Tuberculosis (TB) remains a global burden despite extensive efforts to control it. TB arthritis commonly manifest as monoarthritis of weight-bearing joints. We report a rare presentation of osteoarticular TB involving multiple small joints of the hands, which mimicked rheumatoid arthritis (RA). Magnetic resonance imaging showed tenosynovitis. The patient was initially treated for seronegative RA but failed to respond. Subsequently, synovial biopsy led to the diagnosis. Antituberculosis treatment was given for 1 year.
Adult-onset Still's disease (AOSD) is a rare clinical entity with unknown etiology, characterized by arthritis, fever, evanescent rash and other systemic presentations. This report described a 45-year-old male who presented with sore throat, fever, arthritis, evanescent rash, raised liver enzymes and hyperferritinemia. He was diagnosed to have AOSD based on Yamuguchi criteria after the exclusion of other potential diagnoses. The patient partially responded to combined celecoxib and prednisolone. He was also prescribed methotrexate and his symptoms improved.
This study shows that half of the patients who attended the rheumatology clinic were unaware of the side effect of NSAIDs. Available data showed that most of the knowledgeable patients are more conscience and self-educated. This study also reveals the important roles of clinicians, trained staff nurses as well as the pharmacist in providing the guidance and knowledge of any medication taken by patients.
Tuberculosis (TB) remains a global burden despite extensive efforts to control it. TB arthritis commonly manifest as monoarthritis of weight-bearing joints. We report a rare presentation of osteoarticular TB involving multiple small joints of the hands, which mimicked rheumatoid arthritis (RA). Magnetic resonance imaging showed tenosynovitis. The patient was initially treated for seronegative RA but failed to respond. Subsequently, synovial biopsy led to the diagnosis. Antituberculosis treatment was given for 1 year.
Eosinophilic granulomatosis with polyangiitis is a rare primary vasculitic disease characterized by hypereosinophilia, late onset asthma and extravascular eosinophil granulomas. We report a case presented initially with acute myocardial infarction which later only proceed with asthma, skin manifestations and peripheral neuropathy. Laboratory parameters showed hypereosinohpilia with negative perinuclear pattern of antineutrophil cytoplasmic autoantibodies (p-ANCA). Skin biopsy showed leucocytoclastic vasculitis with eosinophilic infiltration while coronary angiography was normal. The patient's symptoms improved with IV methylprednisolone, pulse cyclophosphamide and azathioprine.
There are an increasing number of reports of myocarditis associated with mRNA-based COVID-19 vaccination. We describe the case of a female patient with underlying systemic lupus erythematosus (SLE) who developed heart failure symptoms following a second dose of the BNT162b2 vaccine. Despite her history of refractory SLE, the disease remained stable after she began rituximab treatment. She underwent serial transthoracic echocardiogram (TTE) and cardiac magnetic resonance imaging (CMR) for the evaluation of cardiomyopathy. She showed improvement in cardiac function after treatment with glucocorticoids and intravenous immunoglobulin therapy (IVIg).
A 31-year-old systemic lupus erythematotus (SLE) patient presented with headache and blurring of vision. Prior to this, she received 2 doses of monthly triptorelin for endometriosis. On examination, she had bilateral sixth nerve paresis. The diagnosis of idiopthic intracranial hypertension (IIH) was confi rmed by an increased intracranial pressure and normal neuroimaging studies of the brain. After releasing the cerebrospinal pressure and cessation of triptorelin, the clinical symptoms resolved without further treatment. It is important to identify the drugs causing IIH rather than attribute to neuropsychiatric SLE to prevent unnecessary treatment.
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