A 53-year-old man was hospitalized for pericarditis, abdominal lymphadenopathy of unknown origin and non-bloody diarrhea. He was admitted for four days, and then he was discharged home without incident. Two months after his initial presentation, he was readmitted for the evaluation of several new issues, including symmetric arthralgias, hypovolemia with associated electrolyte abnormalities and concurrent…
A 52-year-old man living in greater Boston with a history of hypertension presented at our rheumatology clinic with bilateral knee pain and swelling. He had been in his usual state of health until four months earlier when he developed right knee pain and swelling without an incipient trauma, which did not improve with non-steroidal anti-inflammatory…
Some would call Guillermo J. Valenzuela, MD, a hunter of sorts. He has accompanied men and their dogs into the forests of Italy in search of white truffles, an underground fungus considered a European delicacy. “Years ago, when visiting my wife’s family in Italy, I walked into a very old restaurant in Parma,” says Dr….
Eosinophilic gastroenteritis (EGE) is a rare condition caused by eosinophilic infiltration of the gastrointestinal (GI) tract. The condition is subdivided into the GI layers it affects: mucosal, muscular and subserosal.1 EGE usually presents with non-specific GI symptoms, such as impaired motility, intestinal obstruction and, rarely, ascites.2 Below, we report a rare case of EGE leading…
Monosodium urate (MSU) crystal deposition commonly occurs within the distal appendicular skeleton. The peripheral nature of gout is a hallmark feature described in the ACR and the European League Against Rheumatism (EULAR) clinical practice guidelines.1 In this article, we report a rare presentation of a common disease: a case of axial gouty arthropathy masquerading as…
I would like to tell you a story. Two, actually. I am just returning from the 19th International Vasculitis and ANCA Workshop, which is always a fascinating meeting. In its inception, it was a workshop, in the true sense of the word. Now, we discuss anti-neutrophil cytoplasmic antibody (ANCA) testing as casually as we discuss…
Vaccines are often safe for rheumatology patients, but precautions may be needed, said Brian Schwartz, MD, at the 2019 ACR State-of-the-Art Clinical Symposium…
Eosinophilic fasciitis generally presents with the acute onset of edema followed by progressive skin induration in the setting of hypergammaglobulinemia, an elevated erythrocyte sedimentation rate (ESR) and peripheral eosinophilia in 63–93% of patients.1,2 Skin involvement is typically limited to 20.1% of total body surface area and most commonly involves the extremities symmetrically.1,3 The condition was…
Over the past few years, biosimilars and other new drugs have been introduced to treat rheumatic illnesses. Some of the conditions we treat have numerous drug option; others have few or only off-label options. This series, “Rheumatology Drugs at a Glance,” provides streamlined information on the administration of biologic, biosimilar and other medications used to…
A 66-year-old female patient returns for a second infusion of rituximab for her diagnosis of rheumatoid arthritis in multiple sites. She is rheumatoid factor positive. She says the pain in her knees, elbows and neck has slightly improved. She rates the severity of her pain at a 7 on a 10-point scale, which is an…