121 e-Letters

published between 2014 and 2017

  • Choice of antibiotic
    Thomas C Morris

    This is a well written Case Report and helpfully describes some pathology (as well as the phenomenon of S. aureus disease relapse). It should be noted, however, that whilst the supporting evidence for i.v. Linezolid is that it is non-inferior to Vancomycin, it is abundantly clear in the literature that i.v. Vancomycin is wholly inferior to i.v. Flucloxacillin. Regarding data on disc penetration, Gibson et al tested this...

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  • Pulmonary sarcoidosis: calcification within the galaxy sign
    Roberto Calisti

    A relevant and very well described case, useful for ongoing comprehension of sarcoidosis'pathogenesis. The "galaxy sign" summons for a spreading of causal agents (mineral dusts ? bacteria ? others ?)from a "mother" lesion to surrounding areas, in coherence with recent interpretations of sarcoidosis as a peculiar, common reaction to different xenobiotics, particularly in contexts of "heavy" exposomes. Calcification is a...

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  • Diagnosis unconfirmed
    Neil Turner

    This could possibly be anti-GBM disease, though bloody diarrhoea isn't a feature of that condition. But there wasn't a renal biopsy to confirm, or specificity tests on the antibody (e.g. Western blotting with it) so evidence is only the ELISA result. Most such assays encounter occasional false positives.

    Conflict of Interest:

    None declared

  • Neurosarcoidosis: Diagnosis towards Clinical Insight
    Wisam AK Yassin

    Dear Sir, We have read your impressive article "Neurosarcoidosis presenting as a large dural mass lesion" published in BMJ Case report on 8 November 2016. I have read about neurosarcoidosis thoroughly because of my previous exposure with few patients who were recovered as per diagnosis and prognosis.

    First, your esteem has mentioned that the biopsy confirmed the diagnosis while the diagnosis of sarcoidosis depe...

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  • A daily dose of 3,000 IU vitamin D should be safe in a 4-year-old child
    Adrian R Martineau

    The case report from Dr. Boyd and Dr. Moodambail highlights the potential for over-zealous administration of vitamin D to result in toxicity (1). However, we contend that it is very unlikely that the reported daily dose of 3,000 IU (75 micrograms) vitamin D would elevate serum 25-hydroxyvitamin D (25[OH]D) concentrations to over 2000 nmol/L in a 4-year-old child. The US Institute of Medicine specifies a safe Upper Level...

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  • Optimum management of Femoral Neck Stress Fractures.
    Alexander M. Wood

    We would like to thank Petrin et al for an informative case report[1] on an important injury sustained in athletes and service personnel. We agree that a high degree of suspicion for stress fractures should be maintained as we have previously reported the problems with a missed femoral neck stress fracture[2], and the more literature that is available highlighting these training injuries is useful for medical staff lookin...

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  • Non-Disclosure of CAM usage: a case of "for every complex problem, there is a solution that is plain, simple and wrong"?
    Sandra L Lucas

    We thank Dr. Boyd and Dr. Moodambail for their recent article in BMJ Case Reports, which describes the case of a four-year old boy with hypercalcaemia and hypervitaminosis D that was possibly attributed to the inappropriate prescribing of nutrient supplements. The case was complicated by the fact that the parent failed to disclose the use of these supplements until several days into the child's admission.


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  • Re: Trandermal Hyoscine Induced Unilateral Mydriasis
    Sarah C Alexander

    A 4 year old patient with a known diagnosis of a brainstem glioma, ventriculo-peritoneal shunt and ventricular access device was referred to our paediatric district general ward for review following a head injury. She had been knocked over at nursery by her brother on a bicycle and sustained an occipital head injury. Following this, the nursery staff noticed that her pupils were asymmetrical. Mum had collected her from...

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  • Aspirin unmasking acquired haemophilia A in a patient with prostatic cancer
    Arvind Ganesh Kulkarni

    Malignancy of the prostate is very well known to liberate lots of tissue factors controlling the coagulation process. This patient must have developed some sort of Disseminated intra vascular coagulation which was enhanced by the simultaneous administration of Aspirin. Most of the tests used to diagnose a particular coagulation deficiency have a considerable overlap in clinical setting. To say that this patient has develo...

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  • Vitamin D
    Anne Thomas

    I think it is irresponsible of this author not to mention that there has indeed been research linking vitamin D to Autism and it is quite reasonable for parents to consider that supplements might improve their child's symptoms. https://www.vitamindcouncil.org/health-conditions/autism/ I have certainly seen in clinical practice a reduction in autistic symptoms in patients over the summer months.

    There is also evi...

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