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, L&#xf6;fgren's syndrome, and sarcoid myopathy. The patient displayed remarkable clinical and radiological regression after 6-month corticosteroid and MTX therapy.

&#x15e;enol Kobak

Murat Yal&#xe7;in

Fidan Sever

Guray Oncel

Sarcoidosis Presenting as L&#xf6;fgren&#x2019;s Syndrome with Myopathy

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

Rodney Hughes

Case Report of Transverse Myelitis in a Patient Receiving Etanercept for Rheumatoid Arthritis

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&#x2013;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

Ger T. Rijkers

Severe Eosinophilic Syndrome: Highly Unlikely Associated with the Use of Probiotic Supplements!

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

Geries Hakim

Annoying Hiccups following Intra-Articular Corticosteroid Injection of Betamethasone Acetate/Betamethasone Sodium Phosphate at the Knee Joint

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&#x2019;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

Farah N. Khan

Multicentric Reticulohistiocytosis Presenting with Papulonodular Skin Lesions and Arthritis Mutilans

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 L&#xf6;fgren&#x2019;s syndrome and scar sarcoidosis.

Vishnu Vardhan Reddy Munagala

Vaishali Tomar

Amita Aggarwal

Reactivation of Old Scars in an Elderly Man Revealing L&#xf6;fgren's Syndrome

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

Elizabeth B. Russell

Cranial Nerve Palsies: Sarcoidosis to Systemic Lupus Erythematosus

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Case Reports in Rheumatology publishes case reports and case series on paediatric and adult rheumatological and musculoskeletal conditions, including novel therapies and advances in surgery and imaging.

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Case Reports in Rheumatology - Table of contents 2013

title

Case Reports in Rheumatology publishes case reports and case series on paediatric and adult rheumatological and musculoskeletal conditions, including novel therapies and advances in surgery and imaging.

Case Reports in Rheumatology