Methotrexate-associated Lymphoproliferative Disease with Multiple Pulmonary Nodules in a Patient with Rheumatoid Arthritis.

Patients with rheumatoid arthritis (RA) treated with methotrexate (MTX) sometimes develop lymphoproliferative disease (LPD). MTX-associated LPD can affect nodal or extranodal sites, including the gastrointestinal tract, skin, lungs, kidneys and soft tissues, at almost equal frequency. However, it is very rare for MTX-associated LPD to manifest as multiple nodules in the lungs. We herein report the case of a RA patient who developed MTX-associated LPD with multiple pulmonary nodules during a 5-year course of MTX therapy.

Syndrome of inappropriate secretion of antidiuretic hormone induced by tacrolimus in a patient with systemic lupus erythematosus.

We describe the first reported case of a syndrome of inappropriate secretion of antidiuretic hormone (SIADH) induced by low-dose tacrolimus in a patient with autoimmune disease. A 41-year-old man with systemic lupus erythematosus (SLE) developed hyponatremia induced by SIADH after administration of tacrolimus (0.06 mg/kg per day). In this case, the hyponatremia promptly resolved upon withdrawal of tacrolimus. This case strongly suggests that SIADH is a potentially important complication of tacrolimus administration, irrespective of dosage, and should be borne in mind whenever the drug is used.

A case of nodular-type muscular sarcoidosis: findings of imaging, histopathology, and polymerase chain reaction.

We report a case of nodular-type muscular sarcoidosis with no systemic symptoms. Thallium-201 scintigraphy showed intense uptake in the muscular lesion mimicking malignant soft tissue tumor. Magnetic resonance imaging (MRI) demonstrated characteristic signal patterns of peripheral high intensity with central low intensity ("three stripes" pattern). Microscopy revealed sarcoid granuloma with typical histopathological characteristics. Propionibacterium acnes was detected on polymerase chain reaction analysis of the excised tissue.

Munchausen syndrome with foreign-body granuloma mimicking rheumatic diseases.

A 37-year-old man was admitted to our hospital because of fever, polyarthralgia, and subcutaneous tumors. There was swelling of the bilateral wrists and ankles, and subcutaneous tumors over the bilateral elbow joints. Despite his complaints of multiple symptoms, clinical investigations failed to reveal any abnormality. Although laboratory parameters improved rapidly after steroid therapy, the symptoms remained unchanged, and there was an enormous discrepancy between the laboratory data and his symptoms. A biopsy specimen from one of the subcutaneous tumors revealed foreign-body granuloma associated with a foreign body fragment. Because the nursing staff later discovered that the patient had been carrying out self-injection, a diagnosis of Munchausen syndrome was made. Munchausen syndrome should be included in the differential diagnosis of rheumatic diseases.

Clinical usefulness of multiplanar reconstruction images obtained by multi-slice computed tomographic angiography for early-stage Takayasu's arteritis.

We describe a case of Takayasu's arteritis discovered during the early stage (pre-pulseless stage). Cervical ultrasonography and multiplanar reconstruction (MPR) images obtained by computed tomography (CT) showed thickening and stenosis of the walls of the common carotid arteries. However, magnetic resonance arteriography (MRA), volume rendering (VR) imaging CT, and maximum intensity projection (MIP) imaging CT could detect no obvious abnormality. We emphasize the importance of noninvasive vascular investigation with cervical ultrasonography and MPR imaging CT to support the diagnosis of early-stage Takayasu's arteritis.

Remitting seronegative symmetric synovitis with pitting edema: scintigraphic and magnetic resonance imaging findings.

Remitting seronegative symmetric synovitis with pitting edema (RS3PE) was first reported by McCarty et al in 1985 and refers to a rheumatologic set of symptoms with acute onset, with no erosive bone lesions, with seronegative findings, affecting the elderly more frequently, and showing an excellent prognosis with low-dose steroid therapy. Although these characteristics make it possible to differentiate it from rheumatoid arthritis and rheumatic polymyalgia, there have been very few reports on the imaging findings. The authors present scintigraphic and magnetic resonance images in a case of RS3PE.