A breast biopsy showed signs of thrombogenic vasculopathy. After a mastectomy, her pathology report showed gangrene and ischemic necrosis with severe calcification of the arterial wall, which led to her ultimate diagnosis of nonuremic calciphylaxis, a rare condition caused by calcium deposition in small blood vessels that supply the skin and cutaneous fat. Her supplements may have contributed to her lesion development.
Uncommon Myositis
Evan Mulvihill, MD, FAAP, a pediatric rheumatologist at Nationwide Children’s Hospital in Columbus, Ohio, shared the case of a 12-year-old girl admitted to the hospital after six weeks of progressive abdominal pain, mouth sores and a genital ulcer. Her systemic symptoms included fever, weight loss and fatigue, but no joint pain or swelling. She had a bump-like rash on, and tenderness and limited range of motion in, her fingers. She had decreased muscle endurance and could not keep her arm or leg raised off the bed for more than two minutes. She had also had recent bouts of shortness of breath. Suspecting connective tissue disease, the doctor gave her a myositis panel. She tested positive for the anti-MDA-5 antibody, which led to a diagnosis of anti-MDA-5-associated juvenile dermatomyositis.
Castleman’s Disease
Shivani Garg, MD, a rheumatologist at the University of Wisconsin School of Medicine and Public Health in Madison, Wisc., described her patient, a 44-year-old, African-American man who had experienced persistent, high-grade fevers for roughly six months. He also complained of abdominal pain, night sweats and unintended weight loss. His examinations suggested he had some type of generalized lymphadenopathy, and his laboratory tests showed very high erythrocyte sedimentation rate and elevated immunoglobulins. He also showed differential retroperitoneal masses. He was eventually diagnosed with multicentric Castleman’s disease, a rare lymph node disease. After rituximab treatment, this patient fared well, she said.
Susan Bernstein is a freelance journalist based in Atlanta.
