Haytham Hasan, Ivana Surjancev, Jon A Arnason, Shivani Garg, William Nicholas Rose
{"title":"Corticosteroids, Plasmapheresis, Argatroban, Rituximab, and Sirolimus Provided Clinical Benefit for Catastrophic Antiphospholipid Syndrome in a Patient with a History of Heparin-Induced Thrombocytopenia.","authors":"Haytham Hasan, Ivana Surjancev, Jon A Arnason, Shivani Garg, William Nicholas Rose","doi":"10.1155/2023/3226278","DOIUrl":"https://doi.org/10.1155/2023/3226278","url":null,"abstract":"<p><p>We report a patient with catastrophic antiphospholipid syndrome who had significant improvement after corticosteroids, plasmapheresis, argatroban, rituximab, and sirolimus. Argatroban was used instead of heparin due to a history of heparin-induced thrombocytopenia.</p>","PeriodicalId":9622,"journal":{"name":"Case Reports in Rheumatology","volume":"2023 ","pages":"3226278"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9935868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9314493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Time Course of Antispike Antibody Titer after Administration of BNT162b2 mRNA COVID-19 Vaccine in a Patient with Rheumatoid Arthritis on Methotrexate.","authors":"Satoshi Shinohara, Yasuhiro Hirose","doi":"10.1155/2023/4525249","DOIUrl":"https://doi.org/10.1155/2023/4525249","url":null,"abstract":"<p><p>Methotrexate, an anchor drug for rheumatoid arthritis, hinders the immunogenicity of mRNA COVID-19 vaccines. Therefore, an optimal vaccine strategy for patients with rheumatoid arthritis receiving methotrexate is vital. We monitored antispike antibody titers after BNT162b2 mRNA COVID-19 vaccination in seven healthcare workers and one methotrexate-treated rheumatoid arthritis patient. The antispike antibody titers of healthcare workers significantly increased immediately after primary vaccination and then continued to decrease, whereas those of the rheumatoid arthritis patient were significantly lower immediately after primary vaccination and then increased. The titers in all participants dramatically increased 1-month postbooster. These changes over time may suggest that in the methotrexate-treated rheumatoid arthritis patient, the generation of short-lived plasma cells was strongly suppressed; in contrast, the generation of long-lived plasma cells and memory B cells was intact. For methotrexate-treated rheumatoid arthritis patients, it is important to complete the primary and booster vaccination series to ensure sufficient immunity against COVID-19.</p>","PeriodicalId":9622,"journal":{"name":"Case Reports in Rheumatology","volume":"2023 ","pages":"4525249"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10132894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9387112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Rare Presentation of Disseminated Gout Nodulosis and Chronic Inflammatory Arthritis.","authors":"Faria Sami, Shahzad Ahmed Sami, Shilpa Arora","doi":"10.1155/2023/8083212","DOIUrl":"https://doi.org/10.1155/2023/8083212","url":null,"abstract":"<p><strong>Background: </strong>Gout is an inflammatory arthritis caused by monosodium urate (MSU) deposition. Acute gout is a dramatic painful swelling of the joint; however, MSU can deposit in other tissues as well, including skin, gastrointestinal tract, and bones over time. Disseminated tophi in the skin are a rare presentation of gout known as gout nodulosis. We present a case of gout nodulosis with subcutaneous diffuse miliary nodules in nonarticular areas with concurrent findings suggestive of chronic inflammatory arthritis. <i>Case Presentation</i>. A 39-year-old patient presented with intermittent painful swelling in multiple joints with prolonged morning stiffness. On exam, synovitis was present in multiple proximal interphalangeal joints, wrists, elbows, and knees. Chronic raised pearly nodular rash and swellings on extensor aspects of arms, legs, and anterior abdomen were noticeable. He had negative rheumatoid factor and anti-CCP antibody, C-reactive protein of 0.23 mg/dL, erythrocyte sedimentation rate of 37 mm/hr, and uric acid of 10.6 mg/dL. Hand X-rays revealed severe periarticular osteopenia and joint space narrowing in several joints. Musculoskeletal ultrasound showed a double contour sign at multiple joints and a tophaceous deposit over the olecranon fossa. The biopsy of the nodular rash was consistent with tophi. He was diagnosed with chronic tophaceous gout with skin nodulosis and possible overlap of seronegative rheumatoid arthritis given his X-ray findings.</p><p><strong>Conclusion: </strong>This case discusses one of the rare presentations of gout with disseminated gouty tophi in the skin to raise clinical awareness. The clinical dilemma of the overlap of gout and rheumatoid arthritis posing a diagnostic challenge for clinicians is also highlighted.