http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2013 , Hindawi Publishing Corporation . All rights reserved. Tue, 21 May 2013 12:05:38 +0000 http://www.hindawi.com/crim/rheumatology/2013/543953/ Ankylosing spondylitis is a chronic inflammatory disease characterized by inflammatory lower back pain and morning stiffness and accompanied by spine and sacroiliac joint involvement. Klinefelter's syndrome is a genetic condition that only affects males. Affected males have an extra X chromosome. This paper reports a 30-years-old male on followup with the diagnosis of Klinefelters syndrome. The patient admitted with complaints of inflammatory lower back, and neck pain and morning stiffness and was diagnosed with ankylosing spondylitis. Nonsteroidal anti-inflammatory drug and salazopyrine treatment resulted in significant regression in his complaints. Şenol Kobak, Murat Yalçin, Muamer Karadeniz, and Guray Oncel Copyright © 2013 Şenol Kobak et al. All rights reserved. Mon, 20 May 2013 13:26:43 +0000 http://www.hindawi.com/crim/rheumatology/2013/706738/ Sarcoidosis is a multisystem disease which is most commonly manifested in the pulmonary system. However, extrapulmonary manifestations have also been frequently reported. Isolated occurrence of sarcoidosis in the genital system is rare and poses a diagnostic and therapeutic dilemma. Uterine sarcoidosis can present with cervical erosions, endometrial polypoid lesions, and recurrent serometra. In majority of cases, it is diagnosed by endometrial curettage, but it has also been detected by examination of hysterectomy, polypectomy, and autopsy specimens. Nonnecrotizing granulomas are the characteristic pathologic finding of sarcoidosis. However, many infectious and noninfectious etiologies including certain neoplasms can produce similar granulomatous reactions in the female genital tract. These conditions affect the female genital tract more commonly than sarcoidosis, and therefore it is important to rule out these conditions first before making a diagnosis of sarcoidosis. Treatment of sarcoidosis is different from treating these other conditions and the most commonly used systemic or local corticosteroids can be hazardous if the underlying cause is infection. In this case report, the clinical presentation, histopathology, clinical course, and treatment of a patient with isolated uterine sarcoidosis are described, and a brief literature review of sarcoidosis of the female genital tract is provided. Creticus P. Marak, Narendrakumar Alappan, Amit Chopra, Olena Dorokhova, Sumita Sinha, and Achuta K. Guddati Copyright © 2013 Creticus P. Marak et al. All rights reserved. Wed, 15 May 2013 17:17:41 +0000 http://www.hindawi.com/crim/rheumatology/2013/819629/ Objective. Overlap of juvenile idiopathic arthritis (JIA) and juvenile systemic lupus erythematosus (JSLE) is a rare clinical condition in children. This condition has been described as RHUPUS syndrome. Prevalence of this syndrome and 3 cases are reported in this paper. Cases Presentation. During 10 years, 3 patients with SLE had chronic arthritis before or after diagnosis of SLE. Prevalence of this disorder in JSLE was 2.5%. Two patients were females and one of them was a male. According to our review, mean delay between chronic joint involvement and JSLE diagnosis was 50.1 months. In our case report, two females had joint erosion and one of them died due to heart failure, but in the literature review, just 45% cases had joint erosion and 70% cases were polyarticulare form. Conclusion. RHUPUS is unusual presentation of lupus in children. It seems that clinical feature and outcome of RHUPUS syndrome are different in children due to difference between RA and JIA. We suggest juvenile RHUPUS for overlap of JIA and JSLE. Vahid Ziaee, Mohammad Hassan Moradinejad, and Reyhaneh Bayat Copyright © 2013 Vahid Ziaee et al. All rights reserved. Tue, 23 Apr 2013 14:41:10 +0000 http://www.hindawi.com/crim/rheumatology/2013/831708/ Primary Sjögren's syndrome (pSS) is an autoimmune disorder of the