Relapsing cutaneous polyarteritis nodosa associated with streptococcal infections.

BACKGROUND: Polyarteritis nodosa is an aggressive, often fatal form of vasculitis associated with multi-organ involvement. Cutaneous polyarteritis nodosa is purported to be a more benign form of this disorder with involvement limited to the skin. METHODS: The identification of a female patient from childhood to adulthood documenting repeated episodes of cutaneous polyarteritis nodosa following bouts of recurrent streptococcal pharyngitis. RESULTS: Repeated bouts of streptococcal pharyngitis at ages 11, 28, and 33 years were followed by episodes of cutaneous polyarteritis nodosa, documented by histopathologic skin changes and clinical presentation, and confirmed by therapeutic management. CONCLUSIONS: Various infectious and non-infectious conditions have been linked both to the initiation and relapse of this disease. We describe a patient with recurrent episodes of cutaneous polyarteritis nodosa spanning a period of over 20 years with each episode appearing to be linked to a prior streptococcal infection.

Coexistence of adult onset Still's disease and polymyositis with rhabdomyolysis successfully treated with methotrexate and corticosteroids.

Adult onset Still's disease is a disorder characterized by spiking fevers, rash, arthritis, serositis and myalgia. Erosive arthritis is a well recognized feature, however, myositis is not. We describe a patient with adult onset Still's disease, polymyositis (PM) and rhabdomyolysis successfully treated with methotrexate (MTX) and corticosteroids. This occurrence has previously been reported, however without the presence of rhabdomyolysis or treatment with MTX. Suppression of disease activity was followed by marked radiographic improvement of the arthritis. MTX and corticosteroids in combination may be indicated for the treatment of adult onset Still's disease when PM and erosive arthritis occur.

Giant synovial cysts.

Giant synovial cysts (GSC) are large, well-defined cavities, containing synovial fluid and lined by a synovium-like membrane, which extend for a variable distance outside the joint cavity. We are reporting 15 cases of GSC of various joints. Rheumatoid arthritis is the most common disease process reported in association with GSC. We suggest that trauma may be a more important cause of GSC than has previously been described. Arthrography and ultrasonography are both helpful in diagnosing these large cysts, especially in the knee to aid in differentiating GSC from thrombophlebitis.