ABSTRACT
Introduction: Erythema nodosum (EN) is a self-limited septal panniculitis that presents with fever, arthralgia, and arthritis. Tumor necrosis factor alpha (TNF-α) inhibitor such as golimumab has been found to treat EN in inflammatory bowel diseases (IBD). We herein report the paradoxical occurrence of EN following golimumab for ankylosing spondylitis. Case presentation: A 34-year-old female presented in June 2022 with a complaint of 'sores' on her feet that intermittently presented for approximately 5 months but that had worsened dramatically in the last 24 h. The patient had an 8-year history of ankylosing spondylitis for 7 years. Subcutaneous golimumab was administered every 4 weeks as she had not responded to other treatments. Twenty-four hours after the fifth subcutaneous injection, painful, erythematous nodules appeared, histologically compatible with EN. Despite this side effect, we continue therapy due to the good response and efficacy. Discussion: Skin reactions were associated with the treatment with golimumab, including warm tender skin around the injection site, eruptions, itchiness, and sometimes a full-body rash. Golimumab was successfully used in treating EN in Crohn's disease. Because our patient continued on golimumab, the temporal association of EN flares with therapeutic injection and the lack of any etiology support a direct causal relationship between EN and golimumab treatment. Conclusion: TNF-α inhibitors are useful in treating Crohn's disease patients with EN, although it may present as an adverse effect of this treatment. Further work is needed.
ABSTRACT
Any defect in the early phases of the normal complex embryogenic pathway might lead to anatomical anomalies that lead to the formation of ectopic thyroid gland tissue. Overall, ectopic thyroid tissue incidence is one in 300 000, and the rate of malignant transformation among those is merely 1%. However, documented cases of malignant transformation of ectopic thyroid tissue in the tonsils have not yet been - to the best of the knowledge - documented in published literature. Case Presentation: We illustrate the case of a 58-year-old female who was referred to the clinic after she underwent a tonsillectomy due to chronic discomfort and gradual difficulty in swallowing. Documentation of an ectopic primary Papillary Thyroid Carcinoma in one of the patient's excised tonsils was achieved after thorough histopathological and immunohistochemical analyses took place. Radiological evaluation excluded any metastatic involvement and paved the path toward surgical intervention, which was comprised of a total thyroidectomy. Clinical Discussion: Surgical resection of the patient's thyroid gland was achieved, and the subsequent histopathological analysis of the specimens revealed nodular hyperplasia with degenerative changes but without evidence of malignant transformation in her thyroid gland. Conclusion: Ectopic primary Papillary Thyroid Carcinoma is an immensely rare occurrence, regardless of population parameters. Its incidence could originate in various anatomical locations, but to the best of the knowledge, its incidence in the tonsils has not been previously documented in published literature. Adequate levels of clinical awareness in this situation could timely alleviate patient complaints and aid in performing optimal life-saving interventions.