exocrine glands presenting with progressive ocular and oral dryness, parotid gland enlargement, and often with extraglandular manifestations. In this group of patients the risk of development of non-Hodgkin's lymphoma is 16-fold compared to healthy population, mainly of the MALT lymphoma type. This case reports a 52-year-old woman with pSS developing a progressively growing mass at face and neck compatible with blastoid variant mantle cell lymphoma and a fatal outcome. Fabio Bonilla-Abadía, Manuel A. Pérez, Evelyn Muñoz-Buitrón, Joaquín D. Rosales, Carlos A. Cañas, and Gabriel J. Tobón Copyright © 2013 Fabio Bonilla-Abadía et al. All rights reserved. Thu, 18 Apr 2013 16:49:35 +0000 http://www.hindawi.com/crim/rheumatology/2013/212145/ Erythema multiforme (EM) and systemic lupus erythematosus (SLE) are common diseases. Their coexistence is known as Rowell syndrome (RS), first described in 1963. Only few cases of RS have been described and some of them questioned its existence. We present two cases of SLE in the setting of a newly developed EM-like eruption, which shares many similarities with the so-called Rowell syndrome. Ralph Yachoui and Patrick M. Cronin Copyright © 2013 Ralph Yachoui and Patrick M. Cronin. All rights reserved. Tue, 16 Apr 2013 14:29:44 +0000 http://www.hindawi.com/crim/rheumatology/2013/795027/ Hyperimmunoglobulinemia D syndrome is a rare autosomal recessive autoinflammatory disorder caused by mutations in the mevalonate kinase gene (MVK). In a proportion of patients, however, no MVK mutations are detected. Although various standard anti-inflammatory drugs have been tried, until now there is no consensus about how HIDS should be treated. We present a case of HIDS in an 8-year-old girl whose clinical picture had started before the end of the first year of life. The patient had consistently elevated IgD levels but no mutations were found after a full-length analysis of the MVK gene. The method of MVK mutational analysis is presented in details. Treatment with canakinumab in a final single dose of 4 mg/kg every 4 weeks resulted in the disappearance of febrile attacks and a considerable improvement of patients’ quality of life during a 12-month follow-up period. The drug has been well tolerated, and no side effects were observed. Elena Tsitsami, Charis Papadopoulou, and Matthaios Speletas Copyright © 2013 Elena Tsitsami et al. All rights reserved. Wed, 10 Apr 2013 13:31:44 +0000 http://www.hindawi.com/crim/rheumatology/2013/923797/ Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a rare but well-reported clinical entity. It is classically described as symmetrical involvement of both upper extremities. Asymmetrical involvement had also been reported, but unilateral presentation is very rare. We hereby report a case of unilateral RS3PE in a patient of seronegative rheumatoid arthritis which was initially misdiagnosed as cellulitis and was given high dose antibiotics without any significant improvement. Later a rheumatologic consultation leads to a prompt diagnosis, and treatment with steroids leads to dramatic reversal of symptoms. This case demonstrates the rare presentation of this rare clinical entity and highlights the necessity of awareness regarding unilateral disease to clinicians. Ankur Nandan Varshney, Nilesh Kumar, Ashutosh Tiwari, Ravi Anand, Sashi Ranjan Prasad, Arvind Anand, Abhinandan Mishra, and N. K. Singh Copyright © 2013 Ankur Nandan Varshney et al. All rights reserved. Thu, 04 Apr 2013 09:49:41 +0000 http://www.hindawi.com/crim/rheumatology/2013/759193/ Hemiarthroplasty of the shoulder can be a safe and an effective treatment for pain in patients with rheumatoid arthritis. Many complications have been previously described in the literature; the most common of which are dislocation, loosening, periprosthetic fractures, and infection. We report a patient who presented with a discharging sinus over the tip of the acromium which was created by the displacement of the prosthesis and erosion of the AC joint and distal clavicle. The erosion