We present an unusual tumorous variety of scleromyxedema mimicking facies leonina in lymphoma. In spite of pronounced and widespread cutaneous changes, hypergammaglobulinaemia and paraproteinaemia, the general condition of the patient was satisfactory, there was no internal involvement and no symptoms of any malignancy. Initially, melphalan and corticosteroids were applied but were not effective. High-dose intravenous immunoglobulin (IVIG) therapy had dramatic effect, and after five 5-day monthly courses the tumours almost regressed and the skin became less hard. After a further five courses in the following year there was complete clearance, which was sustained without any therapy for 1 year (until now). IVIG appears to be the therapy of choice for scleromyxedema. We stress, however, that at the start of therapy, IVIG applications should be supplemented with small doses of melphalan and/or corticosteroids.
Pancreatitis is an obvious but a rare event in pregnancy. From mild disease to multiorgan failure and sepsis acute pancreatitis has numerous causes and an often unpredictable outcome. The authors present a case of 22-year-old pregnant woman with severe pancreatitis due to biliary sludge. An unusual clinical manifestation of pancreatitis in our patient is worth emphasizing: massive bleeding from upper alimentary tract and concomitant two pancreatic fistulas. The bleeding is a manifestation of the pancreatic juiceinduced injury to the splenic artery, whereas the fistulas are consequence of the disconnected duct syndrome and superficial necrosis of the pancreatic head. After two and a half years lasting treatment the patient was on regular oral diet with supplementation of pancreatic enzymes, and showed normal glycaemia level. She returned to fully physical activity.
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