Case of Polymyalgia Rheumatica Misdiagnosed as Infectious Spondylitis

A 60-year-old woman visited the authors' clinic with low back pain and arthralgia. Her symptoms had occurred 6 months previously, and she was treated with an epidural injection and a balloon dilatation procedure based on the assumption of spinal stenosis, but both treatments were ineffective. Her low back pain was aggravated, accompanied by fever and chills over a period of 4 months. As a result, she visited another referral hospital and was diagnosed with infective spondylitis associated with the invasive procedure. Her symptoms improved with antibiotics, but they recurred. When she visited our clinic, she still had continuous low back pain and febrile senses. Magnetic resonance imaging of her lumbar spine revealed interspinous bursitis, and 18 F-fluorodeoxyglucose positron emission tomography showed multifocal synovial inflammation. She was diagnosed with polymyalgia rheumatica and treatment was started on prednisolone and celecoxib. Her symptoms improved dramatically and the inflammatory markers normalized.

Cardiovascular and Gastrointestinal Effects of Etoricoxib in the Treatment of Osteoarthritis: A Systematic Review and Network Meta-analysis

OBJECTIVE: To estimate the cardiovascular (CV) and gastrointestinal (GI) risks of etoricoxib in the treatment of osteoarthritis (OA) compared to a placebo and other non-steroidal anti-inflammatory drugs (NSAIDs). METHODS: A systematic review of randomized, controlled trials (RCTs) of etoricoxib were performed. Bayesian network meta-analysis was used over a duration of 12 weeks. The incidence of CV and GI events for a duration ≥26 weeks were also tabulated and presented using descriptive statistics. RESULTS: From this search, 10 studies were identified. Of these, 6 and 5 RCTs that measured the CV and GI events at 12 weeks were included in meta-analysis. They showed that etoricoxib did not increase the CV events compared to the placebo or NSAIDs during the 12 week period (odds ratio [OR]=0.59 compared to celecoxib, OR=0.89 with ibuprofen, OR=0.70 with placebo, and OR=2.16 with naproxen). The risk of GI events was comparable to that of most comparators, with the exception of naproxen, which had a significantly lower risk of GI events (OR=0.18) during the 12 week period. For a duration ≥26 weeks, the incidence of CV and GI events with etoricoxib increased with increasing duration. CONCLUSION: Etoricoxib is an alternative short-term treatment option for OA, showing comparable CV and GI complications to other NSAIDs. Nevertheless, further studies will be needed to elucidate the long-term safety of etoricoxib in the treatment of OA.

Intramural Duodenal Hematoma Caused by Acute Gallstone Pancreatitis / 대한내과학회지

Intramural duodenal hematoma (IDH) is a rare complication of pancreatitis. We report a unique case of IDH caused by acute gallstone pancreatitis in a 37-year-old man. The patient presented with hematemesis and sudden exacerbation of upper abdominal pancreatic pain. An abdominal computed tomography scan showed an intramural hyperdense hematoma and symmetric thickening of the duodenal wall along with peripancreatic inflammation and gallbladder stones. A duodenoscopy also revealed a bloody edematous duodenal wall with a narrow lumen due to IDH. The patient recovered fully from the acute pancreatitis and IDH without pancreaticoduodenectomy using conservative management and a subsequent cholecystectomy.

A Case of Malignant Pheochromocytoma Presenting as Inverted Takotsubo-Like Cardiomyopathy

Takotsubo cardiomyopathy or stress induced cardiomyopathy is characterized by acute transient left ventricular apical ballooning without significant coronary artery disease. The pathophysiology of Takotsubo cardiomyopathy remains unclear, but it has been suggested that the stress related neurohumoral factors, especially catecholamines, play an important role. Recently, several reports have described an inverted Takotsubo cardiomyopathy, which is characterized by the dysfunction of the basal and mid-ventricular segments sparing the apex of the heart. In this report, we present a case of a 50-year-old female with a transient left ventricular dysfunction in an inverted Takotsubo pattern, that later was diagnosed as a malignant pheochromocytoma.