of the distal clavicle and AC joint caused the remaining proximal clavicle to become mobile and displaced posteriorly; this spike of clavicle was then able to penetrate the trapezius muscle and eventually the skin causing an aseptic sinus. This was successfully treated with the exploration and excision of the distal 2 cm of the clavicle. Oliver D. Stone and S. J. Breusch Copyright © 2013 Oliver D. Stone and S. J. Breusch. All rights reserved. Wed, 03 Apr 2013 09:10:03 +0000 http://www.hindawi.com/crim/rheumatology/2013/125251/ A 34-year-old female patient, who had proximal muscle weakness for 8 months, presented with erythema nodosum lesions on the pretibial region in addition to pain, swelling, and movement restriction in both ankles for the last one month. Thoracic CT demonstrated hilar and mediastinal lymphadenopathy. She underwent mediastinoscopic lymph node biopsy; biopsy result was consistent with noncaseating granuloma. Serum angiotensin converting enzyme level and muscle enzymes have been elevated. Muscular MRI and EMG findings were consistent with myositis. Muscle biopsy was done, and myopathy was found. The patient was diagnosed with sarcoidosis, Löfgren's syndrome, and sarcoid myopathy. The patient displayed remarkable clinical and radiological regression after 6-month corticosteroid and MTX therapy. Şenol Kobak, Murat Yalçin, Fidan Sever, and Guray Oncel Copyright © 2013 Şenol Kobak et al. All rights reserved. Tue, 19 Mar 2013 15:47:04 +0000 http://www.hindawi.com/crim/rheumatology/2013/728371/ Etanercept is a monoclonal antibody targeted against Tumour Necrosis Factor-alpha (TNF-a) which is an effective treatment for rheumatoid arthritis and is in cases where conventional disease modifying agents such as methotrexate have failed. Neurological complications of treatment have been documented. We describe a case of transverse myelitis occurring in a 48 year-old lady with RA since 1994 who had been receiving etanercept for four years. Helen Defty, Edward Sames, Teresa Doherty, and Rodney Hughes Copyright © 2013 Helen Defty et al. All rights reserved. Sun, 17 Mar 2013 11:08:35 +0000 http://www.hindawi.com/crim/rheumatology/2013/769127/ A recent report in this journal suggested a causal relation between probiotic consumption and eosinophilia. In our opinion, the data presented does not suggest such a relationship. The two described eosinophilia cases have not been shown to be caused by infection and certainly not by probiotic infection. The consumed probiotics could not be retrieved in shops, so their identity remains unknown. Furthermore, the alleged consumption took place 2–4 weeks prior to the onset of the symptoms; during such time period, probiotics tend to have disappeared from the intestine. Because most probiotic health benefits are strain specific, also potential risks are strain specific. Thus, generalizing a risk to probiotics as a class is incorrect. We do, however, agree with the authors of the case report that quality control of probiotics should be rigorous. We also do not dispute that there may be certain risk groups (e.g. severely immune-compromised patients), where probiotic use should be carefully monitored. In conclusion, the data presented in the case report do not indicate that specific probiotics strains might cause eosinophilia. Arthur C. Ouwehand and Ger T. Rijkers Copyright © 2013 Arthur C. Ouwehand and Ger T. Rijkers. All rights reserved. Thu, 14 Mar 2013 10:40:34 +0000 http://www.hindawi.com/crim/rheumatology/2013/829620/ Hiccups is a type of reflex that could happen secondary to different causes including drugs, especially systemic corticosteroids. Usually, high rather than regular doses of systemic steroids are incriminated, and this could explain the fact that very few cases of hiccups following regional corticosteroid treatment were reported. Here, we report the first case of hiccups in the English literature following intra-articular corticosteroid injection (IACI) at the knee joint and review all the previous reported cases of