Article Types
Medical education
‘Once Bitten’: A Case of Tetanus Following Snakebite in Australia
We present a case of tetanus following a snakebite in Victoria, Australia. An otherwise healthy 58-year-old woman presented following suspected Tiger snake (Notechis scutatus) bite with envenomation. She was not up-to-date with tetanus vaccination and was not offered a booster vaccination. She re-presented 12 days later with features consistent with tetanus infection and was treated with tetanus immunoglobulin and metronidazole with clinical improvement. Snakebites remain a risk for tetanus infection and the assessment of tetanus risk should be included within clinical guidelines for Australian healthcare settings.
Adrian A. S. Doherty, Naomi N. E. Clarke, Sarah Fletcher, Sarah Huffam, Camille V. Awburn, Eugene Athan
Buruli Ulcer Acquired From Ringtail Possum Rescue
We describe the first reported Buruli ulcer case likely acquired from a ringtail possum scratch, which represents a newly recognised mechanism for Buruli ulcer acquisition. We aim to alert health practitioners of this possibility in order to educate patients and facilitate early Buruli ulcer diagnosis, which reduces morbidity and allows less complex treatment. We also aim to influence public health messaging around the risk of Buruli ulcer acquisition from handling sick or injured possums.
Daniel P. O'Brien, Naomi Clarke, Sara Bonnici, Mohammad A. Hussain
Intranasal Adrenaline Use for the Management of Insect Venom-Induced Anaphylaxis
Intranasal adrenaline has recently become available in Australia as a needle-free alternative to adrenaline autoinjectors for anaphylaxis management. Intranasal adrenaline may be particularly suitable for patients with barriers to adrenaline autoinjector usage, such as needle aversion or poor compliance with autoinjector carriage. However, although the data supporting real-world efficacy of intranasal adrenaline for anaphylaxis are growing, there is no published evidence confirming its efficacy in insect venom anaphylaxis. We report three cases of intranasal adrenaline (neffy, CSL Seqirus, Victoria, Australia) used to treat insect venom-induced anaphylaxis. Clinicians should be aware of the availability and current level of evidence for intranasal adrenaline for anaphylaxis management.
Thomas J. Young, Wilhelmina R. F. Johnson, Braydon L. Pennington, Troy Wanandy, Wun Y. Lau, Thanh-Thao A. Le
Q Fever Visceral Abscesses After Contact With Native Australian Marsupials
We describe two patients in Far North Queensland with acute Q fever. One patient had their infection complicated by a splenic abscess, the other developed a hepatic abscess. Both patients had contact with small Australian marsupials in the weeks before presentation and both required prolonged doxycycline to treat their infection.
Samantha J. Laws, Enzo Binotto, James Stewart, Jennifer Ho, Trent Yarwood, Josh Hanson, Simon Smith
A Rare Case of Storage Mite Anaphylaxis in Infancy
This is one of the first reported cases of storage mite anaphylaxis in Australia, occurring in an infant who had two episodes of severe anaphylaxis, triggered by previously tolerated foods. Both episodes occurred following extended periods of food storage, and in both instances, the child required two doses of intramuscular adrenaline. Skin prick testing was negative to implicated foods, but demonstrated sensitisation to house dust mite, and serum-specific IgE confirmed storage mite sensitisation. Clinician recognition of this condition is essential for timely diagnosis and implementation of preventive measures to reduce further episodes of life-threatening anaphylaxis in at-risk patients.
Eliza Kluckow, Katie Frith
Rhabdomyolysis After COVID-19
We report a case of a kidney transplant recipient who presented with generalised muscle pain, weakness and brown urine discoloration in the setting of acute severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Investigations demonstrated rhabdomyolysis with elevated creatine kinase levels and severe acute kidney injury (AKI). A muscle biopsy was consistent with an immune-mediated necrotising myositis. The patient received intravenous fluids, remdesivir and haemodialysis, with subsequent resolution of muscle injury and recovery of kidney function. This case indicates the potential for severe myositis to develop in patients with SARS-CoV-2 infection with the potential for rhabdomyolysis and AKI to occur.
