Case A 46-year-old Caucasian female presented to the outpatient rheumatology clinic where she had been followed for several years. Her chief complaint was pain in her right knee, posterior right thigh and right hip that had begun gradually over the previous three weeks. Her past medical history was significant for rheumatoid arthritis (RA), obesity and…
Erdheim-Chester disease (ECD) is a rare, non-Langerhan’s cell histiocytosis characterized by tissue infiltration of CD68-positive and CD1a-negative foamy histiocytes.1 ECD was discovered as a lipid granulomatosis in 1930 by Jakob Erdheim and his pupil, William Chester, and approximately 500 cases have been described to date.1 ECD has a heterogeneous course and prognosis ranging from an…
Systemic capillary leak syndrome (SCLS) is a very rare disorder, characterized by recurrent episodes of severe hypotension, hypoalbuminemia and hemoconcentration.1 Attacks of SCLS occur in three phases: 1) prodrome; 2) hypovolemia with weight gain; and 3) hypervolemia with fluid overload and polyuria often complicated by pulmonary edema. Often, compartment syndrome can lead to rhabdomyolysis as…
A 73-year-old white male presented with a one-day history of a cold, painful, right foot. The foot had a blue discoloration to it, particularly the toes. The emergency physician suspected an atheroembolic cause, given this patient’s age and history of coronary artery disease. However, the patient also reported a one-year history of painful pallor in…
A 50-year-old man with history of superficial bladder carcinoma presented to our rheumatology clinic for a three-year history of symmetric polyarthralgias. He had undergone multiple transurethral resection of bladder tumor procedures and bacillus Calmette–Guerin (BCG) treatments. Prior to receiving BCG, he was fully functional and employed. Days after receiving his second BCG treatment, he developed…
Rheumatoid arthritis (RA) is rarely associated with renal manifestations, but secondary amyloidosis due to chronic inflammation is reported to be the etiology of renal dysfunction in many cases of RA.1,2 The discovery of biologic therapy, with TNF-alpha inhibitors in particular, made a huge difference in the disease course and prognosis of RA patients. However, TNF-alpha…
“That’s a great case. Why don’t we write it up?” It’s a question I’ve heard many times throughout medical school, residency and fellowship. It’s typically intended to be more of a politely worded request than a rhetorical question. We must acknowledge that the process of writing, editing and submitting a case report is onerous, but it…
The Case A 41-year-old woman was referred to the dermatology clinic for a three-month history of tender lesions on her elbows and around the joints of her hands. Her medical history was notable for seropositive, non-erosive rheumatoid arthritis (RA), which was being treated with 5 mg prednisone daily, 10 mg methotrexate weekly by mouth, 200…
Case report: A 60-year-old Hispanic male with poorly controlled hypertension was sent from the primary care clinic for evaluation of malignant hypertension with a systolic blood pressure above 200 mmHg. His symptoms at the time of presentation included episodic confusion, worsening vision and an unsteady gait. A head computed tomography (CT) scan showed a subacute…
SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, and osteitis) is an obscure condition that can vex patients and clinicians