Pub Date : 2023-10-20DOI: 10.4103/injr.injr_115_23
Rahul Rudrakar, Ashok Kumar
Dear Editor, A 43-year-old woman presented to our rheumatology clinic with a 4-year history of painful ulcerated lesions over the dorsal surface of her feet and ankles with intermittent serous discharge from ulcers and a burning sensation of the distal extremities. The patient did not have features of systemic rheumatic disease (sicca symptoms, Raynaud’s phenomenon, fever, polyarthralgia, photosensitivity, oral ulcers, and skin thickening) or any nodules/rashes preceding the ulcers. She was nondiabetic with no history of deep-vein thrombosis, peripheral gangrene, or recurrent abortions. Physical examination revealed multiple stellate ulcers, with irregular erythematous margins, firm and tender edges, and scanty serous discharge with no fixation to underlying muscle [Figure 1a]. All peripheral pulses were normal. There was no lymphadenopathy, varicose veins, thickened nerves, or calf tenderness. Neurological examination was normal.Figure 1: Clinical images of leg ulcers: (a) Pretreatment and (b) Posttreatment; Photomicrographs of skin lesion, (c) Thrombosed vessel in the mid-dermis with mild perivascular inflammation (H and E, ×100), and (d) The same in high-power view (H and E, ×400)Her investigation showed normal complete blood count, liver and renal function, and coagulation profile. Erythrocyte sedimentation rate was 30 mm/h, C-reactive protein 8.1 mg/l, glycated hemoglobin 5.6, and normal urinalysis. Hepatitis B surface antigen, antibody to hepatitis C virus, and human immunodeficiency virus serology (1 and 2) were negative. Antinuclear antibody, rheumatoid factor, antibody to cyclic citrullinated protein, antineutrophil cytoplasmic antibody, and thrombophilia profile were negative. Chest X-ray, Doppler ultrasound, and nerve conduction study of the lower limbs were normal. A clinical diagnosis of livedoid vasculopathy (LV) was suspected. Skin biopsy showed hyalinized degeneration of the subintimal layer of mid-dermal vessels along with intraluminal thrombosis, extravasation of red blood cells, and mild perivascular lymphocytic infiltration [Figure 1c and d] – features typical of LV. The patient initially received antiplatelets, prednisolone (40 mg daily tapered to 5 mg daily over 6 months, then stopped), methotrexate (15 mg/week for 2 years), and warfarin (3–4 mg/day for 6 months) with no significant benefit. We commenced her on tofacitinib 5 mg twice daily as a monotherapy. The pain subsided in 1 month, and the ulcers healed over the next 2 months [Figure 1b]. LV is a chronic, painful, thrombo-occlusive cutaneous vasculopathy and characteristically heals with stellate porcelain-white scars called “atrophie blanche.”[1] It is typically seen in late-adolescent or middle-aged females, and histopathology is confirmatory.[2] Associations include connective tissue diseases, hypercoagulable states, thrombophilia, and malignancy. However, 20% of cases may have no such associated disease as was observed in our case.[3] A mean diagnosis delay of 5 yea
{"title":"Livedoid Vasculopathy: Successful Treatment with Tofacitinib","authors":"Rahul Rudrakar, Ashok Kumar","doi":"10.4103/injr.injr_115_23","DOIUrl":"https://doi.org/10.4103/injr.injr_115_23","url":null,"abstract":"Dear Editor, A 43-year-old woman presented to our rheumatology clinic with a 4-year history of painful ulcerated lesions over the dorsal surface of her feet and ankles with intermittent serous discharge from ulcers and a burning sensation of the distal extremities. The patient did not have features of systemic rheumatic disease (sicca symptoms, Raynaud’s phenomenon, fever, polyarthralgia, photosensitivity, oral ulcers, and skin thickening) or any nodules/rashes preceding the ulcers. She was nondiabetic with no history of deep-vein thrombosis, peripheral gangrene, or recurrent abortions. Physical examination revealed