Mycoplasma bovis-pneumonia and polyarthritis in feedlot calves in Argentina: First local isolation / Neumonía y poliartritis por Mycoplasma bovis en terneros de feedlot: primeraislamiento local

Abstract Bovine respiratory disease (BRD) is one of the most frequent clinical concerns inweaned calves after their arrival at the feedlot. This work reports the first local isolation ofMycoplasma bovis from feedlot calves with pneumonia and polyarthritis in Argentina. Twentyfour out of 545 calves showed progressive, subacute to chronic respiratory distress, coughing,and fever. Thirty percent of the affected calves also showed lameness and swelling of elbowor carpal, and knee or tarsal joints. Five necropsies were performed and severe multifocal tocoalescent pulmonary nodules, containing white-yellowish caseous exudate encircled by fibroustissue, and fibrinonecrotic arthritis and tenosynovitis were detected. Mycoplasma was isolatedfrom lung and joint samples. The 16S-23S rRNA ITS consensus sequence obtained from theseisolates showed 100% similarity with the same region of M. bovis strains. Since there are no com-mercially available vaccines in the region for the prevention and control of M. bovis pneumoniaand arthritis, surveillance is a priority to reduce the source of disease to naïve animals.

Resumen La enfermedad respiratoria bovina es uno de los problemas sanitarios más fre-cuentes en terneros recién destetados luego de su arribo a los corrales de encierre (feedlots).Este trabajo describe el primer aislamiento local de Mycoplasma bovis de terneros de feedlotcon neumonía y poliartritis en Argentina. Se vieron afectados 24 de 545 terneros; mostraron enfermedad respiratoria progresiva, subaguda a crónica, tos y fiebre. De los terneros afecta-dos, el 30% presentó, además, problemas en articulaciones carpales o tarsales. Se realizaron5 necropsias de terneros afectados y se observaron nódulos pulmonares multifocales a coa-lescentes, que contenían un exudado caseoso blanco-amarillento, rodeados de tejido fibroso,artritis y tenosinovitis fibrinonecrótica. Se aisló Mycoplasma de muestras de pulmón y artic-ulación. La secuencia consenso del gen codificante del ARNr 16S-23S rRNA obtenido de estosaislamientos mostró un 100% de similitud con la misma región de cepas de M. bovis. Teniendoen cuenta que no hay vacunas disponibles comercialmente en la región para la prevencióny el control de neumonías y poliartritis por M. bovis, es importante realizar una vigilanciaepidemiológica a fin de reducir las fuentes de infección para animales susceptibles.

Anti-inflamatórios não esteroides tópicos para o alívio da dor artritica, beneficios para idosos / Non-steroid anti-inflammatory topics for arthritic pain relief, benefits for elderly / Temas antiinflamatorios no esteroides para el alívio del dolor artritico, beneficios para personas mayores

Objetivo: Identificar e analisar os anti-inflamatórios não esteroides tópicos para o alívio da dor artrítica, benefícios para idosos. Métodos: Trata-se de uma revisão integrativa realizada nas bases de dados no mês de maio de 2020, mediante consulta às bases de dados MEDLINE/PubMed, CINAHL, EMBASE, Web of Science, SCOPUS e índice bibliométrico LILACS, acessados por meio do Portal Periódicos da Comissão de Aperfeiçoamento de Pessoal de Ensino Superior, utilizando os descritores: idoso (Aged/elderly), anti-inflamatório não esteroide (Anti-Inflammatory Agents, Non-Steroidal) artrite (Arthritides/Polyarthritis). No qual foram selecionados 13 artigos sem limitador para tempo e idioma. Resultados: Detectou se que as variáveis mais evidenciadas foram: inglês (100%); artigos indexados na MEDLINE/PubMed (69,2%); pais com mais publicações Inglaterra (46%). Destaca-se que 69,3% dos artigos foram ensaios clínicos randomizados controlados; anti-inflamatório tópico mais usado diclofenaco sódico (61,5% seguido do cetoprofeno (38,7%). Conclusão: Concluiu se o diclofenaco e o cetoprofeno apresentam eficácia e segurança no alívio da dor artrítica, e baixa toxicidade cutânea local. (AU)

