A 39-year-old woman presented at the emergency department with three weeks of progressive, constant and pulsatile right-sided headache. She said her headache was worse in the morning and when she would bend forward. She reported associated nausea and vomiting. On initial assessment, she did not have any focal neurological deficits. Her medical history was significant for…
Primary Sjögren’s syndrome is a systemic autoimmune condition noted for findings of xerostomia, keratoconjunctivitis sicca and focal lymphocyte infiltrate in salivary glands.1 In the initial publications regarding keratoconjunctivitis sicca, Henrik Sjögren, a Swedish ophthalmologist, described a group of 19 women with dry eyes, some of whom had other organ dryness and inflammatory infiltrates.2,3 The syndrome…
Polymyalgia rheumatica (PMR) is an inflammatory rheumatic condition characterized by pain and morning stiffness at the neck, shoulders and hip girdle. It can be associated with giant cell arteritis (GCA); in fact, the two disorders may represent a continuum of the same disease process. This case describes a patient who initially refused treatment for PMR…
Relapsing polychondritis (RPC) is a systemic and, in some cases, fatal disease. Dyspnea with findings of small airway disease—even in the absence of the more commonly associated tracheobronchial abnormalities or pathognomonic clinical findings, such as saddle nose and cauliflower ear—may be presenting signs and symptoms of relapsing polychondritis. Below, we present a case demonstrating that…
Synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome is a heterogeneous, inflammatory, musculoskeletal disease. The disease is an insidious, sterile osteitis with associated skin and synovial inflammation.1 Diagnosis can prove challenging, but a thorough clinical history, high clinical suspicion and imaging techniques can help clinch it. The below case reveals a rare, fulminant presentation of…
Immune checkpoint inhibitors (ICIs) are increasingly used to treat a variety of malignancies, leading to better cancer treatment outcomes and patient survival. However, the emergence of autoimmunity has been a major adverse event resulting from ICI use. Below, we describe a patient who experienced a flare of preexisting psoriasis and new-onset severe psoriatic arthritis after…
Note: Updated May 2, 2018, to correct a link in the reference section. The error was introduced in editing. A 44-year-old Caucasian woman presented to the outpatient rheumatology clinic that had followed her for several years for rheumatoid arthritis. She was compliant with her regimen of hydroxychloroquine, etanercept and salsalate. Her chief complaint was worsening…
A 58-year-old African American woman with a past medical history of hypertension (HTN), hyperlipidemia, severe gastroesophageal reflux disease (GERD) and limited cutaneous systemic sclerosis (lcSSc) presented to the emergency department with shortness of breath (SOB) and progressive bilateral lower extremity swelling for three weeks. She denied any chest pain, but endorsed generalized fatigue and dyspnea…
The year was 1991. It was my first Tuesday as a rheumatology fellow at the University of Pittsburgh’s Presbyterian Hospital. Navigating a maze of buildings and hallways, I delivered myself to the entrance to the scleroderma clinic. Running late and not knowing whether there was a separate entrance for staff, I clicked open the door….
Every year, my program goes through a ritual—I scrub my face, put on a smile and meet hordes of medical residents from across the country. And every year, I do my best to convince all of them that Baltimore would be an amazing place for them to complete their medical subspecialty training in rheumatology. Now…