A 56-year-old white male was admitted to the hospital due to multiple skin lesions. In addition, he complained for dysuria and hematuria within the last month prior to his admission, with clinical characteristics compatible with urethritis or prostatitis. One month prior to his admission, pruritic skin lesions appeared, first on his back, and then spread to upper extremities trunk and finally to the lower extremities. His primary physician treated him with steroids per os but no improvement was achieved. During the last days prior to his admission the patient noticed an increase in the number of skin lesions, as well as seropurulent discharge from several of them. The patient did not report arthralgias, anorexia, or loss of weight. His past medical history included an idiopathic thrombocytopenic purpura episode 8 years ago, a cytomegalovirus "mononucleosis like" infection 1 year ago, and a urinary truck infection (not otherwise specified) six months ago.

Physical examination revealed multiple skin lesions with diameter ranging from 0,5 cm to 5 cm (Figures 1 and 2). Some lesions had a central crust, while others an erythematous halo. The lesions were in different shapes vesicles and pustules, coalescing in some areas. In some of the lesions, seropurulent discharge was present. No lymphadenopathy was found. The rest of the physical examination was normal.

A 35-year-old man with no significant past medical history suffered from relapsing infections of the upper respiratory tract and episodes of nasal bleeding for five months. Chest radiography, which was perfomed in a local hospital, showed a big infiltrate in the right upper pulmonary field. Fiberoptic bronchoscopy was performed twice and a Staphylococcus aureus strain and a Klebsiella pneumoniae strain grew from bronchial samples. The patient had no clinical improvement despite the anti-bacterial and anti-tuberculous treatment that he received for a month.

The patient refused to be operated on for the postulated diagnosis of a pulmonary abscess. He was admitted in an infectious diseases department of another hospital for the management of a persisting pulmonary abscess despite the antimicrobial treatment that he received. Physical examination on admission in our hospital showed fever up to 38.80 C. There were small blood clots in the nose. The examination of the chest showed ronchi in the upper right lung field.

Laboratory tests on admission revealed white blood cell count (WBC) of 13,230/cubic mm (neutrophils = 77.9%, lymphocytes = 12.9%), hematocrit (Ht) =36.3%, platelets =588,000/cubic mm, C-reactive protein = 21.74 mg/dl (normal values < 0.50 mg/dl), and erythrocyte sedimentation rate (ESR) = 105 mm/first hour (normal values 0-20 mm). Laboratory tests for cancer indices and renal function, including urinalysis, did not show abnormal findings. Chest radiography and computed tomography of the thorax showed a big infiltrate with a central cavitation in the right upper pulmonary field (figure 1 and 2). Craniofacial computed tomography revealed ethmoid sinusitis.

A 37-year-old Greek woman presented for a routine "check up" physical examination. Her past medical history included mitral valve prolapse, an episode of herpes zoster of the first branch of the left trigeminal nerve, and a cyst in the left ovary, which did not need surgical removal. She did not complain of any symptoms.

Physical examination revealed a systolic murmur over the mitral area with intensity 2 out of 6, which was attributed to the known mitral valve prolapse. Deep palpation of the right upper abdominal quadrant caused mild discomfort and pain to the patient. The rest of the physical examination was normal.

Routine laboratory testing, including complete blood cell count, serum glucose, creatinine, total lipids, cholesterol, triglycerides, alanine animotransferase (ALT), aspartate aminotransferase (AST), gamma glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), iron, ferritin and thyroid hormones (T3, T4, TSH) did not reveal any abnormal findings. There was a slightly elevated erythrocyte sedimentation rate (ESR) [26 mm/first hour (normal values less than 20)]. The finding of the right upper abdominal quadrant tenderness was further investigated with an ultrasound (U/S) examination, which revealed a well-circumscribed mass, with mixed echographic pattern, in the right hepatic lobe. A contrast enhanced CT of the abdomen was subsequently performed (Figures 1 and 2). What is the diagnosis?

A 49-year-old woman complaining of thoracic spine pain for 18 months was admitted to the hospital for evaluation. The pain was accompanied by profuse sweating but she did not report any fever.

Physical examination revealed tenderness of the affected area on percussion, as well as pain and limitation of motion.

Erythrocyte sedimentation rate (ESR) was 86 mm (first hour). Chest x-ray showed destruction of the lower part of the body of the eighth thoracic vertebra. Magnetic resonance imaging of the thoracic spine showed pathology of the T8-T9 intervertebral disk and destruction of the T8 vertebral body (Figure 1). Computed tomography scan-guided fine needle aspiration of the affected disc was performed. Gram stain and culture of the obtained specimens for common microorganisms and Brucella species were negative. Serology tests for brucellosis were also negative. In addition, Ziehl-Neelsen stain, polymerase chain reaction (PCR), and culture for Mycobacteria were negative. Because of continuing symptoms and lack of diagnosis the patient underwent a vertebrectomy and substitution of the eighth thoracic vertebra with Moss titanium cylinder filled-up with auto-bone grafts. The stabilization was completed using the Kaneda system (Figure 2).