An autopsy performed on a 53-year-old man who had unrelieved obstruction of the small bowel due to gallstone ileus revealed morphological features that were typical of acute Wernicke's encephalopathy. The likely sequence of disease in this patient was the development of thiamine deficiency owing to the unrelieved intestinal obstruction, which resulted in the development of acute Wernicke's encephalopathy. A high clinical awareness is required for the diagnosis of acute Wernicke's encephalopathy in patients with malnutrition from any cause.

Eosinophilic gastroenteritis is a rare disorder characterised by eosinophilic infiltration of the bowel wall and various gastrointestinal manifestations. Diagnosis requires a high index of suspicion and exclusion of various disorders that are associated with peripheral eosinophilia. We report on a woman who had a short history of abdominal pain and ascites, and who responded dramatically to a course of low-dose steroid.

A 26-year-old Thai woman who has lived in Hong Kong for the past 3 years presented with a 2-month history of feverishness, intermittent epigastric discomfort, anorexia, and weight loss. She had had per rectal bleeding for 10 days. Colonoscopy on two separate occasions revealed multiple ulcerations involving the entire colon, with rectal sparing. Histological examination of the two sets of colonic biopsies that were obtained during colonoscopy suggested Crohn's disease. There was no response to mesalazine and metronidazole, but the patient responded promptly to a therapeutic trial of antituberculous drugs. Cultures from the first set of colonic biopsies were negative for acid-fast bacilli, but 8 weeks after the second colonoscopy, cultures from the second set of biopsies yielded Mycobacterium tuberculosis. This case illustrates that the diagnosis of colonic tuberculosis requires a high index of suspicion. In cases where the information available does not reveal a definite differentiation between colonic tuberculosis and Crohn's disease, corticosteroids should be withheld. The administration of corticosteroids to a patient with colonic tuberculosis may have disastrous results, and a therapeutic trial of antituberculous drugs should be considered instead.

We report on a healthy 34-year-old woman who received an elective myomectomy for uterine fibroid, and postoperatively developed fatal streptococcal toxic shock-like syndrome. We discuss the series of events that led to this life-threatening disease and its pathophysiology, and suggest areas in which management might have been improved.

Hereditary angioedema is characterised by recurrent episodes of peri-orbital and peri-oral swelling which can cause an upper airway obstruction, abdominal pain, vomiting, diarrhoea, and even hypotensive collapse. This potentially fatal condition is frequently misdiagnosed; its early recognition and appropriate treatment are thus important. We report a familial cluster of hereditary angioedema in a Chinese family and describe the clinical course of two patients.