hiccups following regional corticosteroid treatment. Usually, this phenomenon of hiccups responds to regular antihiccups treatment; however, it is recommended not to repeat an IACI in a patient who had this adverse effect before due to an expected severe recurrent attack of hiccups afterwards. George Habib, Suheil Artul, and Geries Hakim Copyright © 2013 George Habib et al. All rights reserved. Sun, 10 Mar 2013 11:06:12 +0000 http://www.hindawi.com/crim/rheumatology/2013/201563/ Multicentric reticulohistiocytosis is a rare multisystem disorder of unknown etiology that is characterized by erosive polyarthritis and papulonodular lesions on the skin, mucous membranes, and internal organs. We report the case of a 54-year-old female who was misdiagnosed as having rheumatoid arthritis and underwent numerous joint replacement surgeries for progressively destructive arthritis in her hands, shoulders, hips, and knees. The patient finally received a diagnosis of multicentric reticulohistiocytosis after histopathological examination of the patient’s left knee arthroplasty which revealed a diffuse histiocytic infiltrate, multinucleated giant cells, and finely granulated eosinophilic cytoplasm with a ground-glass appearance. Raya Saba, Shawn G. Kwatra, Bishwas Upadhyay, Aibek E. Mirrakhimov, and Farah N. Khan Copyright © 2013 Raya Saba et al. All rights reserved. Mon, 04 Mar 2013 17:28:39 +0000 http://www.hindawi.com/crim/rheumatology/2013/736143/ Here, we report the case of a 55-year-old man with reactivation of old cutaneous scars associated with a febrile illness, episcleritis, polyarthralgias, erythema nodosum and hilar adenopathy. High-resolution computed tomography (HRCT) revealed right paratracheal, bilateral hilar, and subcarinal lymphadenopathy without any nodular densities in both lung fields. A scar biopsy revealed multiple noncaseating granulomas and confirmed the diagnosis of sarcoidosis. A short course of oral steroids led to regression of systemic symptoms, and the scars returned to baseline size. This patient represented a rare case of simultaneous Löfgren’s syndrome and scar sarcoidosis. Vishnu Vardhan Reddy Munagala, Vaishali Tomar, and Amita Aggarwal Copyright © 2013 Vishnu Vardhan Reddy Munagala et al. All rights reserved. Tue, 22 Jan 2013 09:29:11 +0000 http://www.hindawi.com/crim/rheumatology/2013/175261/ Cranial palsies are a very rare feature of SLE. Similarly, peripheral sensory-motor axonal neuropathy is very uncommon in SLE. The combination of the two as the presenting symptoms of SLE is a diagnostic challenge particularly in an elderly male patient with a known diagnosis of sarcoidosis. This case serves to highlight the diagnostic considerations in such a patient. The lack of response to standard therapy and the presence of subtle clues like anemia, proteinuria, and mild serositis should prompt the physician to look for alternate diagnoses. The potential association of SLE and sarcoidosis is also discussed. SLE can be present in elderly male patients with cranial and peripheral neuropathy. Fawad Aslam, Firas Bannout, and Elizabeth B. Russell Copyright © 2013 Fawad Aslam et al. All rights reserved. Sun, 30 Dec 2012 17:27:55 +0000 http://www.hindawi.com/crim/rheumatology/2012/325062/ Kikuchi Fujimoto’s disease (KFD) is a rare, immune-mediated, self-limiting disorder with unique histopathological features. KFD is usually seen in young Asian females; however, cases have been reported throughout the world and in all ethnicities. It has been recognized that there is a rare association between Systemic Lupus Erythematosus (SLE) and KFD via sporadic case reports. The exact pathophysiological relationship between these two diseases is still unclear. We report a case of a young Asian female who presented with persistent fever and lymphadenopathy and was diagnosed with Kikuchi Fujimoto’s disease based on lymph node biopsy; although an SLE workup was done, she did not meet the American Rheumatology Association (ARA) diagnostic criteria for lupus, and the lymph node