SUMMARYThis is a case of a 65-year-old man with seropositive erosive rheumatoid arthritis (RA), well controlled on methotrexate, sulfasalazine, low-dose prednisolone and monthly infusions of tocilizumab. He presented with a 3-week history of pain and swelling in his left knee, gradually increasing in severity with an inability to bear weight . He was systemically well with normal vital signs. Examination confirmed an effusion and aspiration was turbid in appearance. C reactive protein (CRP) was normal. He was treated empirically with antibiotics. Synovial fluid and blood cultures confirmed Staphylococcus aureus infection. He completed a 6 weeks course of antibiotics with complete resolution of symptoms. Throughout the treatment his CRP remained normal which is likely to have been the result of prior treatment with tocilizumab.
SUMMARYWe discuss two cases of reactive focal myositis that had different clinical presentations but responded well to conservative management. These cases demonstrate that reactive myositis can present acutely but resolves quickly with expectant treatment and has a favourable prognosis.
BACKGROUND
Antifreeze poisonings give more insight into copycat behaviourEditor-Hawton et al highlight the effect of the media on influencing the incidence of deliberate self poisoning. 1 However, they and other authors suggest that the changes noted are the result of spontaneous variation in the patterns of particular overdoses rather than a direct effect of the specific televised incident. 2 3 One of the limitations of previous studies has been that the investigators have monitored the total numbers of deliberate self poisoning and, specifically, paracetamol overdoses, which are comparatively common. A clearer picture emerges for agents used less commonly for deliberate self harm, such as antifreeze, which commonly contains ethylene glycol or methanol.The figure shows the numbers of intentional and accidental cases of poisoning by ethylene glycol reported to the National Poisons Information Service (London) during two specific months and, for comparison, from January 1996 to January 1997. In April 1995 the Independent reported an inquest into an antifreeze poisoning, 4 which subsequently received further media coverage. On 15 February 1997 an episode of the BBC television drama Casualty depicted an incident of self harm with ingestion of antifreeze.The mean number of intentional antifreeze poisonings for 1996 was 2.0 per month (range 1-3 per month). Moreover, the mean number of cases reported during 1995 and 1997, excluding the incident months, was 1.9 and 1.8 respectively. For April 1995 and February 1997 the number of reported cases was 9 and 6-a significant increase (P = 0.016). Interestingly, all the cases of intentional ingestion of antifreeze during April 1995 and February 1997 occurred after the announcements in the media. Furthermore, in one specific case not only the agent but also the manner in which the antifreeze was taken (mixed with lemonade and drunk in a field) was identical with that reported.These data further support the concept that media portrayal of self poisoning influences subsequent self harm behaviour.
SummaryA 48-year-old immunosuppressed woman presented to a rheumatology follow-up clinic after suffering from herpes zoster infection. She had manifestations of foot drop 3 months after the initial infection. She was diagnosed with motor radiculopathy following herpes zoster infection that was effectively managed by physiotherapy and amitriptyline.
BACKGROUND
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.