Plasmablastic Myeloma: An Unusual Cause of Peripheral Facial Paralysis.

Peripheral facial paralysis refers to the involvement of the facial nerve (VII cranial nerve) at any point along its path, which starts from its nucleus, located in the pons, and extends to its most distal branches. The etiology is heterogeneous, including viral infections, bacterial infections, trauma, and neoplasms, among others. However, in the majority of cases, the cause is idiopathic, commonly referred to as Bell's palsy. The diagnosis is therefore one of exclusion, based in particular on the physical examination. Naturally, the diagnosis is decisive in directing the therapeutic approach. However, the signs/symptoms of the various primary pathological processes can appear late in the course of the disease. This is why the Physical Medicine and Rehabilitation specialist is particularly important, since, in addition to the initial assessment, he or she monitors the patient more closely and over a longer period of time, together with the team of therapists. New clinical findings and diagnostic tests requested accordingly can dramatically change the initial diagnosis and guide new treatments. We present the clinical case of a 60-year-old man initially diagnosed with Bell's palsy, whose poor clinical evolution and new clinical findings during the rehabilitation program led to the diagnosis of plasmablastic myeloma and a radically different therapeutic approach.

Tuberculosis Presenting as Chronic Monoarthritis: A Case Study.

Mycobacterium tuberculosis infection remains a common disease in developing countries with the potential to involve the osteoarticular system. The authors report a case of knee arthritis due to tuberculosis (TB) in a 34-year-old woman. The patient presented with pain and swelling of the right knee as major complaints, without a history of respiratory symptoms. Magnetic resonance imaging (MRI) demonstrated a marked joint effusion, involving synovial tissue with cartilaginous lesion compatible with pigmented villonodular synovitis (PVNS). After several physiotherapy courses without significant relief, total knee arthroplasty was proposed. Two months after surgery and rehabilitation, symptoms did not completely resolve, with limited active range of motion. Microbial bone biopsy culture at the time of the arthroplasty revealed a TB infection. Due to the rarity and clinical nonspecificity of TB bone manifestations, early diagnosis may be challenging. Yet, attempted diagnosis and prompt pharmacological intervention are paramount to improve outcomes.