</p>","PeriodicalId":9622,"journal":{"name":"Case Reports in Rheumatology","volume":"2023 ","pages":"8083212"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10284652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10070065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Coexistent Relapsing Polychondritis and Clinically Amyopathic Dermatomyositis: A Rare Association of Autoimmune Disorders.","authors":"Rafael A Ríos-Rivera, Luis M Vilá","doi":"10.1155/2023/3719502","DOIUrl":"https://doi.org/10.1155/2023/3719502","url":null,"abstract":"<p><p>Relapsing polychondritis (RPC) is an uncommon autoimmune systemic disease characterized by recurrent inflammation of the cartilage tissue. It can occur alone or in association with other autoimmune diseases, vasculitis, or hematologic disorders. However, the association of RPC with dermatomyositis is extremely rare. Herein, we present a case of a 38-year-old man who developed concurrent RPC and clinically amyopathic dermatomyositis (CADM) manifested by auricular chondritis, nasal chondritis, polyarthritis, gottron papules, fingertip papules, skin biopsy consistent with dermatomyositis, and positive antimelanoma differentiation-associated gene 5 (MDA5) antibodies. RPC features resolved with corticosteroids, but CADM manifestations were resistant to corticosteroids, cyclophosphamide, azathioprine, and hydroxychloroquine. Subsequent therapy with rituximab was effective to control CADM manifestations. This case highlights the importance of recognizing CADM as part of the autoimmune diseases linked with RPC and maintaining a high level of awareness to initiate effective therapy to avoid the long-term complications associated with these conditions.</p>","PeriodicalId":9622,"journal":{"name":"Case Reports in Rheumatology","volume":"2023 ","pages":"3719502"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10113061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9386237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A Case Report of Pericardial Effusion with False-Positive Mesothelioma and Adenocarcinoma Markers as the Initial Presentation of Systemic Lupus Erythematous.","authors":"Gita Bhattacharya, Pritha P Gupta","doi":"10.1155/2022/8081055","DOIUrl":"https://doi.org/10.1155/2022/8081055","url":null,"abstract":"<p><p>Pericardial effusion or the accumulation of fluid in the pericardial sac, can result from infectious, malignant, or autoimmune processes such as systemic lupus erythematous (SLE). However, pericardial effusion is infrequently the first presentation of SLE. Here, we describe the case of a 54-year-old African American woman who presented with hypertensive emergency and was found to have pericardial effusion on echocardiogram. Her hypertensive symptoms resolved with medical management and a work up were positive for serum markers of SLE and mesothelioma cell markers (calretinin, CK 5/6) and adenocarcinoma marker MOC31 in the pericardial fluid. Her effusion ultimately improved on high-dose steroid therapy and has not recurred in one year. Given normal pleura and pericardium on computed tomography (CT) imaging and long-term clinical improvement in SLE therapy, we hypothesize that she had false-positive mesothelioma markers in the setting of SLE.</p>","PeriodicalId":9622,"journal":{"name":"Case Reports in Rheumatology","volume":" ","pages":"8081055"},"PeriodicalIF":0.0,"publicationDate":"2022-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9649300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40691356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bhesh Karki, Louis Costanzo, Sameer Joshi, Aleksey Fiksman
{"title":"Aftermath of Apixaban: Atypical Anticoagulation Aftereffect.","authors":"Bhesh Karki, Louis Costanzo, Sameer Joshi, Aleksey Fiksman","doi":"10.1155/2022/6221640","DOIUrl":"https://doi.org/10.1155/2022/6221640","url":null,"abstract":"<p><p>An elderly man with prostate cancer and a deep vein thrombosis (DVT) of the lower extremity diagnosed 12 days ago on apixaban presented with a new-onset palpable rash on both of his legs. Extensive laboratory workup was largely unremarkable, except for multiple skin punch biopsies revealing deposition of immunoglobulin A (IgA) in the superficial blood vessels with infiltration of leukocytes, concerning for a small vessel vasculitis. Given the temporal association along with the negative workup, the rash was attributed to apixaban, and the anticoagulation regimen was switched to dabigatran. At a 2-week follow-up visit, the patient was asymptomatic and tolerating dabigatran without any adverse events.</p>","PeriodicalId":9622,"journal":{"name":"Case Reports in Rheumatology","volume":" ","pages":"6221640"},"PeriodicalIF":0.0,"publicationDate":"2022-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9617718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40674368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Glomerulonephritis and Interstitial Nephritis Originating from Vasculitis of the Interlobular Arteries of the Kidney in a Patient with Eosinophilic Granulomatosis with Polyangiitis.","authors":"Takashi Nawata, Masaki Shibuya, Yukio Takeshita, Makoto Kubo, Noriko Uesugi, Masafumi Yano","doi":"10.1155/2022/9606981","DOIUrl":"https://doi.org/10.1155/2022/9606981","url":null,"abstract":"<p><p>Eosinophilic granulomatosis with polyangiitis (EGPA) is a type of antineutrophil cytoplasmic antibody-associated vasculitis. Patients often present with peripheral neuropathy and purpura, suggesting impairment of small vessels, especially capillaries. However, medium-sized vessels and small vessels with a vascular diameter larger than that of capillaries may also be impaired, causing atypical findings. We report a case of EGPA treated with corticosteroids, cyclophosphamide, and mepolizumab. Renal biopsy revealed vasculitis of the interlobular arteries as the cause of glomerulonephritis and interstitial nephritis. This case suggests the importance of considering vessels upstream of capillaries dominant EGPA as a differential diagnosis in patients with eosinophilia.