obstruction can lead to inflammatory strictures, recurrent cholangitis, the formation of more stones and eventually secondary biliary cirrhosis. This can lead to a shortened life expectancy. We report a case of a 61 year old male from Somalia, who presented with recurrent painless jaundice. He had had similar presentations in another country but lacked documentation to show the treatment ensued. Liver function tests (LFTs) at our institution showed evidence of cholestasis. Repeated initial radiological studies failed to show any biliary dilatation and/or obstruction but did reveal evidence of liver cirrhosis with portal hypertension. A liver biopsy at this stage showed bile plugs consistent with a cholestatic picture, as well as evidence of secondary biliary cirrhosis. A magnetic resonance cholangiopancreatography (MRCP) confirmed the presence of biliary dilatation secondary to choledocholithiasis. He underwent an endoscopic retrograde cholangiopancreatography (ERCP), which showed common bile duct stones and an associated biliary stricture, as well as features suggestive of secondary sclerosing cholangitis (SSC) of the intrahepatic ducts. Dilatation and stenting of the stricture were performed, while complete stone clearance was achieved at the second ERCP. LFTs decreased gradually thereafter. Biliary drainage in a patient with cholestasis from a mechanical cause should be the mainstay of treatment. Every effort should be made to prevent the development of chronic cholestasis due to the risk of developing SSC and biliary cirrhosis. Our patient had unfortunately developed chronic choledocholithiasis, with radiological and histological evidence of liver cirrhosis at the time of presentation at our institution.

A young lady with a long history of recurrent infections was referred to the gastroenterology department by an infectious disease consultant because of a long history of profuse diarrhoea. A nitroblue tetrazolium (NBT) test performed in her mid-teens had shown zero reduction of the dye. The clinical, biochemical, radiological and endoscopic findings were suggestive of possible underlying Crohn's disease. However, the NBT test was more suggestive of a granulomatous colitis which frequently mimics Crohn's disease in patients with Chronic granulomatous disease. Management with immunosuppressants is proving to be very difficult in this patient in view of recurrent sepsis on introducing these drugs.