biopsy did not show features of SLE. She improved clinically with a short course of steroid therapy. Two months later, the patient presented with central facial rash and arthralgia. SLE workup was repeated, a skin biopsy was done, and the results at this time supported a diagnosis of SLE. Yu Zuo, Michelle Foshat, You-wen Qian, Brent Kelly, Brock Harper, and Bernard Karnath Copyright © 2012 Yu Zuo et al. All rights reserved. Sun, 30 Dec 2012 10:50:03 +0000 http://www.hindawi.com/crim/rheumatology/2012/982361/ Cocaine abuse is relatively common in our society. To enhance profitability and acceptability of the product, it is not uncommon for illicit drugs to undergo several processes. The Drug Enforcement Agency (DEA) has reported that seventy percent (70%) of cocaine seized at USA borders has been adulterated with levamisole, previously used as chemotherapeutic and immunomodulator for several conditions. Among the side effects of levamisole-adulterated cocaine, necrotizing vasculitis is the more dramatic. We report three cases of necrotizing vasculitis associated with antineutrophils cytoplasmic antibodies (ANCAs) positivity, linked to the use of cocaine. To our knowledge, these are the first cases of cocaine induced vasculitis reported in the Caribbean. Alfredo Sánchez-Cruz, Sylmarie Marrero, José Betancourt, Myrna Andino, Adolfo Lopez, and Jose Gutierrez-Nuñez Copyright © 2012 Alfredo Sánchez-Cruz et al. All rights reserved. Mon, 24 Dec 2012 17:29:58 +0000 http://www.hindawi.com/crim/rheumatology/2012/270315/ Tocilizumab, a humanized anti-human interleukin-6 (IL-6) receptor monoclonal antibody, is beneficial for treating autoimmune conditions such as rheumatoid arthritis (RA). The most common adverse event is upper respiratory tract infection; ocular side effects are rare. We describe a case of skin ulceration and bilateral retinopathy with multifocal cotton-wool spots and retinal hemorrhages in a patient with RA treated with tocilizumab. Tocilizumab administration increased the serum level of IL-6 without affecting the IL-8 levels. We could not exclude the possibility of blood coagulation or retinal vascular changes caused by tocilizumab. The current case highlights the need to consider that ocular adverse effects can develop in patients treated with tocilizumab. Asumi Tada, Noriyasu Hashida, Toshio Tanaka, and Kohji Nishida Copyright © 2012 Asumi Tada et al. All rights reserved. Sun, 23 Dec 2012 10:45:57 +0000 http://www.hindawi.com/crim/rheumatology/2012/724013/ Tumour necrosis factor (TNF) is an important cytokine involved in the pathology of a number of inflammatory conditions, and thus blockade with anti-TNF therapies is becoming the cornerstone in managing such diseases. With increasing use, evidence is collected for the association of sarcoid-like granulomatous disease developing after the initiation of anti-TNF-α therapy, with disease reversal after discontinuation. Kuljeet Bhamra and Richard Stevens Copyright © 2012 Kuljeet Bhamra and Richard Stevens. All rights reserved. Mon, 17 Dec 2012 16:08:18 +0000 http://www.hindawi.com/crim/rheumatology/2012/534236/ Paraneoplastic dermatomyositis (DM) associated with testicular cancer is extremely rare. We report the case of a patient with skin tightening, polymyalgia, hypereosinophilia, and nodular regenerative hyperplasia revealing seminoma and associated paraneoplastic DM. Sarah Norrenberg, Valérie Gangji, Véronique Del Marmol, and Muhammad S. Soyfoo Copyright © 2012 Sarah Norrenberg et al. All rights reserved. Sun, 16 Dec 2012 10:06:43 +0000 http://www.hindawi.com/crim/rheumatology/2012/923897/ Vasculitic leg ulcers are a cutaneous manifestation of hepatitis C virus (HCV) infection often associated with cryoglobulinemia. Their treatment is difficult and is based on steroids and immunosuppressive drugs with an erratic response and a high probability of adverse reaction. We report three patients with vasculitic leg ulcers associated with hepatitis C virus infection who were treated successfully with rituximab. The pain