{"title":"Induced membrane technique and intramedullary beaming for the extensive bone defect of the talonavicular joint: A case report and literature review.","authors":"Yuki Ohue, Kosho Togei, Hiroaki Shima, Yoshihiro Hirai, Ken Tanaka, Masashi Neo","doi":"10.1093/mrcr/rxae048","DOIUrl":"10.1093/mrcr/rxae048","url":null,"abstract":"<p><p>Cases involving both the induced membrane technique and intramedullary beaming are generally rare. Here, we report such a case in an 83-year-old man who suffered from left midfoot pain. Pyogenic arthritis was suspected based on clinical findings, and curettage was performed, revealing an extensive bone defect. The patient was clinically diagnosed with seronegative rheumatoid arthritis. Therefore, the patient underwent both induced membrane technique and intramedullary beaming for the extensive bone defect in the talus and navicular regions caused by seronegative rheumatoid arthritis. The patient exhibited satisfactory short-term outcomes.</p>","PeriodicalId":94146,"journal":{"name":"Modern rheumatology case reports","volume":" ","pages":"35-40"},"PeriodicalIF":0.9,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sepehr Khosravi, Babak Zamani, Mohammad Reza Motamed, Fahimeh H Akhoundi
{"title":"Adalimumab-induced CNS demyelination in a patient with multiple pre-existing autoimmune diseases: Treatment contemplation.","authors":"Sepehr Khosravi, Babak Zamani, Mohammad Reza Motamed, Fahimeh H Akhoundi","doi":"10.1093/mrcr/rxae069","DOIUrl":"10.1093/mrcr/rxae069","url":null,"abstract":"<p><p>Anti-tumour necrosis factor (TNF) agents like adalimumab are safe and effective for rheumatologic disorders, but they have been reported to cause demyelinating diseases like multiple sclerosis. A 47-year-old woman with weakness in the left hand was evaluated. She had a previous medical history of intermediate uveitis and rheumatoid arthritis. Anti-TNF-α treatment was initiated with adalimumab 2 years before this visit. Magenetic resonance imaging showed numerous T2-hyperintense lesions in bilateral periventricular, juxtacortical, and subcortical areas, which were absent in her scan before anti-TNF therapy. She was diagnosed with multiple sclerosis, and adalimumab was discontinued. IV glucocorticoids were administered with marked improvement. She was then started on anti-CD20 therapy with rituximab. A year later, she was symptom-free, and her follow-up brain magnetic resonance imaging showed no new lesions. The link between multiple sclerosis and TNF-α inhibitors is poorly understood, but several hypotheses have been proposed. Discontinuing anti-TNF therapy alone may not be enough to prevent further demyelinating disease activity, and it is essential to consider the necessity of starting a disease-modifying treatment. Autoimmunity plays a significant role in rheumatologic and neurological diseases, and as personalised medicine advances, understanding genetic risk is crucial for selecting appropriate therapeutic targets. A thorough evaluation of a patient's family background is recommended before a therapeutic decision-making, especially in patients with multiple autoimmune disorders, and the question of whether TNF-α is a suitable therapeutic target in patients with multiple autoimmune disorders is raised.</p>","PeriodicalId":94146,"journal":{"name":"Modern rheumatology case reports","volume":" ","pages":"75-78"},"PeriodicalIF":0.9,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Harsh Jain, S Kartik, Abhishek Kumar, Aradhana Dwivedi, Sankar Jayaprakash, V Vasdev, Ashish Chandwani