multiple stellate ulcers, with irregular erythematous margins, firm and tender edges, and scanty serous discharge with no fixation to underlying muscle [Figure 1a]. All peripheral pulses were normal. There was no lymphadenopathy, varicose veins, thickened nerves, or calf tenderness. Neurological examination was normal.Figure 1: Clinical images of leg ulcers: (a) Pretreatment and (b) Posttreatment; Photomicrographs of skin lesion, (c) Thrombosed vessel in the mid-dermis with mild perivascular inflammation (H and E, ×100), and (d) The same in high-power view (H and E, ×400)Her investigation showed normal complete blood count, liver and renal function, and coagulation profile. Erythrocyte sedimentation rate was 30 mm/h, C-reactive protein 8.1 mg/l, glycated hemoglobin 5.6, and normal urinalysis. Hepatitis B surface antigen, antibody to hepatitis C virus, and human immunodeficiency virus serology (1 and 2) were negative. Antinuclear antibody, rheumatoid factor, antibody to cyclic citrullinated protein, antineutrophil cytoplasmic antibody, and thrombophilia profile were negative. Chest X-ray, Doppler ultrasound, and nerve conduction study of the lower limbs were normal. A clinical diagnosis of livedoid vasculopathy (LV) was suspected. Skin biopsy showed hyalinized degeneration of the subintimal layer of mid-dermal vessels along with intraluminal thrombosis, extravasation of red blood cells, and mild perivascular lymphocytic infiltration [Figure 1c and d] – features typical of LV. The patient initially received antiplatelets, prednisolone (40 mg daily tapered to 5 mg daily over 6 months, then stopped), methotrexate (15 mg/week for 2 years), and warfarin (3–4 mg/day for 6 months) with no significant benefit. We commenced her on tofacitinib 5 mg twice daily as a monotherapy. The pain subsided in 1 month, and the ulcers healed over the next 2 months [Figure 1b]. LV is a chronic, painful, thrombo-occlusive cutaneous vasculopathy and characteristically heals with stellate porcelain-white scars called “atrophie blanche.”[1] It is typically seen in late-adolescent or middle-aged females, and histopathology is confirmatory.[2] Associations include connective tissue diseases, hypercoagulable states, thrombophilia, and malignancy. However, 20% of cases may have no such associated disease as was observed in our case.[3] A mean diagnosis delay of 5 yea","PeriodicalId":54167,"journal":{"name":"Indian Journal of Rheumatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135567596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-20DOI: 10.4103/injr.injr_111_23
Ingrid de Groot
Abstract Being diagnosed with myositis changed my life in both bad ways and good. Crucial in those 1 st years was obtaining reliable information, which I did by becoming a member of the patient association and by connecting to other patients. Reading about myositis, sharing experiences with other patients, and meeting physicians and researchers made me realize that my experiential knowledge of living with myositis could be valuable in myositis research. I joined the OMERACT Myositis Working Group as a patient research partner (PRP), a member of a research group who contributes to the patients’ perspective by actively collaborating with researchers as an equal partner. The aim of sharing my experiences as a PRP is to encourage clinical researchers to acknowledge that patients are experts vital to the success of research projects. My narrative provides insights in and practical examples on how, when, and to what extent PRPs can contribute to research. In conclusion, patients provide a unique perspective of lived experience that is complementary to that of clinicians and researchers. Moreover, the relevance and quality of the research process and outcomes improve as a result of patient participation. Engagement of patients strengthens opportunities for the dissemination and implementation of research.
