Olmesartan-associated enteropathy is a rare cause of severe enteropathy that should be considered in the differential diagnosis of patients with unexplained chronic diarrhoea. It may be difficult to recognise because of its clinical and histologic similarities to other clinical entities. The authors present the case of a 72-year-old woman with a 6-month clinical history of non-bloody diarrhoea and weight loss. Discontinuation of olmesartan resulted in clinical and histologic recovery, and therefore, physicians need to be aware of olmesartan-associated enteropathy in order to avoid unnecessary testing. Although rare, it is considered an emerging and underdiagnosed enteropathy. LEARNING POINTS Olmesartan-associated enteropathy is characterised by chronic diarrhoea (often severe) and weight loss that is unresponsive to a gluten-free diet. When a patient presents with unexplained chronic diarrhoea, a detailed medication review is needed. If duodenal biopsies reveal villous atrophy and coeliac disease is excluded, drug-induced enteropathy is likely. Clinical response and histologic improvement are expected after olmesartan is withdrawn.

SUMMARY Drug-induced liver injury (DILI) to flucloxacillin is rare and is classified as idiosyncratic, as it is dependent on individual susceptibility, unpredictable, and dose-independent. The authors present the case of a 74 - year - old man with a history of monoclonal gammopathy under investigation and alcoholic habits of 24 g/day, with asthenia, anorexia, nausea, abdominal discomfort, and fever with three days of evolution. He was treated with two courses of antibiotic therapy with flucloxacillin to erysipelas previously (3 months and 2 weeks before admission). Lab tests showed serum AST levels of 349 U/L, ALT 646 U/L, alkaline phosphatase 302 U/L, GGT 652 U/L, total bilirubin 3.3 mg/dL and direct bilirubin 2.72 mg/dL. Infectious, autoimmune, and metabolic causes were ruled out. Magnetic resonance cholangiopancreatography showed normal results. Liver biopsy showed mild multifocal (predominantly microvesicular) steatosis; marked changes in the centrilobular areas (sinusoidal dilatation, marked congestion, hemorrhage, and multifocal hepatocyte collapse); expansion of the portal areas with the formation of bridges; proliferated bile ducts and inflammatory infiltrate of variable density, predominantly mononuclear type. The HLA-B*5701 screening test was positive. Hepatic biochemical tests remain abnormal with a significative increase in total bilirubin, which reached levels of 24.1 mg/dL, with the development of jaundice, pruritus, and choluria. DILI was assumed, and the patient was treated with ursodeoxycholic acid. There was favorable evolution, without evidence of blood coagulation dysfunction or encephalopathy. The analytic normalization was, however, slow, with evolution to chronicity. The authors present this case to remind the possibility of moderate/severe drug-induced liver injury to flucloxacillin, an antibiotic commonly used in clinical practice and association with the HLA-B * 5701 allele reported in the literature.

This paper presents the forecast of electricity consumption based on mathematical models by using the available historical consumption, with daily resolution, including upscaling, applying a hybrid model that incorporates multiple linear regression with artificial neural networks. Therefore, the hybrid model exploits both the unique features of the regression model and of the artificial neural network to determine different patterns. Thus, it is advantageous to model linear and nonlinear patterns separately using different models and then combine the forecasts to improve overall performance modelling and forecasting. The applied methodology is very reliable given that the forecast errors are close to zero, and the observed differences are justified essentially by temperature effect.

A masquerade syndrome is an ophthalmological entity where a neoplasm mimics an inflammatory condition. Ocular melanoma (chiefly uveal) may present with symptoms suggestive of intraocular inflammation such as endogenous endophthalmitis. Ocular melanoma is most commonly found in middle-aged and older caucasian patients. One-third of all uveal melanoma cases present asymptomatically. Early diagnosis facilitates treatment before ocular melanoma reaches metastatic stage IV. Current therapy options for stage IV patients are palliative care and clinical trial participation.eed for clinicians to be aware of rare metastases at the time of diagnosis.

Terlipressin is used for the treatment of bleeding oesophageal varices and hepatorenal syndrome in patients with cirrhosis. Adverse effects are usually minimal. However, potentially serious side effects such as skin necrosis involving the extremities, scrotum, trunk and abdominal skin can rarely occur. Our patient had greater skin involvement than other described cases. We present the case of a patient with extensive skin necrosis, unrelated to the infusion site, in the lower and upper limbs, scrotum and abdomen after the use of terlipressin. Skin necrosis secondary to terlipressin is a rare complication and early identification is essential so the drug can be immediately suspended.LEARNING POINTSSkin necrosis secondary to terlipressin is a rare complication.Early identification is essential so the drug can be immediately suspended.Death is not directly related to the skin necrosis but to the secondary complications of advanced liver disease.

SUMMARY Goiter is a localized or generalized thyroid hypertrophy. It can remain within the cervical region or grow down until it invades the mediastinum. The signs and symptoms depend on the size and location of the goiter. Although drugs and radioactive iodine are often used to treat thyroid disease, the presence of symptomatic substernal goiter is a clear indication for surgery. Death or postoperative complications rarely occur. We present a case of a 71-year-old man with recurrent thyroid pathology in the form of substernal goiter and hyperthyroidism even after partial thyroidectomy. The importance of this relates to the clinical evolution, volume, and location of the goiter as well as the surgical and pharmacological approach.