</p>","PeriodicalId":9622,"journal":{"name":"Case Reports in Rheumatology","volume":"2022 ","pages":"9606981"},"PeriodicalIF":0.0,"publicationDate":"2022-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9534698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33496809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Rapid Onset and Resolution of Hydroxychloroquine Cardiomyopathy: A Case Report.","authors":"Ahmad Ramahi, Amer Heider, J Michelle Kahlenberg","doi":"10.1155/2022/6503453","DOIUrl":"https://doi.org/10.1155/2022/6503453","url":null,"abstract":"<p><p>Systemic lupus erythematosus (SLE) is an autoimmune, chronic, and heterogenous disease with organ damage resulting from immune complex deposition and inflammatory infiltrates. Antimalarial drugs, such as hydroxychloroquine (HCQ), are cornerstone immunomodulators for the treatment of SLE. Rarely, HCQ toxicity can occur, leading to devastating outcomes. We report a case of a patient with SLE on HCQ who presented with a rapid onset of large pericardial effusion and a dramatically decreased left ventricular ejection fraction. Endomyocardial biopsy was positive for curvilinear bodies, confirming the diagnosis of hydroxychloroquine cardiotoxicity. Hydroxychloroquine cardiomyopathy is a rare but life-threatening medication side effect. It is important to consider it in any patient taking the medication who presents with a new onset or worsening symptoms of heart failure.</p>","PeriodicalId":9622,"journal":{"name":"Case Reports in Rheumatology","volume":"2022 ","pages":"6503453"},"PeriodicalIF":0.0,"publicationDate":"2022-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9529523/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33490876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Nephrotic Syndrome as an Extramuscular Manifestation of Anti-EJ Antibody-Positive Dermatomyositis: A Case Report and Review of the Literature.","authors":"Syoko Tsubouchi, Takahiro Mizuuchi, Yusuke Yamamoto, Daiki Fujimori, Kayo Ishii, Mayu Tago, Eri Kato, Hiroaki Mori, Haeru Hayashi, Koichiro Tahara, Tetsuji Sawada","doi":"10.1155/2022/1233522","DOIUrl":"https://doi.org/10.1155/2022/1233522","url":null,"abstract":"<p><p>Renal involvement is underestimated as an extramuscular manifestation of dermatomyositis (DM). Here, we describe a 67-year-old woman with anti-glycyl-transfer ribonucleic acid synthetase (anti-EJ) antibody and anti-ribonucleoprotein antibody-positive DM complicated by systemic sclerosis, who developed nephrotic syndrome concurrently with the exacerbation of DM, as indicated by incremental serum creatine kinase levels, high-intensity lesions on muscle magnetic resonance imaging, and active interstitial pneumonitis on chest computed tomography. Renal biopsy revealed the presence of immune-deposition in the glomerulus by immunofluorescence. To our knowledge, this is the first report describing the coexistence of anti-EJ antibody-positive DM and nephrotic syndrome. More reports of similar cases are warranted to substantiate the association.</p>","PeriodicalId":9622,"journal":{"name":"Case Reports in Rheumatology","volume":"2022 ","pages":"1233522"},"PeriodicalIF":0.0,"publicationDate":"2022-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9553724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33518058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Priyanjali Pulipati, Jayakar Kamantha Reddy, Syed Ali Husain
{"title":"Severe Anti-HMG-CoAR Necrotizing Autoimmune Myopathy Secondary to Statin Use.","authors":"Priyanjali Pulipati, Jayakar Kamantha Reddy, Syed Ali Husain","doi":"10.1155/2022/6120424","DOIUrl":"https://doi.org/10.1155/2022/6120424","url":null,"abstract":"<p><p>Immune-mediated necrotizing myopathy is an uncommon but debilitating disease that can be triggered by drugs, toxins, or cancer. It is similar to polymyositis in presentation but is differentiated by findings on muscle biopsy. We present a case of a 79-year-old male on statin therapy who presented with proximal muscle weakness and elevated creatinine kinase (CK) levels. He had a confirmatory muscle biopsy for immune-mediated necrotizing myopathy. Unfortunately, the patient's condition eventually escalated, involving respiratory and esophageal muscles in spite of prompt diagnosis and treatment.</p>","PeriodicalId":9622,"journal":{"name":"Case Reports in Rheumatology","volume":"2022 ","pages":"6120424"},"PeriodicalIF":0.0,"publicationDate":"2022-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9507801/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33484657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}