{"title":"Patient Research Partner as an Equal Member of the Research Team: A Personal Experience of the OMERACT Myositis Working Group","authors":"Ingrid de Groot","doi":"10.4103/injr.injr_111_23","DOIUrl":"https://doi.org/10.4103/injr.injr_111_23","url":null,"abstract":"Abstract Being diagnosed with myositis changed my life in both bad ways and good. Crucial in those 1 st years was obtaining reliable information, which I did by becoming a member of the patient association and by connecting to other patients. Reading about myositis, sharing experiences with other patients, and meeting physicians and researchers made me realize that my experiential knowledge of living with myositis could be valuable in myositis research. I joined the OMERACT Myositis Working Group as a patient research partner (PRP), a member of a research group who contributes to the patients’ perspective by actively collaborating with researchers as an equal partner. The aim of sharing my experiences as a PRP is to encourage clinical researchers to acknowledge that patients are experts vital to the success of research projects. My narrative provides insights in and practical examples on how, when, and to what extent PRPs can contribute to research. In conclusion, patients provide a unique perspective of lived experience that is complementary to that of clinicians and researchers. Moreover, the relevance and quality of the research process and outcomes improve as a result of patient participation. Engagement of patients strengthens opportunities for the dissemination and implementation of research.","PeriodicalId":54167,"journal":{"name":"Indian Journal of Rheumatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135567597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Background: Rheumatoid arthritis (RA) is the most common form of autoimmune inflammatory arthritis with an Indian prevalence of around 0.75%. Nearly 55% of Indians resort to primary health-care centers as their first point of contact. MBBS students must be well equipped to diagnose and treat patients with RA within the community and refer the relevant cases appropriately to higher medical facilities. Materials and Methods: A cross-sectional study was conducted assessing the basic knowledge of RA in senior medical undergraduate students in two domains. The first domain included assessment, clinical features, and diagnosis of RA while the second domain included treatment, radiological features, and therapeutics of RA. The total score was summed up for each domain. Self-assessment of knowledge was also inquired. The questionnaire was validated after a pilot study. The analysis was done using SPSS software using Pearson’s Chi-square test for correlation and paired t -test for comparison with basic descriptive statistics. Results: A total of 142 students participated, classified by year of study. There were 69% of female respondents. The mean self-assessment value was 4.82 ± 1.944, and the mean score in the questionnaire was 7.27 ± 2.183. The mean score out of 9 for Domain A was 5.09 ± 1.63 and for Domain B out of 4 was 2.17 ± 0.977. Students performed better in Domain B. A significant association was found between final assessment score and year of study ( P < 0.01) as well as self-assessment and year of study ( P < 0.01). Conclusion: Participants had less confidence in themselves as compared to how they performed. Female students performed better. Awareness about Domain B was higher, and senior students performed better.
{"title":"Knowledge about rheumatoid arthritis among senior undergraduate medical students of a medical college in South India","authors":"Drishti Marwaha, NAjith Kumar, CharakkulamVijay Sreelakshmi, Dhevarsh Priyadarshan, Sandeep Surendran","doi":"10.4103/injr.injr_108_23","DOIUrl":"https://doi.org/10.4103/injr.injr_108_23","url":null,"abstract":"Abstract Background: Rheumatoid arthritis (RA) is the most common form of autoimmune inflammatory arthritis with an Indian prevalence of around 0.75%. Nearly 55% of Indians resort to primary health-care centers as their first point of contact. MBBS students must be well equipped to diagnose and treat patients with RA within the community and refer the relevant cases appropriately to higher medical facilities. Materials and Methods: A cross-sectional study was conducted assessing the basic knowledge of RA in senior medical undergraduate students in two domains. The first domain included assessment, clinical features, and diagnosis of RA while the second domain included treatment, radiological features, and therapeutics of RA. The total score was summed up for each domain. Self-assessment of knowledge was also inquired. The questionnaire was validated after a pilot study. The analysis was done