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The febrile episodes encountered in our pediatric oncology unit over a 2-year period were reviewed. A total of 138 febrile episodes were recorded in 59 patients (29 with leukemia and 30 with a solid tumor). There was no difference in the number of episodes between leukemia and solid tumor patients, nor between neutropenic and non-neutropenic patients. The degree of neutropenia was more severe in leukemia patients. A total of 18.8% of the episodes were accompanied by positive blood cultures. Gram-positive bacteria were more frequent than gram-negative bacteria, and there were four anaerobic isolates. Seventeen episodes were accompanied by clinical signs of central venous line (CVL) infection. A total of 70.2% of the episodes resolved with a first-line antibiotic combination of flucloxacillin, piperacillin, and netilmicin, 27.5% required modification of the antibiotic combination, and three patients (5%) died due to gram-negative septicemia. These findings indicate that the pattern of infectious complications in the United Arab Emirates is now similar to that observed in Europe and the United States.

Polymyalgia rheumatica should be suspected in older patients with bilateral shoulder and hip stiffness that is worse in the morning and improves with use. An array of nonspecifi c musculoskeletal complaints, constitutional symptoms, and elevated serum infl ammatory markers may be present, so other conditions should also be considered. Prolonged glucocorticoids with patient-tailored dosing and duration are the mainstay of treatment. Corticosteroid-sparing therapy with adjunctive methotrexate may benefi t select patients. KEY POINTSRheumatoid arthritis, late-onset spondyloarthritis, and RS3PE (remitting seronegative symmetrical synovitis with pitting edema) are important mimics of polymyalgia rheumatica.Diagnosis usually requires either an elevated erythrocyte sedimentation rate (> 30 or 40 mm/h) or C-reactive protein level (> 6 mg/dL).Ultrasonographic evidence of infl ammation, especially subacromial bursitis, increases diagnostic specifi city.Patients should be evaluated at diagnosis and periodically for the development of giant cell arteritis.To help avoid relapse, therapy should continue until symptoms resolve, followed by slow tapering.Preliminary studies show possible benefi t from tocilizumab, an interleukin-6 receptor antibody, as monotherapy or for refractory cases.

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Constrictive pericarditis is a rare presentation. We need a very high index of clinical suspicion to diagnose the disease. It most commonly presents secondary to tuberculosis (TB) in the developing world and post-radiation therapy in the developed world. Classically, it presents with symptoms of heart failure and as pericardial thickening or calcification on imaging studies. In hospital settings, constrictive pericarditis is not usually considered as a differential in patients presenting with pleural effusion. According to the literature, associated pleural effusions in cases of constrictive pericarditis could be left-sided. Herein, we present two unusual presentations of cases with bilateral pleural effusions. One of our cases developed constrictive pericarditis with concurrent active tuberculosis. This is a rare presentation because, normally, constrictive pericarditis is a late complication of tuberculosis. We suggest that when dealing with cases of bilateral pleural effusion, the etiology of constrictive pericarditis should be considered.

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Giant cell arteritis (GCA) is a vasculitis causing granulomatous inflammation involving medium to large sized vessels and can lead to blindness. 1 Bisphosphonates, particularly amino-bisphosphonates such as zoledronate, have been reported to cause an acute phase response (APR) that can rarely elicit autoimmune reactions such as uveitis and scleritis. 2 A recent case report highlighted the development of GCA after administration of zoledronate. We sought to further evaluate this association via a retrospective study of patients who had received either zoledronate or ibandronate.

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