Navya Kataria, Abel Devadass, Lana Sundac, Laura De Souza, Nabeel Sheikh, Samantha Ng, Scott Campbell, Yishen Wang, Ross S. Francis
When ‘Liver Enzymes’ Are Not Hepatic: Late-Onset Pompe Disease
Elevated liver function tests are commonly attributed to hepatic disease but may reflect extrahepatic pathology. We describe the case of an 18-year-old athletic woman with a 2-year history of elevated aspartate aminotransferase (AST), alanine aminotransferase (ALT) and creatine kinase (CK) levels, initially investigated extensively for hepatic causes. Despite normal liver imaging and biopsy, ongoing abnormalities prompted metabolic evaluation, leading to the diagnosis of late-onset Pompe disease. This case highlights the diagnostic challenges of rare metabolic myopathies, the importance of recognising muscle-derived aminotransferase elevation and the need for broad diagnostic consideration when standard investigations are unrevealing.
Shauna Madigan, Georgina England, Wayne Rankin
Lesson From Practice: Not Gone, Should Not Be Forgotten: Recognising PIMS-TS Cases in a Post-Pandemic World
We describe the clinical presentation, laboratory findings and complications of severe paediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (PIMS-TS), also known as multisystem inflammatory syndrome in children in a 16-year-old female diagnosed in June 2025. This case highlights the importance of prompt diagnosis of PIMS-TS in the post-coronavirus disease 2019 pandemic era to ensure timely and appropriate management.
Rana Sawires, Anneke Engwerda, Mehyar Khair Baik, Philip N. Britton, David P. Burgner
A Diagnostic Headache
Giant cell arteritis (GCA) is the most prevalent systemic vasculitis of the elderly and can lead to irreversible vision loss and stroke. We report the case of an 84-year-old woman who presented with a persistent headache, prompting investigation for GCA, initially with a temporal artery ultrasound (TAUS) scan. The results were suggestive of GCA and the diagnosis was confirmed on a subsequent temporal artery biopsy (TAB). TAUS is now part of the classification criteria of GCA, and a diagnosis can be made without biopsy. TAB should be reserved for high-risk patients with a negative TAUS result.
Thomas Glynn, Michelle T. Leech, Stacy K. Goergen, Emily Lin, Nadeem Toodayan, Ralph Junckerstorff
Treatment Failure and Post-Artesunate Delayed Haemolysis in a Returned Traveller From Uganda With Partially Drug-Resistant Severe Plasmodium falciparum Malaria
A man aged in his 40s, recently returned from Uganda, was hospitalised with Plasmodium falciparum malaria, with hyperparasitaemia of ~1.5×106 parasites/μL (26%). He received intravenous artesunate followed by artemether–lumefantrine. However, parasite clearance was delayed, and despite a negative blood film following treatment, the patient was readmitted 3weeks later with recurrent parasitaemia. Further testing for drug-resistant phenotypes and genotypes demonstrated reduced susceptibility to lumefantrine, an A675V mutation in the pfk13 gene and increased ring-stage survival, consistent with partial artemisinin resistance. The case highlights the high risk of P. falciparum treatment failure in patients with hyperparasitaemia and partial drug resistance.
Jye Travis, Kate McCarthy, Paul Chapman, Lawrence Huang, Angelica Tan, Qin Cheng, Bridget E. Barber
Localised Herpes Simplex Following Midline Laparotomy
An older man with Crohn's disease underwent emergency laparotomy for small bowel perforation. A peri-incisional vesiculobullous eruption developed 5days later. Histopathology demonstrated viral cytopathic changes, immunohistochemistry was positive for herpes simplex virus and HSV-1 DNA confirmed by polymerase chain reaction test, representing the first reported case of localised herpes simplex following abdominal surgery.
Jessica S. Bulluss, Paul Chee, Matthew J. Verheyden
Diagnosing Acute Kava Dermopathy: A Case Report of a Characteristic Cutaneous Eruption
A 41-year-old woman presented to the emergency department with a widespread pruritic, erythematous eruption following 6weeks of kava consumption for anxiety and insomnia. The eruption began on the abdomen and progressively involved the chest, upper back and face. Laboratory investigations revealed mild derangement of liver function test results. Skin biopsy results demonstrated folliculocentric inflammation and necrosis of sebaceous glands, consistent with acute kava dermopathy. Kava, a traditional anxiolytic herbal preparation, has been implicated in both chronic and acute cutaneous reactions, including ichthyosiform and sebotropic eruptions. Its active compounds, kavalactones, are hypothesised to provoke a cytotoxic T-cell–mediated response targeting sebaceous glands. This case is notable as it occurred in an Australian woman with no travel history to the Pacific Islands—a region where kava use is prevalent. Moreover, the distinct histopathological findings, rarely documented in the literature, provide valuable diagnostic insight and serve as a visual reference for clinicians encountering this condition.