Objective To identify and analyze topical non-steroidal anti-inflammatory drugs for the relief of arthritic pain, benefits for the elderly. Methods: This is an integrative review carried out on the databases in May 2020, by consulting the MEDLINE / PubMed, CINAHL, EMBASE, Web of Science, SCOPUS and LILACS bibliometric index databases, accessed through the Portal Journals of the Higher Education Personnel Improvement Commission, using the descriptors: elderly (Aged / elderly), non-steroidal anti-inflammatory (Anti-Inflammatory Agents, Non Steroidal) arthritis (Arthritides / Polyarthritis). In which 13 articles were selected without time and language limitations. Results: It was found that the most evident variables were: English (100%); articles indexed in MEDLINE / PubMed (69.2%); parents with the most publications in England (46%). It is noteworthy that 69.3% of the articles were randomized controlled clinical trials; most commonly used topical anti-inflammatory diclofenac sodium (61.5% followed by ketoprofen (38.7%). Conclusion: Diclofenac and ketoprofen were concluded to be effective and safe in relieving arthritic pain and low local skin toxicity. (AU)

Objetivo: Identificar y analizar medicamentos antiinflamatorios no esteroideos tópicos para el alivio del dolor artrítico, beneficios para los ancianos. Métodos: Esta es una revisión integradora realizada en las bases de datos en mayo de 2020, consultando las bases de datos del índice bibliométrico MEDLINE / PubMed, CINAHL, EMBASE, Web of Science, SCOPUS y LILACS, a las que se accede a través del Portal Revistas de la Comisión de Mejoramiento del Personal de Educación Superior, utilizando los descriptores: artritis de edad avanzada (Ancianos / ancianos), antiinflamatorios no esteroideos (agentes antiinflamatorios, no esteroideos) (artritis / poliartritis). En el que se seleccionaron 13 artículos sin limitaciones de tiempo e idioma. Resultados: se encontró que las variables más evidentes fueron: inglés (100%); artículos indexados en MEDLINE / PubMed (69,2%); padres con más publicaciones en Inglaterra (46%). Es de destacar que el 69,3% de los artículos fueron ensayos clínicos controlados aleatorios; diclofenaco sódico antiinflamatorio tópico más utilizado (61.5% seguido de ketoprofeno (38.7%). Conclusión: Se concluyó que el diclofenaco y el ketoprofeno son efectivos y seguros para aliviar el dolor artrítico y la baja toxicidad local de la piel. (AU)

Clinical analysis of 67 cases of polyarticular juvenile idiopathic arthritis / 中华实用儿科临床杂志

