Subject(s)
Fasciitis/diagnostic imaging , Magnetic Resonance Imaging/methods , Sarcoidosis/diagnostic imaging , Fasciitis/drug therapy , Female , Glucocorticoids/therapeutic use , Humans , Immunosuppressive Agents/therapeutic use , Methotrexate/therapeutic use , Middle Aged , Sarcoidosis/drug therapyABSTRACT
AIM: To describe our experience with 16 patients with eosinophilic fasciitis (EF) treated in our clinic over 14 years. METHODS: We retrospectively reviewed the charts of all patients with biopsy-proven EF. We collected data regarding demographics, clinical presentations, possible triggers, labs, imaging, treatment and response to therapy on follow-up. RESULTS: Eight women and eight men with a mean age of 52 years were included in the study. Three patients related the onset to prior strenuous exercise and one was exposed to vibratory machinery. Fourteen patients had a gradual onset and presented with induration of the skin. Two other patients presented with acute-onset and significant edema and weight gain. All patients required immunosuppressive therapy. Methotrexate (MTX) was used in all of our patients. The rate of complete remission was ~60%. Although the recurrence rate after stopping MTX was 70%, these patients responded well to re-treatment with MTX. CONCLUSION: We believe that MTX represents an effective treatment option for EF. The rarity of this disease would make a double-blind controlled trial study difficult to perform.
Subject(s)
Eosinophilia/drug therapy , Fasciitis/drug therapy , Immunosuppressive Agents/therapeutic use , Methotrexate/therapeutic use , Adult , Aged , Biopsy , Eosinophilia/diagnosis , Eosinophilia/etiology , Eosinophilia/immunology , Fasciitis/diagnosis , Fasciitis/etiology , Fasciitis/immunology , Female , Florida , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Recurrence , Remission Induction , Retrospective Studies , Time Factors , Treatment OutcomeSubject(s)
Aquatic Organisms/microbiology , Arthritis, Infectious/diagnosis , Arthritis, Infectious/etiology , Diving/adverse effects , Adult , Anti-Bacterial Agents/therapeutic use , Anti-Inflammatory Agents/therapeutic use , Arthritis, Infectious/drug therapy , Female , Hand/diagnostic imaging , Hand/pathology , Humans , Prednisone/therapeutic use , Radiography , Treatment Outcome , Vancomycin/therapeutic useABSTRACT
OBJECTIVES: Patients with giant cell arteritis (GCA) often respond to corticosteroid (CS) therapy; however, the majority of patients relapse when CS therapy is tapered or withdrawn. The purpose of this study was to assess the efficacy of tocilizumab (TCZ) in patients with relapsing GCA. METHODS: Four patients with relapsing GCA received TCZ monthly (4mg/kg or 8mg/kg). Disease activity and drug tolerability were evaluated clinically and via laboratory test results at the beginning of the study and every 3 months until the publication of this study. All four patients were still receiving TCZ monthly at the time of manuscript submission. RESULTS: All four patients treated with TCZ achieved clinical and laboratory response. No adverse events were detected. CONCLUSIONS: In our small case series, TCZ was efficacious and well tolerated in patients with relapsing GCA. Proper randomised controlled trials are required to achieve confident conclusions regarding the safety and efficacy of TCZ in GCA.
Subject(s)
Antibodies, Monoclonal, Humanized , Giant Cell Arteritis/drug therapy , Glucocorticoids , Interleukin-6/blood , Aged , Antibodies, Monoclonal, Humanized/administration & dosage , Antibodies, Monoclonal, Humanized/adverse effects , Biomarkers/blood , Dose-Response Relationship, Drug , Drug Administration Schedule , Drug Monitoring/methods , Female , Giant Cell Arteritis/immunology , Glucocorticoids/administration & dosage , Glucocorticoids/adverse effects , Humans , Immunosuppressive Agents/administration & dosage , Medication Therapy Management , Monitoring, Immunologic/methods , Secondary Prevention , Treatment OutcomeABSTRACT
Cryoglobulinemic vasculitis is a rare entity. Although it has been reported in diffuse systemic sclerosis, it has not been reported in calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly and telangiectasia (CREST) syndrome. We report a patient with cryoglobulinemic vasculitis with CREST syndrome who did not have typical clinical features of vasculitis. This 58-year-old woman presented with mild generalized weakness and a diagnosis of CREST syndrome, which included Raynaud's syndrome, dysphagia and telangiectasias. She was positive for serum cryoglobulins, which led to a sural nerve biopsy. The biopsy results were consistent with cryoglobulinemic vasculitis. Cryoglobulinemic vasculitis has not been previously reported in CREST syndrome to our knowledge. Additionally, the patient also had limited clinical symptoms. Our patient displays the importance of checking for cryoglobulins and obtaining a nerve biopsy when the serum is positive. Both of these diagnostic tests were integral for directing appropriate treatment for this patient.
