Angina bullosa haemorrhagica is the term used to describe benign subepithelial oral mucosal blisters filled with blood that are not attributable to a systemic disorder or haemostatic defect. It is a very rare condition. Elderly patients are usually affected and lesions heal spontaneously without scarring. The pathogenesis is unknown, although it may be a multifactorial phenomenon. Trauma seems to be the major provoking factor and long-term use of steroid inhalers has also been implicated in the disease. We present a 50-year-old patient with angina bullosa haemorrhagica. Trauma by sharp cusp of adjacent tooth and metal crown were identified as aetiological factors in this case. Lesions healed after removal of the metal crown and rounding of the cusp. Therefore, recognition of the lesion is of great importance to dentists, to avoid misdiagnosis.
We describe a rare account of a patient who developed segmental vitiligo within several months of an episode of viral encephalitis. This case provides further support to the neuronal hypothesis in the etiology of segmental vitiligo. A literature review of the neuronal theory and pathogenesis of vitiligo is further discussed.
Background Inflammatory muscle diseases commonly present with proximal myopathy. However, important differential diagnoses include muscular dystrophy and metabolic myopathy. Objectives To study the clinical profile of inflammatory muscle disease in our patients and to compare the clinical and histopathological diagnosis in these patients. Methods A retrospective study of 25 patients who presented to Rheumatology unit, UMMC from January 2007 to September 2011 with the clinical diagnosis of possible inflammatory myopathy was done. All had muscle biopsy done. Results Mean age was 53.3 years. Of the 25 patients, 17(68%) had diagnosis based on clinical presentation. 16(64%) had diagnosis based on muscle biopsy in which 9(36%) had the histopathological diagnosis of dermatomyositis, 3(12%)polymyositis, 2(8%)muscular dystrophy, 1(4%)inclusion body myositis (IBM) and 1(4%) metabolic myopathy. The remainder 9(36%) had inconclusive histopathological diagnosis. Significant correlation (p=0.01) was seen between clinical diagnosis and the histopathological diagnosis. Final diagnosis of dermatomyositis was made in 11(44%) patients, amyopathic dermatomyositis 2(8%), polymyositis 5(20%), Becker’s muscular dystrophy 2(8%),MCTD 2(8%) and 1(4%) each for IBM, fibromyalgia, and metabolic myopathy. 19 patients had inflammatory myositis conclusively. The most common clinical presentation was proximal myopathy (23, 92%), followed by muscle pain (13, 52%). Raised serum creatinine kinase was seen in all patients and 21(84%) had transaminitis. 18(72%) had positive ANA titre. ENA was positive in 7(28%) out of which 4 were anti-Jo-1 positive. 88% received corticosteroids and 72% received immunosuppressive agents. 9(36%) attained clinical remission. Conclusions Diagnosis of muscular pathologies through muscle biopsies significantly correlated with our clinical diagnosis. Dermatomyositis is the prominent inflammatory muscle disease. References Chahin N, Engel AG. Correlation of muscle biopsy, clinical course, and outcome in PM and sporadic IBM. Neurology. 2008 Feb 5;70(6):418-24. Karen R. Inflammatory myopathies: Narrowing the differential diagnosis. Cleveland Clinical Journal of Medicine. 2001 June;68 (6): 505-519 Erik AW, Robert LW. Diagnosis and management of inflammatory muscle disease. The J Musculoskel Med. 2010;27:470-479 Disclosure of Interest None Declared
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