Objective:To compare the clinical characteristics, clinical efficacy and adverse drug reactions of rheumatoid factor (RF) positive (+ ) and negative (-) polyarticular juvenile idiopathic arthritis (PJIA).Methods:The clinical data of 67 PJIA patients admitted into Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, from January 2013 to December 2018 were analyzed retrospectively.They were divided into RF-positive PJIA group [RF (+ ) group, 23 cases] and RF-negative PJIA group [RF (-) group, 44 cases] according to RF titer.The clinical characteristics, laboratory indexes and clinical efficacy evaluation of the two groups were compared.Results:(1)Distribution of affected joints: the top 3 affected joints in the RF (+ ) group were the knuckles (16 cases, 69.57%), the wrists (15 cases, 65.22%) and the ankles (13 cases, 56.52%), and those in the RF (-) group were the knees (33 cases, 75.00%), ankle joints (29 cases, 65.91%) and hip joints (26 cases, 59.09%). The wrist joint involvement of the RF (+ ) group was significantly higher than that of the RF (-) group, while the knee joint involvement was lower than that of the RF (-) group.The difference was statistically significant (all P<0.01). (2)Magnetic resonance changes of the affected joints: articular cavity effusion (54 cases, 84.38%), synovial thickening (44 cases, 68.75%) and bone edema (26 cases, 40.63%) are common in both groups.The incidence of bone destruction (7 cases, 70.00%) and soft tissue edema (7 cases, 70.00%) in the RF (+ ) group was higher than that in the RF (-) group (2 cases, 18.18% and 2 cases, 18.18%), the difference was statistically significant (all P<0.05). (3) Changes in laboratory indicators: the positive rates of C-reactive protein, erythrocyte sedimentation rate, anti-cyclic citrullinated peptide antibody and anti-nuclear antibody in the RF(+ ) group were significantly higher than those in the RF(-) group, the difference was statistically significant (all P<0.05). (4)Juvenile arthritis disease activity score 27 (JADAS27): the score difference between RF(+ ) group and RF(-) group was not statistically significant [(22.83±5.60) scores vs.(23.07±6.66) scores, t=0.148, P>0.05]. (5) Efficacy analysis: 2 patients were lost to follow-up after discharge, and the remaining 65 patients were treated with traditional therapy, of which 30 were given biologics at the first hospitalization, 9 cases were treated with biologics after the failure of traditional treatments, and 35 patients were treated with biologics to control disease activity.In different dosage regimens, the disease remission rate in the RF(-) group is generally higher than that in the RF(+ ) group. Conclusions:PJIA patients have complicated joint involvement, RF-positive patients are more prone to joint destruction, and traditional treatments are less effective.Biological agents can effectively improve the symptoms of severe PJIA patients, especially those with poor prognosis.

Enfermedad reumática cardiaca: ¿Estamos realmente haciendo lo necesario? / Rheumatic heart disease: are we really doing what is necessary?

Resumen Objetivo: Revisar las características demográficas, clínicas y ecocardiográficas, así como el abordaje quirúrgico de pacientes con fiebre reumática menores de 18 años, durante un periodo de diez años. Materiales y métodos: Estudio descriptivo, retrospectivo, en el cual se incluyeron pacientes menores de 18 años, con diagnóstico de fiebre reumática entre los años 2006 a 2016. Resultados: Se incluyeron 22 niños con edades entre los 10 a los 14 años, de los cuales 59% (13/22) eran mujeres; 13,6% (3/22) provenían de Arauca y el 18,1% (4/22) eran indígenas. Se diagnosticó carditis en el 63,6% (14/22) seguido de poliartralgia y fiebre en un 59% (13/22) y 54% (12/22) respectivamente; así mismo, se detectó corea de Sydenham y eritema marginado 4,5% (1/22). Se determinó compromiso severo de válvula mitral en el 72,7% (16/22). 15 pacientes fueron llevados a cirugía; se realizó reemplazo valvular mitral en 13,3% (2/15), plastia mitral y tricúspide en el 40% (6/15), plastia mitral, tricúspide y aórtica en el 6,66%(1/15) y reemplazo aórtico en el 5,2% (1/15). Un paciente requirió oxigenación por membrana extracorpórea. La mortalidad fue del 0% (0/22). Conclusiones: Se observó que la fiebre reumática ocasionó grave compromiso cardiaco, que requirió un alto grado de intervención quirúrgica. Las poblaciones rurales e indígenas se beneficiarían notablemente de una prevención primordial, primaria y secundaria, al igual que de un diagnóstico y tratamiento oportunos.