Ali Abid, Nicholas Allen, Abeer Hagelamin, Christopher Henderson, Artiene Tatian
West Nile virus Kunjin subtype in rural NSW
The patient experienced headache, anorexia, body aches, and confusion during a camping holiday through central Queensland
Emily Gibson · Megan Whitley · Peter Murray · Linda Hueston · Jane Bennett · Raguharan Kathiresu · David N Durrheim
Splenic injury in severe cases of the zoonoses Q fever and rickettsial infection: diagnostic challenges
A 45-year-old man presented to a regional New South Wales emergency department with five days of malaise, lethargy and dyspnoea
Ashleigh Drury · Philippa Harrison · Aiveen Bannan
A case of Lyme carditis in a returned traveller: a rare cause of reversible heart block in Australia
A well 37-year-old male patient presented to a tertiary hospital in New South Wales in July 2024 with presyncope and his smart watch alerts indicating resting bradycardia at 40 beats per minute
Eunice Chuah · Hari Sritharan · Zachariah Seidman · Avedis A Ekmejian · Karin Chia
Platform trials: key features, when to use them and methodological challenges
Description of key platform trial concepts, when best to use platform trials (including operational considerations), and reflection on the way forward in Australia
Robert Mahar · Steve Webb · Ian Marschner · Andrew B Forbes · Katherine J Lee
No silver lining with health misinformation: argyria caused by intentional silver consumption
A 63-year-old man was brought to the emergency department after a fall with prolonged floor lie of two days, complicated by urinary retention and acute kidney injury, in the context of peripheral neuropathy
Luke Collins · Logesh Palanikumar · Stephen Bacchi
Hyperkalaemic cardiac arrest due to cream of tartar ingestion
A 70-year-old woman presented to the emergency department with symptomatic hyperkalaemia after excessive ingestion of potassium bitartrate to relieve constipation
Daniel Yee Lee Ng · Laksmi Govindasamy · Andrew Hughes · Hwee Min Lee
Neisseria meningitidis: an uncommon cause of conjunctivitis
A 28?year?old man developed a painful left eye with purulent discharge two weeks after recovering from coronavirus disease 2019
Chloe Story · Tina Marinelli · Simeon Crawford · Amrita Ronnachit
Lingual Raynaud phenomenon
An 18-year-old Australian, Indigenous woman with no medical history presented with five months of small joint polyarthralgia and Raynaud phenomenon
Michael Taggart · Mina John
Severe hypoglycaemia secondary to chronic opioid‐induced hypothalamic–pituitary–adrenal axis suppression: an under‐recognised phenomenon
A 49-year-old woman with type 2 diabetes mellitus was hospitalised with critical hypoglycaemia
Michael Do · Annabelle G Hayes · Malgorzata M Brzozowska
Platypus envenomation
A 62-year-old woman presented to an emergency department with severe pain two hours after rescuing a wild platypus, with two penetrating injuries to her right hand
Irene M Moyer de Miguel · Jennifer C Jamieson · Lori Coulson · Ingrid Berling
Updating the diagnosis and management of elevated serum ferritin levels in the era of routine ferritin testing of blood donors by Australian Red Cross Lifeblood
Guidance on how to investigate and manage elevated serum ferritin levels
Gary D Zhang · James Chen · Daniel M Johnstone · Martin B Delatycki · Katie Allen · John K Olynyk
Management challenges and prognostic uncertainties in heat‐induced acute liver failure
A 26-year-old man with central obesity (body mass index, 32.7 kg/m2) and a history of drinking up to 22 standard drinks over weekends, collapsed 5 minutes following a 5 km run in hot and humid conditions in Brisbane, Australia
Nicholas Smith · Richard Skoien · Melita Andelkovic
Tick tock: the travelling time bomb
A 62-year-old man from Connecticut, USA, presented to the emergency department with a six-day history of a febrile illness featuring headache, fatigue, malaise and anorexia
Matthew AK Martin · Maxwell E Olenski