control and healing were achieved quickly. No adverse effects with rituximab in these patients were presented. Fabio Bonilla-Abadía, Andrés F. Echeverri, Jorge H. Izquierdo, Felipe Cañas, and Carlos A. Cañas Copyright © 2012 Fabio Bonilla-Abadía et al. All rights reserved. Wed, 12 Dec 2012 14:48:27 +0000 http://www.hindawi.com/crim/rheumatology/2012/517424/ We report a female patient with rheumatoid arthritis which was refractory to methotrexate, leflunomide, and anti-TNF therapy. She was treated with anti-IL-6 tocilizumab (TCZ), with an early appearance of sterile pustules on erythematous swollen skin of trunk, back, and abdominal area. The lesions were consistent with the diagnosis of acute drug-related generalized exanthematous pustulosis (AGEP). This adverse event was controlled with medical treatment without requiring removal of TCZ. J. H. Izquierdo, F. Bonilla-Abadía, C. D. Ochoa, A. Agualimpia, G. J. Tobón, and C. A. Cañas Copyright © 2012 J. H. Izquierdo et al. All rights reserved. Mon, 10 Dec 2012 11:22:19 +0000 http://www.hindawi.com/crim/rheumatology/2012/250537/ Introduction. Whilst there are reports of viral myopathies affecting children and the immunocompromised, infective myositis is a relatively rare inflammatory myopathy in adults. The clinical spectrum can range from benign myalgias to more serious complications in certain risk groups. Case Presentation. We present two cases of myositis as a result of parvovirus B19 infection. Conclusion. Viral myositis and parvovirus B19 associated myositis should be considered in adults presenting with significant myalgia. Nathan D. Oliver, Auleen Millar, and Adrian Pendleton Copyright © 2012 Nathan D. Oliver et al. All rights reserved. Thu, 06 Dec 2012 11:42:55 +0000 http://www.hindawi.com/crim/rheumatology/2012/934324/ Severe eosinophilic syndromes related to the administration or use of unsuspected immunogenic substances have been described previously. Many of these diseases presented initially as clusters or isolated cases. The spanish toxic oil syndrome, the eosinophilia myalgia syndrome, and nephrogenic systemic fibrosis are examples of such diseases. We describe 2 cases of a severe eosinophilic syndrome characterized by marked peripheral blood eosinophilia (>15,000 cells/ml), mononeuritis multiplex, and necrotizing vasculitis which developed in a close temporal association with the recent onset use of nonprescription probiotics. There was no history of a prior autoimmune disease. Although both cases had prompt response to immunosuppression with rapid resolution of peripheral blood eosinophilia and accompanying constitutional symptoms, they remained with permanent neurological deficits. Fabian A. Mendoza, Shivani Purohit, Lawrence Kenyon, and Sergio A. Jimenez Copyright © 2012 Fabian A. Mendoza et al. All rights reserved. Thu, 29 Nov 2012 16:00:01 +0000 http://www.hindawi.com/crim/rheumatology/2012/208606/ Bevacizumab is a recombinant humanised monoclonal antibody directed against the vascular endothelial growth factor (VEGF). The drug, alone or in combination with other anticancer agents, has been shown to be effective against several types of neoplasms. We report a case of a woman with a history of severe psoriasis who developed psoriatic arthritis during a course of bevacizumab, which was administered for a malignant glioma. D. Graceffa, E. Maiani, A. Pace, F. M. Solivetti, F. Elia, C. De Mutiis, and C. Bonifati Copyright © 2012 D. Graceffa et al. All rights reserved. Tue, 13 Nov 2012 12:46:06 +0000 http://www.hindawi.com/crim/rheumatology/2012/515768/ Transverse myelitis (TM) is an inflammatory process involving a restricted area of the spinal cord. The usual dramatic presentation makes TM a medical emergency. Early detection and aggressive therapy are required in order to improve the prognosis. The association of this unique clinical phenotype and autoantibody provides circumstantial evidence that an autoimmune aetiology might be involved. We describe two cases of TM associated with anti-Ro (SSA) autoantibodies