[Backache and palmar eczema (SAPHO syndrome)]. / Rückenschmerzen und "Handekzem"

HISTORY AND ADMISSION FINDINGS: A 63-year-old female painter was referred for evaluation of the cause of persistent back pain, night sweat and an elevated blood sedimentation rate. Besides, she reported recurrent, probably "atopic eczema" of both hands. Clinical examination revealed midthoracic back pain but no actual skin lesions. INVESTIGATIONS: Contrast medium-enhanced magnetic resonance tomography of the spine showed an increased signal intensity of the thoracic vertebral bodies 6 - 10 and the prevertebral soft tissue in T1-weighted images with fat suppression. The finding was considered to be suspicious for malignant neoplasia. Despite performing various diagnostic tests, neither a malignant nor an infectious process of the spine could be diagnosed. DIAGNOSIS, TREATMENT AND COURSE: In-depth evaluation of history and clinical findings gave the diagnosis of SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis and osteitis). CONCLUSION: The intention of this case report is to demonstrate, once more, the importance of carefully taking a patient's history and fully evaluating the clinical findings.

[Muscle weakness]. / Muskelschwäche.

A 31-year old cook suffered from episodes with muscular weakness since 3 weeks. These episodes resolved, at times, spontaneously and completely after a few hours. The weakness affected mainly the muscles of trunk and proximal extremities. Investigation of the patient revealed flaccid tetraparesis with diminished tendon reflexes, however, cranial muscles were not affected. Mental function and sensibility were intact. These findings were consistent with hypopotassemic periodic paralysis rather than a neurological or psychiatric disease. Serum potassium was determined as 1.8 mmol/l. Moreover, the patient suffered from atrial fibrillation. Grave's disease could be identified as the underlying cause of hypopotasemic periodic paralysis and atrial fibrillation. Further manifestations of primary hyperthyroidism were nervousness, diarrhea and weight loss of 5 kg observed during the previous months. The symptoms resolved under treatment with potassium, betablocker and thyrostatic agents. The patient was treated with warfarin because of atrial fibrillation and finally underwent electroconversion.