BACKGROUND Ledderhose's disease is part of a group of benign fibroblast proliferations called fibromatosis, which superficially affects the plantar fascia and, in some cases, the hands. It is a rare disease, with higher incidence in males aged 30-50 years. Its etiology is unknown, but there is multifactorial evidence, including genetics, microvascular trauma, use of anticonvulsants and immunological reactions. It is characterized by subcutaneous nodules of slow proliferation, more frequently located in the central and medial portions of the plantar fascia, and up to half of the cases affects both feet. Most clinical conditions are asymptomatic, but pain can be triggered after periods of walking. Also, when the nodules invade structures like nerves and muscles, symptoms may become more specific.
BACKGROUND Giant cell arteritis (GCA) is the most common systemic vasculitis in Western countries. It mainly affects individuals older than 50 years, basically involves vessels of great caliber, and has an incidence rate of about 200 cases per 100,000 inhabitants, with women affected 2-6 times more than men. GCA has great clinical relevance, and its main and most common complication is the large-vessel stenosis, rarely presenting aneurysmal lesions. CASE REPORT A 65-year-old woman complained of daily night fever, temporal headache, jaw claudication, weight loss (3 kg), and night sweats for approximately 60 days. She also presented intense pain in the scapular and pelvic girdles. The patient had multiple negative blood cultures and underwent empiric antibiotic therapy for one month, showing no improvement. Initial tests showed hemoglobin (Hb) of 9.8 g/dL, erythrocyte sedimentation rate (ESR) of 110 mm/hr, Creactive protein (CRP) of 26 mg/L, normal liver enzymes and renal function tests. Aortic arch CT angiography revealed an ulcerated and inflamed aneurysm lesion (figure 1 and 2). Abdominal CT showed no abnormalities. Doppler ultrasound of carotid arteries showed bilateral slight thickening of the common carotid artery, with no evidence of active inflammation. After excluding the most common neoplastic causes, the diagnosis of GCA was assumed. We started treatment with prednisone 1 mg/kg, yielding response in 24 hours, with improvement of the general condition, anemia, fever, headache, and body aches. ESR examination showed improvement, with return to baseline levels. A weekly dose of 15 mg methotrexate was added to the treatment, with subsequent increase to 25 mg because of fever relapse and increase in ESR whenever doses of prednisone were reduced. After six months of follow-up and treatment, new CT angiography showed doubling of aortic aneurysm size, with imminent rupture, lesion without active inflammatory activity, normal ESR, and absence of anemia. The patient, in joint follow-up with a cardiologist, presented emergency surgical indication and was referred to the cardiovascular surgery team. CONCLUSION Although aneurysmal lesions are not frequent in cases of GCA, being classified as rare, these injuries and their inflammatory nature should be part of the clinical suspicion, especially when differential diagnoses such as syphilis and tuberculosis are excluded.
BACKGROUND Sarcoidosis is a chronic multisystemic inflammatory disease characterized by non-caseating granulomas formation. Its etiology is unknown, but the most accepted hypothesis involves the genetic predisposition of the patient, in association with human leukocyte antigen (HLA) and exposure to environmental factors (moisture, organic and inorganic particles, and infections).
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.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.