DISCUSSION: Lightning is the second most common cause of environmental death in the United States. It is estimated that the number of human injuries may be as high as 5000 per year with 300 deaths. Permanent sequela may occur in 75% of survivors. The serious injuries from lightning strike are usually cardiovascular or neurologic. Most cases develop burns but they are rarely serious. Eye and ear injuries each occur in 50% of cases. Cardiovascular problems include asystole, dysrhythmias, cardiac contusion, pericardial effusion, EKG changes and cardiac enzyme elevations. Neurologic problems include syncope, confusion, paresthesias, and neuropsychiatric disorders. Respiratory center paralysis may occur. Less commonly seizures, cerebral edema, cranial nerve dysfunction and cerebellar ataxia have been reported. This patient developed autonomic dysfunction with severe disabling postural hypotension. The onset was gradual over several years after the actual lightning strike. A 61 year old man was admitted with atrial fibrillation and congestive heart failure. Pharmacologic treatment to limit the ventricular rate was complicated by episodes of bradycardia. Heart rates as low as 30 beats per minute in the presence of continued tachycardia necessitated the implantation of a pacemaker. A pacemaker was implanted, and anticoagulants were restarted twenty-four hours after the surgery. A hematoma was noted at the site. Warmth and erythema developed, yet the patient was afebrile. Empiric antibiotics were started and an aspirate culture was drawn. The culture grew Corynebacterium Urealyticum. The patient was treated with vancomycin, and the pacemaker was explanted. Cultures of the pacemaker also grew Corynebacterium Urealyticum. DISCUSSION: The incidence of pacemaker infections post-implantation ranges from one to six percent, with the majority of cases being caused by staphylococcus species. This case represents an unreported etiologic organism of pacemaker pocket infections. Corynebacterium Urealyticum is a slow growing, multi-drug resistant, gram positive aerobe that is often found in skin flora in hospitalized patients. 2. Generalized erythroderma is rare in Psoriasis and any such a change should prompt a biopsy and further evaluation. CASE INFORMATION: Peripheral T-cell lymphoma is classified among aggressive group of non-Hodgkin lymphomas by R.E.A.L. classification and accounts for < 15% of lymphomas in US. It presents as generalized disease with pruritis. Lymph nodes, skin, liver spleen and other viscera maybe involved. Presentation with generalized erythroderma is rare with peripheral Tcell lymphomas and is usually seen with primary cutaneous lymphomas. Case History: 78 year old Hispanic female with past medical history of hypertension, psoriasis and eczema for the last ten years presented to dermatology service with two month history of gradually worsening generalized erythematous macular rash with mild itching. Patient denied HIV infection or risk factors. Home medications included plendil, monopril, aspirin and lidex oint. There was no change in her medications recently. Physical exam. revealed generalized erythmatous non scaly macular rash with violacaeous discoloration at some areas and cervical lymphadno -pathy . CBC revealed leukocytosis with eosinophillia. LDH was 441. CXR was unremarkable. Skin biopsy was performed which revealed atypical lymphocytic infiltrate with abundant eosinophills. These cells were positive for CD3, CD4, CD5 (T cell markers) and negative for CD20 & CD30 (B cell markers). Lymph node and bone marrow biopsies were performed to further characterize the disease. Both specimens showed neoplastic infiltrates of lymphoid cells, which were positive for CD3, CD4, and CD5. Review at NIH confirmed the above findings and a diagnosis of peripheral T cell lynphoma-unspecified was made. Patient, who was visiting US from Santo Domingo, declined chemo-herapy and elected to return to her country. DISCUSSION: Peripheral T cell lymphomas-unspecified is a rare kind of lymphoma. Whereas erythro-derma is not an uncommon presentation of primary cutaneous T cell lymphomas especially Sezary syndrome, it is very rare in perpheral T cell lymphoma-unspecified. In a patient with psoriasis, such as ours, generalized erythroderma is rare and such an evolution of the disease should prompt skin biopsy and further workup. Treatment of peripheral T cell lymphomas-unspecified is not clear due to rarity of this disease. These lymphomas are usually very aggressive and have only 20% cure rate.