Recurrent strokes and memory loss in a patient with triple-positive antiphospholipid antibody syndrome.

Antiphospholipid syndrome may cause recurrent thromboembolic events of the microvasculature, arteries and veins. It is also characterised by a range of neurological and psychiatric dysfunctions, as well as complications during pregnancy. Patients with triple-positive antiphospholipid syndrome have persistently elevated levels of lupus anticoagulant (LA), anti-beta-2-glycoprotein I (B2GPI) and anticardiolipin antibodies (aCL). These patients also have a higher risk of initial or recurrent thrombosis.We report the case of a 36-year-old man who was presented with progressive memory loss and recurrent stroke. He had persistently elevated antiphospholipid antibody titres (LA, aCL-immunoglobulin G and B2GPI antibodies). These features persisted while the patient was receiving low-dose aspirin (LDA), 81mg daily. Vitamin K antagonist (VKA); warfarin, with the international normalised ratio (INR) maintained at 2-3 was then added to his treatment regimen. The VKA dose was maintained at - a higher therapeutic INR while LDA administration was continued to achieve resolution of the patient's symptoms.

IgG4-Related Disease With Renal and Pulmonary Involvement.

Immunoglobulin G4-related disease (IgG4-RD) is a rare immune-mediated disease affecting multiple organs and tissues. There is often the presence of elevated serum Ig4 subtype with histological evidence of lymphoplasmacytic infiltration, fibrosis, and phlebitis. The mainstay of treatment is steroids therapy. We report the case of a 66-year-old man presenting with acute on chronic renal failure and pulmonary nodules seen on PET-CT scan. He also had elevated serum IgG4 subclass and histological features in keeping with IgG4-RD. He failed steroid therapy but responded subsequently to rituximab with complete resolution of his symptoms.

Cul de Sac : An Unusual Presentation of Giant Cell Arteritis.

Giant cell arteritis (GCA), previously referred to as temporal arteritis, continues to pose significant diagnostic challenges to clinicians as it could have unusual and atypical presentations. We present the case of a 69-year-old Caucasian male who had presented with painful scrotal swelling and bilateral arm pain and was eventually diagnosed with GCA based on histological findings. His symptoms resolved completely with the initiation of high-dose steroids. It is important to note that some clinical manifestations of GCA could be subtle, atypical, and maybe entirely extracranial. A high index of suspicion is helpful when diagnosing patients who present with non-specific or constitutional symptoms as delay in diagnosis or treatment in these patients could result in severe adverse outcomes.