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Case Report: Blunt Smoker Denies Tobacco Use, Delaying Diagnosis

Rachel E. Elam, MD, ScM, Vishal Arora, MD, & Alyce M. Oliver, PhD, MD  |  

Cannabis arteritis mirrors thrombo­angiitis obliterans in its clinical and arteriographic presentation, but its relevant exposure is cannabis rather than tobacco.1 Whether cannabis arteritis is a subset of thromboangiitis obliterans or a unique pathologic entity is debatable. Delta-9-tetrahydrocannabinol, the primary psychoactive component of cannabis, is a peripheral vasoconstrictor.2 This offers mechanistic insight into how cannabis may…

Looking to Psoriatic Arthritis History to Disrupt Current Thinking

Rebecca H. Haberman, MD, & Jose U. Scher, MD  |  

As the cloud moved away from the tent, Miriam’s skin suddenly became diseased, as white as snow. When Aaron turned toward her, he saw that she was diseased. —Numbers 12:10 For 29 years he [Fray Pedro de Urraca] was afflicted by … pain, suffering it at once in all the joints of his body, with…

Case Report: Intermittent Fevers in a Patient with pJIA

Osman Bhatty, MD, Dale Kobrin, MD, Lauren Mathos, DO, Nazia Khatoon, MD, Yazan Samhouri, MD, Naga Sai Krishna Patibandla, MD, & Mary Chester Wasko, MD, MSc  |  

A 26-year-old woman presented to our emergency department (ED) with intermittent fevers, nausea and vomiting. She had a past medical history of well-controlled, anti-nuclear antibody positive and rheumatoid factor negative polyarticular juvenile idiopathic arthritis (pJIA) and Crohn’s disease. Her maintenance treatment consisted of monthly intravenous infliximab, 10 mg of oral methotrexate weekly and 20 mg…

Case Report: An Unusual Presentation of Neuro-Behçet’s Disease

Zeba Faroqui, MD  |  

A 44-year-old woman presented to the emergency department with bifrontal headaches that had started approximately one month earlier. She was diagnosed with migraines and discharged home. Three days later, the patient returned to the emergency department upon recurrence of her headaches, and this time she also reported abnormal leg movements. A computerized tomography (CT) scan…

The Role Ultrasound Imaging Plays in Diagnosing Hemangiomas

Clara Lin, MD, RhMSUS  |  

A 17-year-old woman presents with chronic finger pain experienced over six months that is worse in the mornings. On physical exam, the patient has no joint swelling, pain on range of motion or limitation of range of motion in any of her finger joints. She has a tender, subcutaneous, firm, flesh-colored nodule on the lateral…

Real-Life Rheumatology: Clinical Pearls for Psoriatic Arthritis

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At the 17th Annual Advances in the Diagnosis and Treatment of the Rheumatic Diseases meeting, Ana-Maria Orbai, MD, MHS, discussed lessons learned from the cases of several patients with psoriatic arthritis.

Case Report: Perplexing Pulmonary Nodules

Monsoon Rashid, DO, & Deana Lazaro, MD  |  

Pulmonary nodules are com­mon; most are benign, but the differential diagnosis is broad and includes life-threatening possibilities.1 Our patient is a former smoker who has a history of a complex autoimmune disease and multiple pulmonary nodules. This case was challenging, but clinical, radiographic and histologic clues helped lead to the correct diagnosis. Case Presentation The…

Case Report: Atypical Presentation of Idiopathic Retroperitoneal Fibrosis

Roshniben Patel, MD, Simon Go, MD, Akhila Mohan, MD, & Maria Pardi, MD  |  

Retroperitoneal fibrosis (RPF) is a rare condition characterized by aberrant fibroinflammatory tissue developing in the retroperitoneum. This disorder was initially called Ormond’s disease. RPF may be idiopathic or secondary to other conditions. Idiopathic RPF is a part of the disease spectrum of chronic periaortitis due to its typical periaortoiliac localization. Idiopathic retroperitoneal fibrosis is a…

Medium-sized blood vessels are seen in the dermis and at the dermal-subcutaneous junction. The black arrow identifies a venule, and the blue arrow points to a fibrin deposition in the vessel wall. Extravasated neutrophils and erythrocytes are seen in the interstitium.

Case Report: A Polyarteritis Nodosa Conundrum

Hannah Krebsbach, MD, Ileannette Robledo Vega, MD, Nirupa Patel, MD, & Nkechinyere Emejuaiwe, MD, MPH  |  

Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis that typically affects medium-sized muscular arteries. The clinical subsets of PAN are idiopathic, generalized, secondary hepatitis B virus (HBV) associated and cutaneous PAN. These clinical subsets are important because of their therapeutic implications. Virtually any organ system can be affected in generalized PAN, but this vasculitis tends…