{"title":"Monogenic lupus with neuroregression in an infant due to rare compound heterozygous variants in C1QA gene: Case-based review.","authors":"Harsh Jain, S Kartik, Abhishek Kumar, Aradhana Dwivedi, Sankar Jayaprakash, V Vasdev, Ashish Chandwani","doi":"10.1093/mrcr/rxae039","DOIUrl":"10.1093/mrcr/rxae039","url":null,"abstract":"<p><p>Monogenic lupus is a rare variant of systemic lupus erythematosus (SLE) that develops in patients with a single gene disorder. Early complement component deficiencies were the first forms of monogenic lupus to be described, and C1Q gene mutations are one of the most common forms. C1QA complement deficiency has been reported to occur usually due to biallelic variants in C1QA gene, and compound heterozygous variants in C1QA gene have rarely been reported. A majority of monogenic lupus patients with C1Q deficiency present with mucocutaneous, renal, and musculoskeletal manifestations. Our patient is an unusual case of monogenic lupus with severe neurological manifestations along with cutaneous, haematological, and hepatic manifestations secondary to rare compound heterozygous variants in C1QA gene and antiribosomal P autoantibody positivity. She was treated with glucocorticoids, rituximab, and fresh frozen plasma with partial neurological recovery. Thus, we present a unique case of monogenic lupus due to a rare compound heterozygous variant in C1QA gene with a brief review of literature.</p>","PeriodicalId":94146,"journal":{"name":"Modern rheumatology case reports","volume":" ","pages":"57-62"},"PeriodicalIF":0.9,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141891404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Katsuhide Kusaka, Shingo Nakayamada, Kentaro Hanami, Aya Nawata, Yoshiya Tanaka
{"title":"A case of immunoglobulin G4-related disease complicated by atopic dermatitis responsive to upadacitinib treatment.","authors":"Katsuhide Kusaka, Shingo Nakayamada, Kentaro Hanami, Aya Nawata, Yoshiya Tanaka","doi":"10.1093/mrcr/rxae047","DOIUrl":"10.1093/mrcr/rxae047","url":null,"abstract":"<p><p>Immunoglobulin G4-related disease (IgG4-RD) is mainly treated with glucocorticoids. In many cases, this disease is resistant to glucocorticoids, and their toxicity can be a problem. We encountered a patient with IgG4-RD affecting multiple organs (such as the skin, lung, and lacrimal gland), who had comorbidities, including atopic dermatitis and diabetes. In this case, while glucocorticoid tapering was difficult, the introduction of upadacitinib resulted in the remission of both atopic dermatitis and IgG4-RD without glucocorticoid dose escalation. Peripheral blood flow cytometry analysis showed that the proportions of activated non-Th1/Th17 cell subset (Th2 cells), follicular helper T cells, and plasmocytes were increased before upadacitinib therapy, but all normalised after treatment. Interleukin-4 and interleukin-21 signals are important for the differentiation of CD4+ T cells into type 2 helper T or B cells in the peripheral blood. Our case suggested that inhibition of Janus kinase 1, which mediates these signals, might have contributed to improved pathological conditions in IgG4-RD.</p>","PeriodicalId":94146,"journal":{"name":"Modern rheumatology case reports","volume":" ","pages":"207-213"},"PeriodicalIF":0.9,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142038131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Anti-asparaginyl-tRNA synthetase antibody-positive pneumonitis in a patient with immune checkpoint inhibitor treatment: A case report and literature review.","authors":"Nobuhiro Oda, Okuto Koguchi, Hiroki Kontani, Jun Hayashi, Ryo Hazue, Yu Oyama, Ryo Rokutanda","doi":"10.1093/mrcr/rxae043","DOIUrl":"10.1093/mrcr/rxae043","url":null,"abstract":"<p><p>In recent years, the use of immune checkpoint inhibitors (ICIS) has increased and there have been case reports of anti-aminoacyl-tRNA synthetase (anti-ARS) antibody syndrome during ICI treatment. However, these cases are limited, and their clinical characteristics are not fully understood. We report the first case of anti-ARS antibody syndrome with asparaginyl-tRNA synthetase antibody during ICI therapy. This report presents our case, along with a literature review of other anti-ARS antibody syndrome cases that developed after ICI use, discussing their clinical characteristics and possible mechanisms of onset. Considering the widespread use of ICIs in cancer therapy, we should be aware of anti-ARS antibody syndrome that develops during the use of ICIs.</p>","PeriodicalId":94146,"journal":{"name":"Modern rheumatology case reports","volume":" ","pages":"88-92"},"PeriodicalIF":0.9,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141891402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kazuhiko Hashimoto, Tomohiko Ito, Yuto Yamagishi, Koji Goto
