Lupus nephritis in Lebanon.

This is a retrospective study of the clinicopathological characteristics of 50 systemic lupus erythematosus patients with nephritis who underwent a kidney biopsy and were admitted to the American University of Beirut Medical Center, in Lebanon, between 1979 and 1999. There were 43 females and seven males, with a median age of 24 y. Renal histology slides from these patients were assessed according to the World Health Organization classification, and were distributed as follows: class I (n = 3, 6%); class II (n = 14, 28%); class III (n = 11, 22%); class IV (n = 19, 38%); class V (n = 1, 2%); class VI (n = 2, 4%). All the patients received oral prednisone, in addition the following treatments were used: pulse intravenous (i.v.) cyclophosphamide (n = 23, 46%); azathioprine (n = 22, 44%); pulse i.v. steroids (n = 19, 38%); chloroquine sulfate (n = 17, 34%); methotrexate (n = 5, 10%); and plasmapheresis (n = 2, 4%). The median duration of follow-up was 5 y (range 1-33 y). On their last evaluation, out of 37 patients who were followed, 20 patients (54%) had controlled disease, eight patients (22%) were still on active medical treatment, four patients (11%) were on chronic hemodialysis, and five patients (13%) had died. Unlike three other Arab populations studies from Kuwait, United Arab Emirates and Saudi Arabia, where the most frequent histopathologic abnormality was class III, diffuse proliferative LN (class IV) was the most common type of lupus nephritis in Lebanon, similarly to reports from USA, France, Netherlands, South Africa, Thailand and Taiwan.

Takayasu's arteritis presenting as fever of unknown origin: report of two cases and literature review.

OBJECTIVES: This study reports two patients with Takayasu's arteritis presenting with a fever of unknown origin (FUO) and reviews the literature on that association. METHODS: We describe the clinical presentation, course, and outcome of the two patients, and reviewed the medical literature from 1968 till 1997 using MEDLINE and the key words fever, diagnosis, and Takayasu's arteritis. RESULTS: Takayasu's arteritis is rarely reported as a cause of FUO. Noninvasive diagnostic techniques such as magnetic resonance imaging, computed tomography scanning, gallium-67 scintigraphy, and ultrasonography may help in the diagnosis of Takayasu's arteritis in the prepulseless stage. CONCLUSION: Takayasu's arteritis should be considered in the differential diagnosis of FUO, especially in young women.

Mondor's disease. A forgotten cause of anterior chest pain.

A 50-year-old woman sought a rheumatological consultation for anterior chest pain of three weeks duration. The diagnosis of superficial phlebitis of the anterior chest wall (Mondor's disease) was made. This was confirmed thereafter by the pathological report. She was treated with a non-steroidal anti-inflammatory drug Oxyphenylbutazone (Tanderil) and made a prompt recovery.

Sacral osteoid osteoma in a 10 year old girl.

We report the case of a ten year old female student who complained of chronic back pain and morning stiffness of several months duration. She failed to respond to non-steroidal anti-inflammatory drugs (NSAIDS). Further investigations which included bone and CT scan revealed the presence of an osteoid osteoma at the first sacral vertebra (S1 vertebra). The patient made an excellent recovery after surgical excision.

Juvenile progressive systemic sclerosis: report of five cases.

Five cases of juvenile progressive systemic sclerosis (SSc) are reported (4 girls and 1 boy). The age of onset of the disease ranged from 4 to 13 years. The clinical features included Raynaud's phenomenon present in 4 of 5 cases; hyperpigmentation, skin tightening and contractures of the large joints were noted in all 5 cases. One patient initially diagnosed as having eosinophilic fasciitis developed SSc 3 months later. Another patient was diagnosed initially as having juvenile rheumatoid arthritis. There was one case of pulmonary fibrosis and another of mild restrictive lung disease. Two cases of esophageal and intestinal hypomotility were reported. Scleroderma nephropathy was absent in all 5 cases.

Mixed connective tissue disease, Sjögren's syndrome, and abdominal pseudolymphoma.

A young female with mixed connective tissue disease (MCTD) presented with the unusual occurrence of abdominal pseudolymphoma. Although the pseudolymphoma could be related to concomitant sicca complex, some data suggest that MCTD, as such, could carry a high incidence of malignancy.

Erythema nodosum-arthopathy complex as an initial presentation of Behçet's disease. Report of five cases.

In five males an erythema nodosum-arthropathy complex preceded the classical oro-genito-ocular triad of Behçet's disease by an average of 27 months. This symptom complex involving the legs initially suggested "idiopathic" erythema nodosum syndrome or acute sarcoidosis. As the diagnosis of Behçet's disease is clinical, these protean manifestations shoud be recognized as a possible "forme fruste" of the disease.