using SPSS software using Pearson’s Chi-square test for correlation and paired t -test for comparison with basic descriptive statistics. Results: A total of 142 students participated, classified by year of study. There were 69% of female respondents. The mean self-assessment value was 4.82 ± 1.944, and the mean score in the questionnaire was 7.27 ± 2.183. The mean score out of 9 for Domain A was 5.09 ± 1.63 and for Domain B out of 4 was 2.17 ± 0.977. Students performed better in Domain B. A significant association was found between final assessment score and year of study ( P < 0.01) as well as self-assessment and year of study ( P < 0.01). Conclusion: Participants had less confidence in themselves as compared to how they performed. Female students performed better. Awareness about Domain B was higher, and senior students performed better.","PeriodicalId":54167,"journal":{"name":"Indian Journal of Rheumatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135666889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-19DOI: 10.4103/injr.injr_114_23
AnkurKumar Jindal, SyahrulSazliyana Shaharir
{"title":"Optimal health in rheumatology: The unmet need of the hour?","authors":"AnkurKumar Jindal, SyahrulSazliyana Shaharir","doi":"10.4103/injr.injr_114_23","DOIUrl":"https://doi.org/10.4103/injr.injr_114_23","url":null,"abstract":"","PeriodicalId":54167,"journal":{"name":"Indian Journal of Rheumatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135666888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-14DOI: 10.4103/injr.injr_210_22
B. Pandey, V. Krishnamurthy, U. Kumar, S. Upadhyaya, N. Jain, M. Dugar, Sagar S. Panchal, N. Shah, Tanuja Korde, Jitendra Dixit
Tumor necrosis factor (TNF) has been associated with inflammation and joint destruction in patients with rheumatoid arthritis (RA), and several anti-TNF agents, including golimumab, are currently in clinical use. This postmarketing surveillance (PMS) study was carried out at six rheumatology centers in India to assess the safety and efficacy of golimumab in patients with moderate-to-severe RA, in a real-world setting. This was a prospective, multicenter, open-label, single-arm, PMS study, where golimumab 50 mg subcutaneous was administered monthly as per locally approved prescribing regulations. The primary endpoint was to assess the safety of golimumab. Health Assessment Questionnaire-Disability Index (HAQ-DI), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), auto-injector satisfaction/user-friendliness, injection-site pain/reactions, and 28-joint Disease activity score (DAS-28) including erythrocyte sedimentation rate (ESR) (DAS-28-ESR) and C-reactive protein (CRP) (DAS-28 CRP), were evaluated as per investigator’s routine practice. Over 6 months, 120 patients were enrolled and 109 completed the study. Sixty-two (51.7%) patients experienced ≥1 treatment-emergent adverse events (TEAEs). The majority of TEAEs reported in the study were mild to moderate in severity. No deaths were reported. The mean (standard deviation [SD]) change from baseline in HAQ-DI (−0.9 [0.65]) and FACIT-F (14.8 [10.20]) suggested improvement in physical function and fatigue, respectively. The majority of patients (n = 77 [64.2%]) were “very satisfied” on the satisfaction/user-friendliness parameters of auto-injector and majority (n = 99 [91.7%]) did not experience injection-site reactions. Mean (SD) change from baseline of DAS-28 scores (not assessed for all patients; DAS-28 ESR [n = 62]: −2.0 [1.25]) indicated an improvement in disease activity. Golimumab (50 mg) in combination with methotrexate was found to be safe and well-tolerated in Indian patients with moderate-to-severe RA. No new safety signals emerged.
{"title":"Safety and Efficacy of Golimumab in Rheumatoid Arthritis: A Prospective, Multicenter, Real-World Study from India","authors":"B. Pandey, V. Krishnamurthy, U. Kumar, S. Upadhyaya, N. Jain, M. Dugar, Sagar S. Panchal, N. Shah, Tanuja Korde, Jitendra Dixit","doi":"10.4103/injr.injr_210_22","DOIUrl":"https://doi.org/10.4103/injr.injr_210_22","url":null,"abstract":"\u0000 \u0000 \u0000 Tumor necrosis factor (TNF) has been associated with inflammation and joint destruction in patients with rheumatoid arthritis (RA), and several anti-TNF agents, including golimumab, are currently in clinical use. This postmarketing surveillance (PMS) study was carried out at six rheumatology centers in India to assess the safety and efficacy of golimumab in patients with moderate-to-severe RA, in a real-world setting.