{"title":"Bilateral atypical femur fracture in a patient with breast cancer taking zoledronic acid and denosumab: A case report.","authors":"Kazuhiko Hashimoto, Tomohiko Ito, Yuto Yamagishi, Koji Goto","doi":"10.1093/mrcr/rxae059","DOIUrl":"10.1093/mrcr/rxae059","url":null,"abstract":"<p><p>A 54-year-old woman developed stage IV breast cancer 8 years prior. Chemotherapy was administered, and she was started on zoledronic acid treatment for her bone metastases. Her chemotherapy regimen was then switched, owing to disease progression. Fifty-seven months after starting treatment with zoledronic acid, the patient suffered an atypical femoral fracture of her right femur, for which she underwent surgery. Twenty months later, she developed another atypical femoral fracture in her left femur and underwent intramedullary nail fixation. Zoledronic acid and denosumab use in patients with metastatic bone tumours caused by breast cancer should be done cautiously, considering atypical femoral fracture risk.</p>","PeriodicalId":94146,"journal":{"name":"Modern rheumatology case reports","volume":" ","pages":"41-45"},"PeriodicalIF":0.9,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142368095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Deciphering the association between biopsy-confirmed systemic small vessel vasculitis and Epstein-Barr virus-positive polymorphic B-cell lymphoproliferation.","authors":"Atsuhiko Sunaga, Takahiro Seno, Satoshi Omura, Takuya Inoue, Aya Miyagawa-Hayashino, Ikoi Omatsu, Makoto Wada, Masataka Kohno, Yutaka Kawahito","doi":"10.1093/mrcr/rxae028","DOIUrl":"10.1093/mrcr/rxae028","url":null,"abstract":"<p><p>The Epstein-Barr virus (EBV) is associated with various lymphoproliferative disorders (LPDs). Additionally, EBV infection has correlated with diverse autoimmune diseases. However, the association between EBV and systemic small vessel vasculitis (SVV) remains controversial. Here, we report a case of SVV with pauci-immune glomerulonephritis accompanied by an EBV-positive polymorphic B-cell LPD, not otherwise specified. The intricate distinction between EBV-positive B-cell LPD and SVV was difficult, as both diseases demonstrated similar clinical presentations. Lymph node and kidney biopsies facilitated the accurate diagnosis of these two conditions. The administration of high-dose prednisolone, combined with rituximab, proved efficacious, with no instances of relapse over the subsequent 2-year period. This case indicates an association between EBV-positive B-cell LPD and SVV. The diligent execution of biopsies is a crucial diagnostic and interpretive strategy, generating precise comprehension of this condition and guiding its appropriate therapeutic management.</p>","PeriodicalId":94146,"journal":{"name":"Modern rheumatology case reports","volume":" ","pages":"117-121"},"PeriodicalIF":0.9,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141161335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Idiopathic multicentric Castleman disease-TAFRO after COVID-19: A case report.","authors":"Tatsuro Shiina, Eriko Kashihara Yamamoto, Hirotaka Yamada, Sho Sendo, Maki Kanzawa, Jun Saegusa","doi":"10.1093/mrcr/rxae045","DOIUrl":"10.1093/mrcr/rxae045","url":null,"abstract":"<p><p>TAFRO syndrome, a rare disease characterised by thrombocytopaenia, anasarca, fever, reticulin fibrosis, and organomegaly, is thought to be caused by hypercytokinaemia. It is a heterogeneous clinical entity, and a recent comprehensive international definition defined TAFRO syndrome with lymph node histopathology consistent with idiopathic multicentric Castleman disease (iMCD) as iMCD-TAFRO. Herein, we present a rare case of iMCD-TAFRO following coronavirus disease 2019 (COVID-19) infection. A 62-year-old Japanese woman, initially diagnosed with COVID-19, developed a persistent fever and fluid retention, prompting the diagnosis of iMCD-TAFRO. Following the initiation of prednisolone and cyclosporine, her symptoms gradually resolved. Therefore, we discuss the potential pathophysiological link between COVID-19 and iMCD-TAFRO, emphasising the role of cytokine storms. This case report highlights the importance of recognising the spectrum of inflammatory states after COVID-19 and differentiating iMCD-TAFRO after COVID-19 from the COVID-19 cytokine storm syndrome.