Abstract Objective: The aim of this study is to review the demographic, clinical, and cardiac ultrasound characteristics, as well as the surgical approach, of patients less than 18 years-old with rheumatic fever. Materials and methods: A descriptive, retrospective study was conducted that included patients less than 18 years-old diagnosed with rheumatic fever between the years 2006 to 2016. Results: The study included a total of 22 children with ages between 10 and 14 years, of whom 59% were female. It was recorded that 13.6% (3/22) were from Arauca Department (Colombia), and 18.1% (4/22) were indigenous. Carditis was diagnosed in 63.6% (14/22), followed by polyarthralgia and fever in 59% (13/22) and 54% (12/22), respectively. Sydenham's chorea and marginal erythema was also detected in 4.5% (1/22). The severity of mitral valve involvement was determined in 72.7% (16/22). Of the 15 patients that had surgery, 13.3% (2/15) had a mitral valve replacement, mitral and tricuspid repair in 40% (6/15), mitral, tricuspid, and aortic repair in 6.66%, respectively (1/15), and aortic replacement in 5.2% (1/15). One patient required extracorporeal membrane oxygenation. There was no mortality. Conclusions: It was observed that rheumatic fever led to serious cardiac compromise that required a high rate of surgical interventions. Rural and indigenous population would notably benefit from basic, primary, and secondary prevention, as well as a timely diagnosis and treatment.

Poliartritis migratriz: presentación atípica de leucemia en pediatría / Migratory polyarthritis: an atypical presentation of leukemia in pediatrics

La leucemia linfoblástica aguda es la enfermedad oncohematológica más frecuente en la edad pediátrica. El debut con manifestaciones osteoarticulares obliga a realizar el diagnóstico diferencial con artritis idiopática juvenil. El tratamiento con corticoides ante una sospecha de enfermedad reumatológica puede retrasar el diagnóstico y demorar la instauración de un tratamiento adecuado. Describimos el caso clínico de una niña de 8 años con poliartritis migratriz como forma de presentación atípica de leucemia

Acute lymphoblastic leukemia is the most common oncohematological disease in childhood. The onset of the disease with osteoarticular manifestations requires a differential diagnosis with juvenile idiopathic arthritis. Treatment with corticosteroids in case of suspected rheumatic disease can delay the correct diagnosis of leukemia and therefore postpone adequate treatment. We describe the clinical case of an 8-year-old girl with migratory polyarthritis as a form of atypical presentation of leukemia

Polyarthritis and erythema nodosum: an unusual presentation of tuberculosis

Reactive arthritis and erythema nodosum occur in presence of active tubercular infection and both are immunological phenomenon. Author described a case report of a 17year old female with 10months history of symmetrical polyarthritis and presence of healed lesions of erythema nodosum. She was also found to have caseating granulomatous lesion in right supraclavicular lymph node which led us to diagnosis of tuberculous lymphadenitis presenting as reactive polyarthritis (poncet’s disease) and erythema nodosum. Her joint pain and swelling dramatically resolved after 2weeks of ATT. Thus, tuberculosis may manifest as reactive polyarthritis (poncet’s disease) and erythema nodosum and they should be kept in mind even in the absence of other clinical clues of TB, to provide patients with a good clinical outcome.

Poliartritis agudas virales / Viral acute polyarthritis

Las poliartritis agudas son cuadros de menos seis semanas de duración, cuyas causas pueden o no ser infecciosas. Entre las primeras, destacan las virales, con gran varie-dad de agentes causales. Entre ellos se distinguen por su frecuencia: virus hepatitis B,virus hepatitis C, parvovirus B19, virus rubéola y la fiebre Chicungunya. Tienen elementos comunes, como su expresión poliarticular, generalmente simétrica, con predilección por las pequeñas articulaciones de las manos, siendo habitualmente autolimitadas. A su vez, poseen elementos propios, clínicos y de laboratorio, que permiten diferenciarlos, teniendo algunos una evolución más agresiva con morbilidad más significativa. A su vez, por sus características clínicas y de laboratorio, plantean el diagnóstico diferencial con enfermedades inmunoreumatológicas, como la artritis reumatoidea y el lupus eritematoso sistémico, entre otras.Se realiza una revisión del cuadro clínico y de laboratorio de las poliartritis causadas por los virus señalados, su diagnóstico diferencial y posibilidades terapéuticas.

