Limited orbital granulomatosis with polyangiitis (GPA) is uncommon and its diagnosis may be delayed, especially when isolated lacrimal involvement is the initial presentation, because clinical manifestations are non-specific and systemic diagnostic criteria are not applicable. Making an early diagnosis despite the absence of systemic progression is extremely important because in some cases the disease is locally destructive, with irreversible visual and functional loss, and it can be refractory to corticosteroids and conventional immunosuppressive drugs to induce remission. The authors report an unusual limited form of orbital GPA in a 35-year-old woman presenting with bilateral dacryoadenitis, evolving later to locally aggressive bilateral orbital pseudotumour leading to proptosis, extraocular myositis, diplopia and medial deviation of the nasal septum. She had never had systemic manifestations but her disease was persistently active and unresponsive to corticosteroids and immunosuppressors. The aim of this paper is to provide further evidence of aggressive and refractory limited forms of GPA.
COLLAGENOUS COLITIS: AN UNDERDIAGNOSED CAUSE OF CHRONIC DIARRHEA Microscopic colitis is a disorder that includes collagenous colitis and lymphocytic colitis. It is considered to be a common cause of chronic diarrhea. Although it is benign, it can have a significant impact on the patient's quality of life. The diagnosis is exclusively histological. Although microscopic colitis was first described in 1976, it has only recently been recognized as a common cause of diarrhea. Many clinicians are not yet aware of this entity. We present the case a patient with chronic watery diarrhea, initially without significant systemic repercussions and with normal or inconclusive laboratory or imaging tests. This evolved into hypovolemic shock with severe renal dysfunction. Greater awareness of this condition by clinicians, leading to the performance of timely biopsies, required for the correct diagnosis and appropriate therapy, is required.
Hydropneumopericardium is a rare event with a risk of serious complications. Timely diagnosis and treatment is important as it can improve prognosis. We report the case of a 77-year-old male patient who presented with acute interscapular pain which developed during a meal. An oesophago-pericardial fistula was found in the context of malignant oesophageal disease.
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