RESUMO
Behçet's disease (BD) is a systemic vasculitis characterized by recurrent painful oral and genital ulcers, uveitis, and skin lesions. Pemphigus vulgaris (PV), on the other hand, is an autoimmune blistering disorder affecting the mucous membranes and skin, characterized by the presence of intraepidermal vesicles. Herein, we present a female in her 40s with a history of BD who presented to the emergency department with worsening oral and vaginal ulcers and extensive bullae of four months onset. A skin biopsy revealed an intraepidermal vesicle with preservation of the basal layer consistent with PV. A complete workup including vasculitides, connective tissue diseases, and human leukocyte antigen (HLA)-B*51 was performed, which revealed a positive HLA-B*51. She was treated with oral corticosteroids, rituximab, dapsone, and azathioprine. After nine months, she has remained stable. Our case suggests there may be a shared pathway in the pathophysiology of BD and PV, providing valuable insights for treatment decisions.
RESUMO
About 16 million adults present with chronic back pain, the sixth most costly condition in the United States (US). Estimates suggest that about 60% of initial back surgeries have a successful outcome; however, many don't, leaving over 80,000 failed back surgeries per year. Failed Back Surgery Syndrome (FBSS) is defined by the International Association for the Study of Pain as back pain, with or without radiating pain, located in the lower limbs, of unknown origin, which persists or begins after surgical procedures are performed to treat lumbar disc herniations. Psychiatric comorbidities and psychosocial factors have been associated with patients presenting with this syndrome. A retrospective cross-sectional study was performed to identify the prevalence of FBSS in a population of patients during the period of January 2019-December 2020 across Hospital Corporation of America (HCA) Healthcare in the US. With a sample of 28,426 patients who underwent back surgery only 8% had FBSS. Those with FBSS (N = 2434) were mainly females (54.27%) with a mood disorder (61.18%), P-value <.0001. Among those with FBSS, there was a statistically significant relationship between mood disorder and smoking (57.37%) and obesity (54.61%) compared to non-smokers and non-obese. Lifestyle interventions may ameliorate disabling symptoms and improve the well-being of this population.
RESUMO
Sarcoidosis is a multi-organ systemic disease that presents with several clinical manifestations, and patients can develop neurologic complications. Neurosarcoidosis may be life-threatening; therefore, early recognition and treatment are key. Here, we present a case of a 55-year-old African American male who presented with a complaint of dizziness and left-sided weakness; he ultimately received a diagnosis of neurosarcoidosis after elaborate radiographic investigations and bladder mass biopsy. Neurosarcoidosis remains a diagnostic dilemma as it can clinically and radiographically mimic multiple conditions including multiple sclerosis, central nervous system lymphoma, multiple myeloma, and progressive multifocal leukoencephalopathy.
RESUMO
Calcinosis cutis is a chronic condition involving skin and soft tissue deposition of calcium and phosphate. It is associated with several conditions including idiopathic, iatrogenic, malignant metastasis, calciphylaxis, and connective tissue diseases. The most common connective tissue diseases it is associated with include systemic sclerosis and dermatomyositis. We present a case image of a patient with Sjogren's syndrome and calcinosis cutis and its progression over time. The patient was optimized on her current treatment regimen to prevent further progression. Written informed consent was obtained from the patient to publish this report in accordance with the journal's patient consent policy.