\u0000 \u0000 \u0000 \u0000 This was a prospective, multicenter, open-label, single-arm, PMS study, where golimumab 50 mg subcutaneous was administered monthly as per locally approved prescribing regulations. The primary endpoint was to assess the safety of golimumab. Health Assessment Questionnaire-Disability Index (HAQ-DI), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), auto-injector satisfaction/user-friendliness, injection-site pain/reactions, and 28-joint Disease activity score (DAS-28) including erythrocyte sedimentation rate (ESR) (DAS-28-ESR) and C-reactive protein (CRP) (DAS-28 CRP), were evaluated as per investigator’s routine practice.\u0000 \u0000 \u0000 \u0000 Over 6 months, 120 patients were enrolled and 109 completed the study. Sixty-two (51.7%) patients experienced ≥1 treatment-emergent adverse events (TEAEs). The majority of TEAEs reported in the study were mild to moderate in severity. No deaths were reported. The mean (standard deviation [SD]) change from baseline in HAQ-DI (−0.9 [0.65]) and FACIT-F (14.8 [10.20]) suggested improvement in physical function and fatigue, respectively. The majority of patients (n = 77 [64.2%]) were “very satisfied” on the satisfaction/user-friendliness parameters of auto-injector and majority (n = 99 [91.7%]) did not experience injection-site reactions. Mean (SD) change from baseline of DAS-28 scores (not assessed for all patients; DAS-28 ESR [n = 62]: −2.0 [1.25]) indicated an improvement in disease activity.\u0000 \u0000 \u0000 \u0000 Golimumab (50 mg) in combination with methotrexate was found to be safe and well-tolerated in Indian patients with moderate-to-severe RA. No new safety signals emerged.\u0000","PeriodicalId":54167,"journal":{"name":"Indian Journal of Rheumatology","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48278415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.4103/injr.injr_148_22
B. S. Shiva Prasad, Subramanian Ramaswamy, Aumir Moin, S. Nalloor
Neurological involvement in sarcoidosis has varied presentations. Peripheral neuropathy is one of them. Symmetrical axonal type sensory-motor polyneuropathy is the most common form; focal and multifocal neuropathy, polyradiculopathy, and vascular neuropathy are among the others. Cases of demyelinating polyneuropathy masquerading as acute inflammatory demyelinating polyradiculopathy/Guillain–Barre syndrome (GBS) and chronic inflammatory demyelinating polyneuropathy have been reported rarely. Neurosarcoidosis (NS) often masquerades as other disorders, and the occurrence of GBS-like clinical phenotype is a diagnostic challenge. We report a case of NS presenting as atypical GBS.
{"title":"Neurosarcoidosis camouflaging as partial miller: Fisher syndrome","authors":"B. S. Shiva Prasad, Subramanian Ramaswamy, Aumir Moin, S. Nalloor","doi":"10.4103/injr.injr_148_22","DOIUrl":"https://doi.org/10.4103/injr.injr_148_22","url":null,"abstract":"Neurological involvement in sarcoidosis has varied presentations. Peripheral neuropathy is one of them. Symmetrical axonal type sensory-motor polyneuropathy is the most common form; focal and multifocal neuropathy, polyradiculopathy, and vascular neuropathy are among the others. Cases of demyelinating polyneuropathy masquerading as acute inflammatory demyelinating polyradiculopathy/Guillain–Barre syndrome (GBS) and chronic inflammatory demyelinating polyneuropathy have been reported rarely. Neurosarcoidosis (NS) often masquerades as other disorders, and the occurrence of GBS-like clinical phenotype is a diagnostic challenge. We report a case of NS presenting as atypical GBS.","PeriodicalId":54167,"journal":{"name":"Indian Journal of Rheumatology","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43780642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.4103/injr.injr_215_22
Mahmood Dhahir Al-Mendalawi
{"title":"Prevalence of metabolic syndrome in rheumatoid arthritis patients: Association with disease","authors":"Mahmood Dhahir Al-Mendalawi","doi":"10.4103/injr.injr_215_22","DOIUrl":"https://doi.org/10.4103/injr.injr_215_22","url":null,"abstract":"","PeriodicalId":54167,"journal":{"name":"Indian Journal of Rheumatology","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49247402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We hereby present a case of a 41-year-old female with hypertension and right mastectomy, who presented with bilateral visual loss, weakness of all four limbs, and livedo reticularis of acute onset and was found to have multifocal areas of infarct in bilateral occipital lobes and left external capsule due to antiphospholipid syndrome. Various differentials in the form of sepsis-induced posterior reversible encephalopathy syndrome, posterior circulation stroke, and purpura fulminans confused the final diagnosis of an orphan disease – Sneddon syndrome. This case is reported for the rarity of the disease and the diagnostic dilemmas faced by the nondermatologist in diagnosing this condition even in the presence of striking skin changes.
