BACKGROUNDIliac vein compression syndrome (IVCS), also known as May-Thurner or Cockett syndrome, occurs from compression of the left common iliac vein by the right common iliac artery. The main clinical manifestations are pain and edema in the left lower limb, or left iliofemoral deep vein thrombosis (DVT). The main risk factors for DVT are prolonged rest, pregnancy and surgery.
CASE REPORTAES, female, 13 years old, with a history of chronic pain and edema in the left lower limb. Referred to a reference service in Pediatric Rheumatology for investigation of a possible diagnosis of scleroderma. On examination, she presented diffusely significant asymmetry between the lower limbs, without signs of arthritis and without other alterations on physical examination. Inflammatory evidence unchanged. Computed tomography angiography of the limbs showed the presence of extrinsic compression of the left common iliac vein by the right common iliac artery, compatible with the diagnosis of SCVI or May-Thurner syndrome. After this diagnosis, the patient. Clinical conditions such as the one reported require early diagnosis and intervention. For SCVI, when the patient is symptomatic, surgical treatment is indicated, with the aim of treating symptoms related to venous hypertension and preventing sequelae of venous occlusive disease.
CONCLUSIONFor pediatric rheumatologists, it is important to make the differential diagnosis of pain and edema in limbs with vascular diseases, considering the need for early intervention to ensure better outcomes and reduce associated morbidity and mortality. Despite their rarity, these diagnostic possibilities should also be considered in the pediatric age group, not just in adult patients.
BACKGROUND Calcium pyrophosphate deposition disease (CPPD) is a systemic inflammatory arthropathy that affects 4-7% of the adult population (1). In despite of rare cases being described in the literature, crowned dens syndrome (CDS) has a prevalence of 12.5% in CPPD patients and 2% of them have acute neck pain (1,2). We report a case of febrile acute neck pain secondary to CDS. CASE REPORT A 63-year-old woman with previous diagnosis of CPPD started having cervical pain, limited mobility and fever, accompanied by neck stiffness, for the last six weeks. She also had left knee arthritis and low back pain. Besides knee effusion and neck stiffness the rest of physical examination was unremarkable. Laboratory workup revealed leukocytosis, elevated platelets count and increased reactive C protein. Serology for viral hepatitis, HIV and syphilis was negative; radiograph of knees showed chondrocalcinosis; Blood culture resulted positive for staphylococcus aureus; Transesophageal echocardiogram was normal. A cervical computed tomography scan demonstrated dense calcification in the form of a halo around the odontoid process, in the atlantoaxial joint, which is characteristic of CDS (Figure 1 to 4). The patient was treated with diclofenac and colchicine, with great improvement of the cervicalgia, fever, joint mobility and peripheral articular symptoms. She also received intravenous oxacillin for bloodstream infection. CONCLUSION CDS is an uncommon manifestation of CPPD. First described in 1980, it is characterized by cervicalgia, fever and neck stiffness. From the pathophysiological point of view, there is a deposition of calcium pyrophosphate (3). In the present case, it was probably associated with bloodstream infection. Differential diagnosis with meningitis is crucial. The gold standard diagnostic test is cervical spine tomography and the patients commonly have a good response to the treatment, as it was showed in this case.
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