The acute polyarthritis are pictures of less six weeks duration, whose causes can be or not to be infectious. Among the first, the viral ones stand out with a variety of causal agents. Among there distinguished by their frequency: virus hepatitis B, hepatitis C virus, parvovirus B19, rubella virus and the fever Chicungunya. They have common elements, such as his expression polyarticular, usually symmetrical, with a predilection for the small joints of the hands, being usually self-limiting. At the same time, they have own laboratory and clinical elements that allow differentiation, some having a more aggressive evolution with more significant morbidity. At the same time, for its clinical and laboratory characteristics, raise the differential diagnosis of immunohematological diseases, such as arthritis rheumatoid and systemic lupus erythematosus among others.Is done a review of clinical and laboratory of the polyarthritis caused by the mentioned viruses, differential diagnosis and therapeutic possibilities.

Chronic Multiple Gouty Arthritis Diagnosed during Anti-Tuberculosis Treatment of Recurrent Tuberculous Arthritis: A Case Report / 대한족부족관절학회지

Gout occurs mainly in monoarthritis and is found in more than 50% of cases in hallux of the foot. In addition, symptoms sometimes begin in the hand, wrist, and elbow, but they are rarely observed in the spine. The patient was referred for tuberculous polyarthritis due to antituberculosis drug failure. Inflammatory findings were observed in the lumbar, elbow, wrist, hand and foot areas. Surgery was performed on the foot area and a pathology diagnosis revealed gouty arthritis. We report this case with a review of the relevant literature.

Approach To Symmetrical Polyarthritis with Focus on Rheumatoid Arthritis

Symmetrical polyarthritis is not uncommon as a presenting clinical problem in the primary care setting. The ability to differentiate inflammatory from non-inflammatory, articular from peri-articular joint pain will help the Family Physician (FP) to further narrow the diagnosis of joint pain, and provide early referral and effective treatment when necessary. Integrating clinical reasoning with the concept of likelihood ratios in the process of diagnosis, FPs can also easily differentiate the various diagnoses of symmetrical polyarthritis, including rheumatoid arthritis (RA). There is also increasing evidence that shared care of patients with rheumatoid arthritis can be done successfully and safely between FPs and rheumatologists.

Policondritis recidivante / Relapsing polychondritis

La policondritis recidivante, es una infrecuente enfermedad inflamatoria del tejido conjuntivo, de etiología desconocida. Se caracteriza por inflamación episódica y progresiva de tejido cartilaginoso, principalmente del pabellón auricular, nariz y árbol traqueo-bronquial. Se presenta el caso de una paciente femenina de 58 años, que consulta por enrojecimiento y dolor en pabellón auricular derecho, con episodios previos similares en ambos oídos y nariz, además de estudio por poliartritis simétrica. Al examen físico destaca: eritema, edema y dolor local en pabellón auricular, respetando lóbulo. Con exámenes complementarios normales y presencia de tres criterios característicos de McAdam, se diagnostica policondritis recividante, iniciando prednisona oral, con respuesta favorable. Pese a ser una enfermedad poco frecuente, es importante considerarla en casos recurrentes de eritema y dolor local en regiones cartilaginosas, principalmente en pabellón auricular y nariz, de tal forma de lograr un diagnóstico precoz, para suprimir las crisis y mejorar el pronóstico de estos pacientes.

Relapsing Polychondritis (RP) is a rare inflammatory connective tissue disease of unknown etiology. It is characterized by episodic and progressive inflammation of cartilage tissue, especially ear, nose and tracheobronchial tree. We report the case of 58 year old Chilean female patient, who consulted for redness and pain in the right ear, with similar previous episodes in both ears and nose; along with symmetric polyarthritis study it is presented. Physical examination highlighted erythema, edema and local pain in ear, respecting lobe. With normal complementary examinations and presence of three diagnostic criteria of McAdam y col. relapsing polychondritis diagnosed, initiating oral prednisone, with favorable response. Despite being a rare disease, it is important to consider in recurrent cases of erythema and local pain in cartilaginous regions, mainly in ear and nose, so to achieve early diagnosis, to suppress the crisis and improve the prognosis of these patients.