{"title":"Misdiagnosing Sneddon syndrome: Always look skin deep!!","authors":"Richa Kumar, Mylavarapu Kumar, Abhyam Gupta, Brijesh Nair","doi":"10.4103/injr.injr_119_22","DOIUrl":"https://doi.org/10.4103/injr.injr_119_22","url":null,"abstract":"We hereby present a case of a 41-year-old female with hypertension and right mastectomy, who presented with bilateral visual loss, weakness of all four limbs, and livedo reticularis of acute onset and was found to have multifocal areas of infarct in bilateral occipital lobes and left external capsule due to antiphospholipid syndrome. Various differentials in the form of sepsis-induced posterior reversible encephalopathy syndrome, posterior circulation stroke, and purpura fulminans confused the final diagnosis of an orphan disease – Sneddon syndrome. This case is reported for the rarity of the disease and the diagnostic dilemmas faced by the nondermatologist in diagnosing this condition even in the presence of striking skin changes.","PeriodicalId":54167,"journal":{"name":"Indian Journal of Rheumatology","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44972510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.4103/injr.injr_163_22
S. Baliga, U. Agrawal, A. Sunavala, N. Madnani, R. Joshi, Asna Shaikh, R. Nanavati, Parmeshwar S. Patil, Soham Kadam, R. Samant
The globe has not yet recovered from Coronavirus disease 2019 (COVID-19). The infection with the virus and its treatment can lead to a state of immunological aberration predisposing to many infections. Here we present this patient who was treated with steroids during COVID but later developed mucocutaneous nodular lesions and arthritis. This was initially treated as an autoimmune disease which was eventually diagnosed to be systemic histoplasmosis. There are few case reports on post-COVID histoplasmosis in HIV patients. However, there is a paucity of literature on non-HIV patients. We report this case as the treating physician and rheumatologist must be cognizant of the atypical infections which can mimic an autoimmune disease. As management differs in both, awareness can avoid morbidity for the patient.
{"title":"An unusual case of disseminated histoplasmosis mimicking an autoimmune disease!","authors":"S. Baliga, U. Agrawal, A. Sunavala, N. Madnani, R. Joshi, Asna Shaikh, R. Nanavati, Parmeshwar S. Patil, Soham Kadam, R. Samant","doi":"10.4103/injr.injr_163_22","DOIUrl":"https://doi.org/10.4103/injr.injr_163_22","url":null,"abstract":"The globe has not yet recovered from Coronavirus disease 2019 (COVID-19). The infection with the virus and its treatment can lead to a state of immunological aberration predisposing to many infections. Here we present this patient who was treated with steroids during COVID but later developed mucocutaneous nodular lesions and arthritis. This was initially treated as an autoimmune disease which was eventually diagnosed to be systemic histoplasmosis. There are few case reports on post-COVID histoplasmosis in HIV patients. However, there is a paucity of literature on non-HIV patients. We report this case as the treating physician and rheumatologist must be cognizant of the atypical infections which can mimic an autoimmune disease. As management differs in both, awareness can avoid morbidity for the patient.","PeriodicalId":54167,"journal":{"name":"Indian Journal of Rheumatology","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46266973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.4103/injr.injr_181_22
G. Dharmshaktu
{"title":"Tophus and the toes","authors":"G. Dharmshaktu","doi":"10.4103/injr.injr_181_22","DOIUrl":"https://doi.org/10.4103/injr.injr_181_22","url":null,"abstract":"","PeriodicalId":54167,"journal":{"name":"Indian Journal of Rheumatology","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45933590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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