Subject(s)
CREST Syndrome/complications , Cryoglobulins/metabolism , Vasculitis/complications , Vasculitis/metabolism , CREST Syndrome/pathology , Female , Humans , Middle Aged , Sural Nerve/pathology , Vasculitis/drug therapy , Vasculitis/pathologySubject(s)
Histiocytosis, Non-Langerhans-Cell/pathology , Immunosuppressive Agents/therapeutic use , Joint Diseases/pathology , Wound Healing/physiology , Drug Therapy, Combination , Etanercept , Finger Joint/diagnostic imaging , Finger Joint/drug effects , Finger Joint/pathology , Histiocytosis, Non-Langerhans-Cell/diagnostic imaging , Histiocytosis, Non-Langerhans-Cell/drug therapy , Humans , Immunoglobulin G/therapeutic use , Isoxazoles/therapeutic use , Joint Diseases/diagnostic imaging , Joint Diseases/drug therapy , Leflunomide , Male , Middle Aged , Prednisone/therapeutic use , Radiography , Receptors, Tumor Necrosis Factor/therapeutic use , Remission Induction , Wound Healing/drug effectsABSTRACT
Following uncomplicated cataract surgery, a patient receiving etanercept for psoriatic arthritis developed Mycobacterium chelonae endophthalmitis. Vitrectomy, capsulectomy, and intraocular lens removal was followed by intravitreal amikacin, topical gatifloxacin, intravenous imipenem, and oral clarithromycin for six months. The patient achieved a final corrected visual acuity of 20/20. Etanercept has been implicated in the development of numerous, severe granulomatous infections, though not previously with M. chelonae. This represents the first reported case of visual recovery following M. chelonae endophthalmitis.
Subject(s)
Endophthalmitis/physiopathology , Eye Infections, Bacterial/physiopathology , Mycobacterium Infections, Nontuberculous/physiopathology , Mycobacterium chelonae/isolation & purification , Recovery of Function/physiology , Visual Acuity/physiology , Anti-Bacterial Agents/therapeutic use , Endophthalmitis/microbiology , Endophthalmitis/therapy , Eye Infections, Bacterial/microbiology , Eye Infections, Bacterial/therapy , Follow-Up Studies , Humans , Lens, Crystalline/surgery , Male , Middle Aged , Mycobacterium Infections, Nontuberculous/microbiology , Mycobacterium Infections, Nontuberculous/therapy , VitrectomyABSTRACT
OBJECTIVE: Our objective was to describe the spectrum of MRI features of eosinophilic fasciitis. CONCLUSION: MRI findings in eosinophilic fasciitis are characteristic and consist of abnormal fascial signal intensity and enhancement, both of which are directly proportional to disease activity. MRI provides a useful aid for diagnosis and a marker for disease activity and response to treatment.
Subject(s)
Eosinophilia/diagnosis , Fasciitis/diagnosis , Magnetic Resonance Imaging , Aged , Female , Humans , Male , Middle Aged , Reproducibility of Results , Retrospective StudiesSubject(s)
Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Hand Dermatoses/drug therapy , Histiocytosis, Non-Langerhans-Cell/drug therapy , Immunoglobulin G/administration & dosage , Receptors, Tumor Necrosis Factor/administration & dosage , Recombinant Fusion Proteins/administration & dosage , Diagnosis, Differential , Etanercept , Hand Dermatoses/diagnosis , Hand Dermatoses/diagnostic imaging , Hand Dermatoses/pathology , Histiocytosis, Non-Langerhans-Cell/diagnosis , Histiocytosis, Non-Langerhans-Cell/diagnostic imaging , Histiocytosis, Non-Langerhans-Cell/pathology , Humans , Injections, Subcutaneous , Male , Middle Aged , RadiographyABSTRACT
We describe two patients with temporal artery biopsy-proven amyloidosis presenting with symptoms of jaw claudication, visual disturbance, and proximal muscle stiffness suggestive of giant cell arteritis (GCA) and polymyalgia rheumatica. At the onset of disease, neither patient had other characteristic symptoms to suggest primary amyloid. We point out similarities between GCA and primary amyloid that can lead to confusion in diagnosis.
Subject(s)
Amyloidosis/pathology , Jaw Diseases/pathology , Muscle Weakness/pathology , Temporal Arteries/pathology , Aged , Amyloid/analysis , Amyloid/metabolism , Amyloidosis/complications , Coloring Agents/chemistry , Coloring Agents/metabolism , Congo Red/chemistry , Congo Red/metabolism , Diagnosis, Differential , Giant Cell Arteritis/pathology , Humans , Jaw Diseases/etiology , Male , Middle Aged , Muscle Weakness/etiology , Polymyalgia Rheumatica/pathology , Temporal Arteries/metabolismABSTRACT
Giant cell arteritis (GCA) is a disease of unknown etiology characterized by granulomatous inflammation of medium and large arteries. A 69-year-old man presented with right jaw claudication, intermittent scalp tenderness without headache, and visibly swollen temporal arteries. Results of a right temporal artery biopsy were positive for GCA. Auscultation revealed audible bruits of the temporal arteries. We believe this is the first reported example of bruits of the temporal arteries as a manifestation of GCA. The condition resolved with corticosteroid therapy.