Combination therapy of cyclosporine and prednisolone in a dog with systemic lupus erythematosus

An 11-year-old, spayed female poodle presented with fever and shifting lameness. Physical examination revealed hyperthermia (40.6℃), and proteinuria was detected upon urinalysis. Increased neutrophils (83%) and decreased viscosity were revealed upon synovial fluid analysis. Serum antinuclear antibody was positive at 1 : 80. Based on these findings, the dog was diagnosed with systemic lupus erythematosus. Immunosuppressive therapy was initiated with prednisolone and cyclosporine, and the condition was markedly improved after the treatments. This case report describes the clinical and laboratory findings, imaging characteristics and successful outcomes after prednisolone plus cyclosporine therapy in a canine systemic lupus erythematosus case.

Adult Onset Stills Disease: A Case Report.

Adult onset still’s disease (AOSD) is a rare inflammatory disorder of unknown etiology. Because of lack of a defined diagnostic test the diagnosis of AOSD can only be made after excluding infectious, malignant, and autoimmune diseases. A 21-year-old female patient was admitted in our hospital with intermittent high-grade fever, polyarthritis and rash. On further history, examination and laboratory investigation she was found to be fulfilling all the Yamaguchi criteria for AOSD. All other causes consisting of acute or chronic infections, hematological malignancies, and other rheumatic disorders were excluded by laboratory investigations. Patient was treated as AOSD with non-steroidal anti-inflammatory drugs and steroids and is completely free of symptoms.

Reticulohistiocitosis multicéntrica en paciente con artritis reumatoidea / Multicentric reticulohistiocytosis in a patient with rheumatoid arthritis

La reticulohistiocitosis multicéntrica (RHM) es una patología sistémica, de baja prevalencia, considerada dentro delgrupo de las histiocitosis no Langerhans. Clínicamente se caracteriza por el compromiso de la piel y las articulaciones.Se describe el caso de un paciente masculino con antecedente de diagnóstico de artritis reumatoidea (AR) de 10 años de evolución, que en 2008 se presenta a la consulta por un cuadro de poliartritis asociado a prurito cutáneo,hiperpigmentación facial y presencia de múltiples lesiones nodulares rojovioláceas en codos y manos. Mediante biopsia de las lesiones cutáneas se confirma el diagnóstico de RHM. Cabe destacar que se ha descripto hasta un 30% de asociación de la entidad con patologías neoplásicas; en nuestro paciente el tamizaje fue negativo. En cuanto al tratamiento no existen protocolos avalados científicamente dada la baja incidencia de la enfermedad, por lo que sigue siendo experimental. En nuestro paciente se realizó tratamiento exitoso con metotrexate.

Multicentric reticulohistiocytosis (MRH) is a systemic pathology of low prevalence within the group of histiocytosis no-Langerhans. It is clinically characterized by the involvement of skin and joints. The present article describes the case of a male subject with a diagnosis of rheumatoid arthritis of 10 years’ duration. In 2008 he was seen in our service with multiple nodular, red skin lesions in his hands and elbows. A biopsy of the cutaneous lesions confirmed the diagnosis of MRH. An association with neoplasic disease has been described in 30% of the cases; however, in our patient cancer screening was negative. With regard to the treatment, scientifically proven protocols do not exist. This is due to the low incidence of the disease. Our patient responded well to methotrexate.

Infecção congênita em cabritos por Mycoplasma agalactiae / Congenital infection by Mycoplasma agalactiae in goat kids

This study aimed to report three cases of contagious agalactia (CA) by Mycoplasma agalactiae in goat kids born with polyarthritis. The nanny goats belonging to two different herds presented clinical signs of CA during pregnancy and in parturition they were apparently healthy. The carpal articulations of the three goat kids, the tarsus articulation in one, and thigh-femoral articulation in another showed swelling, pain and impairment of the flexion-extension movements. The articular liquid was collected from two goat kids at birth and revealed a content which varied from transparent to fibrinopurulent, presenting a yellow coloring. The samples were plated on modified Hayflick. The colonies had the appearance of "fried egg" and were confirmed as being M. agalactiae by biochemical tests and 16S rRNA PCR. Blood was collected from three animals soon after birth and submitted to the indirect ELISA test for the determination of the titration of the anti- M. agalactiae antibodies. The results confirmed that the goat kids were infected during pregnancy by M. agalactiae and resulted in the birth of an offspring with clinical signs of CA being immune tolerant...