</p>","PeriodicalId":94146,"journal":{"name":"Modern rheumatology case reports","volume":" ","pages":"174-178"},"PeriodicalIF":0.9,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142038132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Possible usefulness of fluorodeoxyglucose positron emission tomography in diagnosing polyarteritis nodosa: A case report and literature review.","authors":"Toshitaka Yukishima, Shin-Ichiro Ohmura, Haruka Yonezawa, Motoyuki Katayama, Yoshiro Otsuki, Toshiaki Miyamoto, Noriyoshi Ogawa","doi":"10.1093/mrcr/rxae044","DOIUrl":"10.1093/mrcr/rxae044","url":null,"abstract":"<p><p>Polyarteritis nodosa (PAN) is a systemic rheumatic disease that affects medium-sized arteries. PAN is typically not associated with anti-neutrophil cytoplasmic antibodies and has no serological surrogate markers. Therefore, its diagnosis requires pathological findings. However, the positive rate of biopsy in diagnosing PAN is not high, and the biopsy area is often limited. Several investigators have reported the usefulness of imaging findings in diagnosing PAN, independent of pathological findings. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET)/CT has recently been approved for the diagnosis of large-vessel vasculitis in Japan. Several studies have also demonstrated the usefulness of FDG-PET/CT in diagnosing medium-vessel vasculitis. However, no studies have evaluated the usefulness of FDG-PET/CT for diagnosing PAN compared to other modalities, and it is not clear whether FDG-PET/CT is superior to other modalities for diagnosing PAN. Herein, we report a case of PAN and compare the usefulness of FDG-PET/CT with other modalities in diagnosing PAN.</p>","PeriodicalId":94146,"journal":{"name":"Modern rheumatology case reports","volume":" ","pages":"137-142"},"PeriodicalIF":0.9,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yuichiro Ota, Toshiki Ohisa, Akira Ishii, Mai Sugiyama, Yasushi Kondo, Ayumi Nishikawa, Noriko Sasaki, Chiho Yamada, Shinji Sato
{"title":"Coexistence of anti-KS and anti-TIF1-γ antibodies in clinically amyopathic dermatomyositis presenting with rapid progression of interstitial lung disease.","authors":"Yuichiro Ota, Toshiki Ohisa, Akira Ishii, Mai Sugiyama, Yasushi Kondo, Ayumi Nishikawa, Noriko Sasaki, Chiho Yamada, Shinji Sato","doi":"10.1093/mrcr/rxae033","DOIUrl":"10.1093/mrcr/rxae033","url":null,"abstract":"<p><p>Polymyositis/dermatomyositis (DM) is an idiopathic inflammatory myopathy manifesting mainly as symmetrical proximal muscle weakness and/or typical cutaneous features due to autoimmune mechanisms. Clinically amyopathic dermatomyositis (CADM) is a subset of DM that exhibits only the typical cutaneous features without any clinical muscle symptoms. Several autoantibodies have been found specifically in patients with polymyositis/DM, including CADM patients. The anti-KS antibody is one of a group of anti-aminoacyl transfer RNA antibodies that are mainly associated with fever, Raynaud's phenomenon, polyarthritis, and interstitial lung disease (ILD), whereas anti-TIF1-γ antibody is frequently found in DM patients with malignancy. Here, we report a CADM patient having both anti-KS antibody and anti-TIF1-γ antibody. This patient developed an acute exacerbation of ILD and was successfully treated with high-dose corticosteroid pulse therapy together with immunosuppressive agents. Although earlier experience had indicated that the seminal characteristic of anti-KS-positive ILD was slowly developing disease onset with little or no progression over the clinical course, the present patient suffered rapidly progressive disease.</p>","PeriodicalId":94146,"journal":{"name":"Modern rheumatology case reports","volume":" ","pages":"79-83"},"PeriodicalIF":0.9,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141861956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}