Clinical medicine (London, England)
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Case Reports
Lesson of the month 1: Neurosyphilis mimicking viral encephalitis and ischaemic stroke.
With the incidence of syphilis more than doubling over the last decade, knowledge of its manifestations is of increasing importance. Yet, today's clinicians are less experienced in the recognition of syphilis than the physicians of Osler's day. In this case, a 56-year-old man presented with acute confusion and a history suggestive of encephalitis. ⋯ This variability adds to the challenge of diagnosis. Thus syphilis serology screening should be sent in those presenting with acute confusion and neuroimaging abnormalities. In cases of cryptogenic stroke, syphilis serology should be added to the screening tests.
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Case Reports
Lesson of the month 2: Fever, arthralgias and hyperkeratotic, scaling and fissuring eruptions of the hands.
A 56-year-old male hairdresser, presented with fever and arthralgias. He had a worsening 'eczematous' palmar rash which had been attributed to irritation from colouring products used in his work. On examination, hyperkeratotic, fissuring eruptions were noted on the palmar side of his fingers and lung auscultation revealed crackles on both lower lobes. ⋯ This is a characteristic semiology reminiscent of hands of manual workers, resembling hand eczema. 'Mechanic's hands', fever, arthralgias, lung findings and elevated serum muscle enzymes raised the possibility of antisynthetase syndrome. Testing for myositis autoantibodies revealed anti-Jo-1 and anti-Ro52 reactivity supporting the diagnosis. Greater awareness of the typical clinical feature of 'mechanic's hands' will allow for earlier diagnosis and appropriate treatment in patients with antisynthetase syndrome.
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Bronchiectasis is a chronic inflammatory condition with a diverse aetiology including recurrent infections, genetic abnormalities, immunodeficiency and autoimmune disorders. The prevalence has increased over the past few years and this may be due to better imaging and diagnostic techniques. Management remains the emphasis for improving symptoms and reducing exacerbations. This article focuses on highlighting the latest data released since 2014 on new diagnostic techniques as well as potential future pharmacological and non-pharmacological treatment options for patients with bronchiectasis.