Joint, bone, spine : revue du rhumatisme
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Review Case Reports
Spinal epidural lipomatosis revealing endogenous Cushing's syndrome.
Spinal epidural lipomatosis is defined as accumulation of nonencapsulated fat within the spinal canal. It occurs chiefly in patients on long-term glucocorticoid therapy or in obese patients without any other detectable cause. We report the second case of spinal epidural lipomatosis revealing endogenous Cushing's syndrome.
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We describe a 66-year-old woman with cutaneous lesions typical of classic dermatomyositis, clinical evidence of antisynthetase syndrome (arthritis, Raynaud's phenomenon, mechanic's hands and interstitial lung disease with anti-Jo-1 autoantibody) and lack of muscle disease after a full muscle evaluation that included clinical, enzymatic, electromyographic, magnetic resonance imaging and histological studies. The patient did not develop myositis after 9 years of clinical disease. The association of dermatomyositis sine myositis with antisynthetase antibodies suggests that the characteristic skin lesions are closely linked with dermatomyositis on the basis of the similar clinical and serological features of both dermatomyositis sine myositis and classic dermatomyositis.
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To assess the prevalence of fibromyalgia in primary Sjögren's syndrome and to evaluate the clinical differences between patients affected with both primary fibromyalgia and primary Sjögren's syndrome and those affected only with primary fibromyalgia. ⋯ As recently reported by other authors, our study confirms the moderate increase of fibromyalgia prevalence in primary Sjögren's syndrome. Typical fibromyalgic findings are quite similar to those of primary fibromyalgia, but surprisingly, primary Sjögren's syndrome patients with fibromyalgia show a less severe global involvement than those with primary Sjögren's syndrome alone.
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Case Reports
Pseudallescheria boydii knee arthritis in a young immunocompetent adult two years after a compound patellar fracture.
Pseudallescheria boydii arthritis of the knee developed in a 32-year-old immunocompetent man 2 years after a compound patellar fracture contaminated with soil. No other potential portal of entry was identified, suggesting that the fungus remained latent for 2 years. ⋯ Although this organism often shows limited sensitivity to most antifungal agents, our patient achieved a full recovery after surgical synovectomy and 6 months of itraconazole therapy (400 mg/ d). This case illustrates the importance of testing for fungi in patients with torpid arthritis, particularly when mild clinical symptoms contrast with severe bone and joint destruction.
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Comparative Study
Ultrasound versus MRI in the evaluation of juvenile idiopathic arthritis of the knee.
To examine the role of ultrasound versus magnetic resonance imaging (MRI) in assessing joint inflammation in patients with juvenile idiopathic arthritis (JIA) of the knee. ⋯ Ultrasound is a simple, inexpensive and valuable tool in evaluating the initial stages of JIA. In more advanced stages of JIA and also for monitoring the progression of the disease process and response to therapy, MRI examination following gadolinium proved to be superior in evaluation of the joint affection.