without connective tissue disease manifestations. The two patients were treated successfully with IV steroids and cyclophosphamide. G. Melikyan, M. H. Abdelrahman, A. D’Suoza, N. Akhtar, A. N. Elzouki, and M. Hammoudeh Copyright © 2012 G. Melikyan et al. All rights reserved. Thu, 08 Nov 2012 13:35:27 +0000 http://www.hindawi.com/crim/rheumatology/2012/539310/ We describe a 31-years-old female patient with severe pain in both knees who had been diagnosed as Behcet’s disease (BD) for 12 years. She had had a history of complications due to BD including superior vena cava thrombosis, pulmonary thromboembolism, uveitis, and erythema nodosum and has reported the administration of corticosteroid therapy irregularly. After radiologic evaluation, she has been diagnosed with bone infarction of both left and right knee with the existance of lupus anticoagulants (LA) positivity. Severe joint pain without the evidence of arthritis must alert the clinician to the possibility of bone necrosis of the extremity, although those may rarely occur bilateral in BD. Pelin Oktayoglu, Figen Cevik, Mehmet Tahtasiz, Serda Em, Mehtap Bozkurt, Ahmet Kapukaya, and Kemal Nas Copyright © 2012 Pelin Oktayoglu et al. All rights reserved. Wed, 07 Nov 2012 16:11:35 +0000 http://www.hindawi.com/crim/rheumatology/2012/253693/ Introduction. Tophaceous gout of the patella is rare and may masquerade as a tumour or tumour-like condition. Cases. We report two patients with gout involving the patella, one complicated by a pathological fracture and the other occurring in a bipartite patella in a young adult. Discussion. Typical imaging appearances and measurement of serum urate will usually confirm the diagnosis but, occasionally, the serum urate level may be normal in active gout and in such cases, a biopsy will be required. Conclusion. Gout of the patella may masquerade as a tumour or tumour-like condition and it is important to consider gout in the differential diagnosis. Graeme Hopper, Sanjay Gupta, Sarath Bethapudi, David Ritchie, Elaine MacDuff, and Ashish Mahendra Copyright © 2012 Graeme Hopper et al. All rights reserved. Thu, 01 Nov 2012 11:08:11 +0000 http://www.hindawi.com/crim/rheumatology/2012/640353/ Sjögren’s syndrome (SS) is a systemic autoimmune disease characterized by sicca symptoms. Interstitial pulmonary fibrosis and tracheobronchial sicca are the most common symptoms of pulmonary involvement in primary SjS, and they are rarely accompanied by serositis such as pleuritis or pericarditis. We report a case of SS presenting initially with bilateral pleural effusions. A 63-year old man was admitted to our hospital with a one-month history of cough, dyspnea, and right chest pain. Chest-computed tomography revealed bilateral pleural effusions. Serum anti-SS-A antibody titer was 1 : 256. Ophthalmological examination revealed a positive Schirmer test. Lip biopsy showed atrophy and plasmacytic infiltration of the salivary gland. Corticosteroid treatment was initiated. Pleural effusions were almost completely resolved by day 30. The patient has not experienced any recurrence. Go Makimoto, Michiko Asano, Nobukazu Fujimoto, Yasuko Fuchimoto, Katsuichiro Ono, Shinji Ozaki, Koji Taguchi, and Takumi Kishimoto Copyright © 2012 Go Makimoto et al. All rights reserved. Sun, 14 Oct 2012 15:29:00 +0000 http://www.hindawi.com/crim/rheumatology/2012/672959/ Henoch Schonlein purpura is a systemic vasculitis that commonly affects children and teenagers but also affects adults of all ages. In most instances it has a benign course. Organ involvement, particularly in adults, and notably the kidneys and gastrointestinal tract may require therapeutic intervention and may have a less favorable outcome. We report a case of a 58-year-old man who presented with purpura and who rapidly developed catastrophic intestinal vasculitis, leading to his demise. Mekdess Abebe, Asha Patnaik, Frederick Miller, Heidi Roppelt, Nand K. Wadhwa, Mersema Abate, and Edward P. Nord Copyright © 2012 Mekdess Abebe et al. All rights reserved.