Complicated Hyperuricemia.

Gout is most common arthritis in men and its prevalence increases with increased life expectancy. Untreated hyperuricemia lead to complication like renal impairment, hypertension, diabetes, cardiovascular complication. We are reporting here such a case of untreated hyperuricemia. A 45 years old male presented with polyarthritis having since 3 years. He is also a known case of hypertension and diabetes for last 6 months. Patient is on steroid for last 1 year. Patient presently has bilateral pedal edema, swelling of both knee joints, bilateral 1st metatarsophalangeal joint and tophaceous swelling in different areas of the bodies. On blood examination-raised serum uric acid, creatinine, blood urea level. Urine shows uric acid crystal and albuminuria. Synovial fluid shows uric acid crystals. Longterm untreated hyperuricemia associated with hypertension and cardiovascular and renal diseases. Therefore raised uric acid lead to multiple system disease involvement.

A Case of Polyarthritis Associated with Reactivation of Chronic Hepatitis B Virus Infection

Hepatitis viruses (hepatitis B virus (HBV) and hepatitis C virus) have been associated with development of inflammatory arthritis. Approximately 400 million people worldwide have chronic HBV infection. HBV infection is the one of the most common causes of liver disease, and the prevalence of HBV infection in Korea is almost 6%. Arthritis in patients with HBV can be encountered in two settings: as a rheumatoid arthritis (RA)-like, acute, self-limited polyarthritis during the pre-symptomatic phase of acute hepatitis B, or, more rarely, as arthritis occurring in the context of HBV-associated polyarteritis nodosa (PAN). In both cases, the pathogenesis of arthritis is attributed to the deposition of immune complexes containing viral antigens (HBsAg or HBeAg) and their respective antibodies (anti-HBs and anti-HBe) in synovial tissues. Here we report on a case of polyarthritis associated with reactivation of chronic hepatitis B virus infection with a review of the literature.

Coxiella burnetii, the agent of Q fever in Brazil: its hidden role in seronegative arthritis and the importance of molecular diagnosis based on the repetitive element IS1111 associated with the transposase gene

Coxiella burnetii is the agent of Q fever , an emergent worldwide zoonosis of wide clinical spectrum. Although C. burnetii infection is typically associated with acute infection, atypical pneumonia and flu-like symptoms, endocarditis, osteoarticular manifestations and severe disease are possible, especially when the patient has a suppressed immune system; however, these severe complications are typically neglected. This study reports the sequencing of the repetitive element IS1111 of the transposase gene of C. burnetii from blood and bronchoalveolar lavage (BAL) samples from a patient with severe pneumonia following methotrexate therapy, resulting in the molecular diagnosis of Q fever in a patient who had been diagnosed with active seronegative polyarthritis two years earlier. To the best of our knowledge, this represents the first documented case of the isolation of C. burnetii DNA from a BAL sample.

Early-onset Childhood Sarcoidosis with Incidental Multiple Enchondromatosis

The triad of rash, arthritis, and uveitis seems to be characteristic for early-onset childhood sarcoidosis. We describe an interesting case of early-onset childhood sarcoidosis coexisting enchondromatosis, which clinically masquerade as Langerhans cell histiocytosis. A 33 months old girl presented with skin rash, subcutaneous nodules with polyarthritis, and revealed the involvement of lymph nodes as well as spleen during work-up. She also presented with multiple osteolytic lesions which pathologically proven enchondromatosis. Oral prednisone was prescribed at 2 mg/kg/day for 2 months until when subcutaneous nodules and joint swellings almost disappeared, and then slowly tapered over a period of 5 months. We report an unusual case of early-onset childhood sarcoidosis presented with osteolytic bone lesions which were irrelevant to sarcoidosis.