[The unusual mimicker of a polymyositis]. / Der außergewöhnliche Nachahmer einer Polymyositis.

This article describes a hantavirus-associated pronounced myositis as a rare differential diagnosis to polymyositis. The literature on the pathogenesis of hantavirus disease discusses less a direct viral cytopathology but more a secondary immune dysregulation with induction of a capillary leak. This article describes for the first time a case of successful treatment of protracted hantavirus myositis using high-dose glucocorticoids and cyclophosphamide, followed by ciclosporin and MTX.

[Mimetics of systemic sclerosis]. / Imitatoren der systemischen Sklerose.

BACKGROUND: Systemic sclerosis (SSc) is characterized by heterogeneous clinical symptoms. Peripheral skin fibrosis can be a common symptom. Nevertheless, a variety of diseases with different etiologies are associated with a thickening of the skin and make the initial diagnosis of systemic sclerosis more difficult. OBJECTIVE: The different disease entities that can lead to dermal fibrosis should be differentiated. An earlier diagnosis of SSc would therefore be facilitated. METHODS: A literature search was carried out for clinical pictures that can be associated with skin fibrosis. The clinical picture, the etiology and the treatment of the individual diseases are described. RESULTS: Diseases that can mimic the cutaneous symptoms of SSc include morphea, scleroderma, diabetic cheirarthritis, scleromyxedema, nephrogenic systemic fibrosis and eosinophilic fasciitis. The characteristic pronounced skin involvement, an accompanying Raynaud's phenomenon, capillary microscopy, histopathology and antinuclear antibodies help to enable a differentiation of SSc from its mimics. CONCLUSION: An early differential diagnostic distinction between SSc and other sclerosing diseases is important due to SSc-associated and potentially life-threatening systemic organ involvement. If a diagnosis of SSc has been made, a critical and organ-specific evaluation with respect to pulmonary, gastrointestinal, renal and cardiac involvement is mandatory and should be repeated at regular intervals.

Ischemic colitis following uncomplicated colonoscopy.

BACKGROUND/OBJECTIVE: Ischemic colitis is a disorder of the intestine arising from a multitude of reasons thus representing a challenge for causal research. Our aim was to shed further light on the course, etiology and triggers of non-occlusive ischemic colitis by presenting an atypical complication after colonoscopy. DESIGN: We present the case report of a 77-year-old male patient presenting with ischemic colitis after an uneventful outpatient colonoscopy two days prior to onset of symptoms. RESULTS: So far only few cases of post-colonoscopy ischemic colitis have been reported. In the present case no single reason was identified. It remains to be assumed that a combination of predisposing conditions with a modest decrease of blood pressure and short-term increased intraluminal pressure during colonoscopy may have led to ischemic colitis. CONCLUSION: Awareness of ischemic colitis as a complication in comparable settings is favorable. So far, early countermeasures against even modest hypotension in patients with comparable past history may be considered on an individual basis depending on the entirety of risk factors. However, prospective studies are necessary to evaluate potential risk profiles for ischemic colitis in terms of colonoscopy.