We report two cases of unintentional poisoning with anticholinergic agents. The first patient, a 7-year-old girl, was prescribed four different medications by a general practitioner for treatment of abdominal colic and diarrhoea. All drugs had anticholinergic properties. The second patient, a 16-month-old boy, ingested his mother's cyproheptadine tablets. Both children presented with central and peripheral symptoms and signs compatible with acute anticholinergic syndrome. They recovered spontaneously following intravenous fluid replacement and close observation. Gastric lavage was also performed on the boy. Poisoning with cholinergic antagonists in children is a potentially serious hazard in Hong Kong. It may be avoided by careful prescribing on the part of general practitioners and safe storage of all medicinal products in the home environment.

We report on two patients who presented with status epilepticus due to ingestion of rat poison containing tetramine. Both had eaten the same meal, subsequently presumed to be the source of the poison. Physical examination and investigation were unremarkable and diagnosis was based on patient history. Seizures were ultimately controlled with ketamine, after unsuccessful attempt of benzodiazepine and sodium thiopentone. One week after poisoning, both patients underwent one session of high-volume haemofiltration followed by charcoal haemoperfusion to eliminate the toxin from the body. Plasma tetramine levels then decreased from 0.95 ug/mL to 0.35 ug/mL and from 0.53 ug/mL to 0.40 ug/mL, respectively.

Initial presentation of a malignant disease as recurrent attacks of lower limb ischaemia due to emboli from a mural thrombus in the descending thoracic aorta is extremely rare. A diagnosis of malignancy may thus easily be overlooked. Recent advances in imaging technology have made the diagnosis of thoracic aortic mural thrombi much easier. Occult malignancy should always be suspected in the absence of biochemical evidence of hypercoagulability. We report on a patient with underlying malignant disease who presented with lower limb ischaemia that was relieved by axillobifemoral bypass.

We report the successful treatment of infective endocarditis caused by Streptococcus mitis with linezolid in a patient with pre-existing valvular heart disease. The patient had multiple allergies to conventional antibiotics. Linezolid may provide an oral alternative in the treatment of infective endocarditis in patients with adverse drug reactions to traditional antibiotic regimens.

Brucellosis is an infectious disease of humans and animals caused by Brucella species. We report on a 34-year-old housewife who presented with recurrent headache, fever, and malaise. Blood cultures yielded slow-growing gram-negative coccobacilli that were later identified as Brucella melitensis. The patient recalled handling goat placenta in China. She was prescribed a 6-week course of doxycycline and rifampicin. Laboratory staff who had been exposed to the isolate remained asymptomatic. The epidemiology, diagnosis, and treatment of brucellosis are discussed.