ABSTRACT
Still's disease is a subset of juvenile idiopathic arthritis (JIA) that usually presents with intermittent fever, rash, and arthritis. Extra-articular flares can occur several years after disease onset. We report two cases of adult Still's disease with myocarditis after several years of being in remission. A 34-year-old Caucasian man with history of systemic juvenile arthritis in remission since age 13 was admitted in hospital with 10 days history of fever, odynophagia, and arthralgias. Chest X-ray and cardiac ultrasound showed cardiac enlargement. An endomyocardial biopsy revealed acute myocarditis. He was treated with methylprednisolone and intravenous gammaglobulin, with improvement of his general condition and cardiac parameters. A 16-year-old Caucasian male patient with history of systemic JIA in remission for the last 7 years was admitted with 7 days history of fever, odynophagia, arthralgias, and myalgias. Two days after admission, he developed chest pain and pericardial rubbing was found on examination. Cardiac ultrasound showed left ventricular dilatation with impaired systolic function, and posterior, inferior and apical-septal wall hypokinesia. Blood test showed elevated creatine phosphokinase levels. He was treated with IV methylprednisolone with normal follow-up cardiac ultrasound. Cardiac involvement in patients with systemic JIA can be the first symptom of disease reactivation, even after many years of disease remission.
Subject(s)
Myocarditis/etiology , Still's Disease, Adult-Onset/complications , Adolescent , Adult , Arthritis, Juvenile/complications , Arthritis, Juvenile/diagnosis , Fever/etiology , Humans , Male , Myocarditis/diagnosis , Recurrence , Still's Disease, Adult-Onset/diagnosis , Treatment OutcomeABSTRACT
We report a 65-year-old caucasian male, who presented cryptogenic organizing pneumonia (COP) as first manifestation of rheumatoid arthritis. The patient started with fever, myalgias and progressive dyspnea in October 2004. The chest X-ray (CXR) and high resolution computed tomographic scan (HRCT) showed diffuse alveolar exudates with air bronchogram in both the lungs. An open lung biopsy was done and the histological image was compatible with COP. Six months later, a diagnosis of RA was made. Treatment with oral methotrexate and etanercept was prescribed with improvement in symptoms, physical examination, and laboratory tests. Even though COP after the joint involvement is found more frequently in RA, in rare cases it could be the first manifestation of this illness.
Subject(s)
Arthritis, Rheumatoid/diagnosis , Cryptogenic Organizing Pneumonia/diagnosis , Aged , Antirheumatic Agents/therapeutic use , Arthritis, Rheumatoid/complications , Arthritis, Rheumatoid/drug therapy , Cryptogenic Organizing Pneumonia/drug therapy , Cryptogenic Organizing Pneumonia/etiology , Diagnosis, Differential , Etanercept , Humans , Immunoglobulin G/therapeutic use , Male , Methotrexate/therapeutic use , Radiography, Thoracic , Receptors, Tumor Necrosis Factor/therapeutic use , Tomography, X-Ray Computed , Treatment OutcomeSubject(s)
Anti-Inflammatory Agents/therapeutic use , IgA Vasculitis/drug therapy , IgA Vasculitis/pathology , Immunosuppressive Agents/therapeutic use , Skin/pathology , Aged , Biopsy , Cyclophosphamide/therapeutic use , Female , Humans , Immunoglobulin A/blood , Immunoglobulin G/blood , Male , Methylprednisolone/therapeutic use , Middle Aged , Prednisone/analogs & derivatives , Prednisone/therapeutic use , Young AdultSubject(s)
Aged , Female , Humans , Male , Middle Aged , Young Adult , Anti-Inflammatory Agents/therapeutic use , Immunosuppressive Agents/therapeutic use , IgA Vasculitis/drug therapy , IgA Vasculitis/pathology , Skin/pathology , Biopsy , Cyclophosphamide/therapeutic use , Immunoglobulin A/blood , Immunoglobulin G/blood , Methylprednisolone/therapeutic use , Prednisone/analogs & derivatives , Prednisone/therapeutic use , Young AdultABSTRACT
A white female patient developed overlapping features of systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) with severe pulmonary compromise. She was treated with steroids and azathioprine, which improved her clinical condition and spirometric status. In May 2002 she presented with continuous pain in her left ankle that continued even during rest and under treatment with nonsteroidal anti-inflammatory drugs (NSAIDs). Magnetic resonance imaging (MRI) showed multiple avascular necrosis (AVN). Rest and kinesitherapy were indicated for 1 year, and gradually an orthosis was introduced allowing the patient to walk normally.