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SAN DIEGO—At the 2017 Thieves Market, held Nov. 6 at the ACR/ARHP Annual Meeting, rheumatologists from around the world presented patient cases to an audience of colleagues, who then voted via text messaging to choose the cases they felt were most perplexing or intriguing. The winner received a free 2018 Annual Meeting registration, and the runner-up snagged a free Meet the Professor session registration, also for the 2018 Annual Meeting in Chicago in October.
First Prize: Very Rare Extra-Pancreatic Syndrome
Marc Plier, MD, a rheumatologist at Clinique University Saint-Luc in Brussels, Belgium, won top honors for his case of a man who presented to the emergency department after four weeks of severe, widespread pain and swelling. The patient’s painful, swollen digits resembled dactylitis, and he also had a left knee effusion, fever and tender subcutaneous nodules that suggested panniculitis. Aspiration of the swelling on his hands showed a creamy, yellow fluid that looked like liquefied fat, said Dr. Plier. Knee aspiration revealed that the patient had a great deal of fluid in the joint, but no crystals. He had very high C-reactive protein levels and slightly elevated uric acid, but other laboratory test results were normal. Because of his severe pain, Dr. Plier and his colleagues ordered an arthroscopy, which showed unusual bits of free-floating fat in his joint. A synovial biopsy showed a lesion that indicated fat necrosis.