Down's syndrome with coexistent gout in 2 patients: Is the association under reported or is the prevalence actually increasing?

This report describes 2 patients diagnosed with Down's syndrome and who developed acute gouty arthritis. While hyperuricemia in gout is a well-known abnormality, association of gout with Down's syndrome has not been widely discussed. With increasing life expectancy in this syndrome, it is likely that more such cases will occur. For early diagnosis and proper management clinicians must be aware of this association

Erythema nodosum or erythema induratum: an important distinction for appropriate treatment

Objective and Importance: The objective of this case report is to draw the attention of the readers to a commonly seen disorder, namely panniculitis. Clinically, the condition resembles cellulitis, that often causes a diagnostic problem. The report hightlights the importance of accurate diagnosis of panniculitis and its subtypes for its proper management. Clinical Presentation: Two patients with clinically typical lesions of panniculitis on their lower extremities are described. The lesions in these 2 patients had marked clinical resemblance to cellulitis. However, with the help of biopsy and histopathological examination it was possible to accurately diagnose the distinct forms of panniculitis in these patients. It helped in the correct management of the patients with satisfactory outcome. It is concluded that in patients with lesions resembling cellulitis, especially on the shin, the possibility of panniculitis must be considered. The experience with these 2 patients highlights the need for accurate histological characterization as an essential step in the diagnosis and proper management of different forms of panniculitides

Infiltrative mass in the neck as a presenting feature of lupus-like illness in a middle-aged man

A middle-aged man presented with a mass in the cervical region associated with severe constitutional symptoms, generalized lymphadenopathy and hepatosplenomegaly. Histopathology showed angiocentric immunoproliferative lesions consisting of a mixture of lymphocytes, plasma cells, immunoblasts and histiocytes on a background of hyperplastic vascular structures. Active vascular necrosis with fibrinoid changes was present with expansion of T-cell areas with reactive changes typical of angiocentric lesions. Detailed clinical and laboratory workup showed features suggestive of systemic lupus- or latent-lupus-like disease. The patient showed an excellent response to prednisolone and chloroquine with complete recovery of all the clinical features. During the 22 months of follow-up the patient remained in complete normal health. Different histopathological varieties of lymph node lesions seen in systemic immunological disease are discussed with emphasis on features which help in distinguishing them from lymphomas

Diagnosis of systemic inflammatory rheumatic disease: rational use of laboratory investigations

There is no substitute for good clinical diagnosis before ordering investigations for systemic inflammatory rheumatic diseases. Even the most sensitive and specific investigation may be rendered worthless if carried out in persons who are least likely to have that disease. The sequence of events should include clinical diagnosis followed by assessment of laboratory parameters of "acute phase reactions" to confirm the on-going systemic inflammation and finally the specialized investigations to narrow down the diagnosis, determine the severity and sometimes the prognosis of the disease process. Specialized investigations include; rheumatoid factor [RF] which is mainly used for determining prognosis of patients with rheumatoid arthritis; Anti-nuclear antibody [ANA] an excellent screening test for suspected systemic lupus erythematosus [SLE], Anti-dsDN A antibody test useful for SLE activity and predicting relapse; Anti-neutrophil cytoplasmic antibody [ANCA] for systemic vasculitis, Anticardiolipin antibodies [aCL] in patients suspected of antiphospholipid syndrome, Complement C3 and C4 determinations for suspected immune-complex mediated renal diseases. It is to be noted that except for a few of these specialized investigations, the majority are not influenced in short term by the disease process or treatment