[Diagnostic value of 18F-FDG PET/CT in fever of unknown origin]. / A 18F-FDG-PET/CT helye az ismeretlen eredetu láz diagnosztikai algoritmusában.

Fever of unknown origin is a common differential diagnostic problem in medicine. More than 60 years have passed since the first established definition of the disease, and despite constant development and improvement of diagnostic procedures, the differential diagnosis and choosing adequate therapy still remains a challenge in this patient population. The medical literature lists at least 200 diseases that may manifest with fever of unknown origin, and it encompasses a wide clinical spectrum. This symptom is present in approximately 1.5-3% of hospitalized patients. In recent decades, not only the concept of fever of unknown origin has changed several times, but the recommended differential diagnostic procedures as well. Positron emission tomography is one of the latest imaging procedures that also contributes to establishing the correct diagnosis. The purpose of this publication is to provide an overview of different diseases which might cause fever of unknown origin, and the most frequently used diagnostic algorithms, moreover to highlight the importance of positron emission tomography in the evaluation of the aetiology of fever of unknown origin. Orv Hetil. 2022; 163(49): 1935-1942.

Rheumatoid arthritis and metabolic disorders.

Rheumatoid arthritis is a chronic autoimmune inflammatory disease associated with multiple metabolic alterations and increased cardiovascular risk. It is supposed that visceral obesity seems to be a connection between rheumatoid arthritis and cardiovascular diseases. Obesity is not only associated with increased disease activity and worsened quality of life in this group of patients, but also determines the effectiveness of treatment. Biological therapy interferes with metabolic changes, too. Therefore, there is a tendency to select the right anticytokine preparation in the first line of treatment to reduce not only disease activity but also affect aspects of metabolic syndrome and comorbidites, thereby reducing cardiovascular risk and patients mortality. This work offers a basic overview of the associations between rheumatoid arthritis and metabolic disorders, describes the impact of biological therapy on individual components of the metabolic syndrome.

Hypereosinophilic syndrome-a rare adverse event of anti-cytokine treatment in rheumatoid arthritis resolved after Janus kinase inhibitor therapy.

Eosinophilia is uncommon in early rheumatoid arthritis (RA). The most frequent causes of hypereosinophilia during RA treatment are atopic eczema, allergy, helminth infection, haematological malignancy and drug-associated complications. The pathogenesis of this abnormality associated with anti-cytokine therapy is still unknown. We report the case of a young woman with RA and eosinophilia accompanied by systemic symptoms such as dyspnoea, fluid retention and eosinophilic vasculitis. An interesting observation was the persistence of eosinophilia during treatment with various biologics and its normalization after switching to the Janus kinase inhibitor baricitinib.

[A Bizarre Parosteal Osteochondromatous Proliferation - Case Report and Review of Similar Hand Lesions Recorded Since 1983].

Bizarre parosteal osteochondromatous proliferation (BPOP) is an unusual lesion mostly affecting the bones of the hand. The mass grows from the bone surface and consists of cartilaginous, osseous and fibrous tissue. The lesion is commonly under/misdiagnosed and confused with other lesions, mostly the osteochondromas. We present a patient with BPOP that initially confused the practitioner and radiologist in their diagnosis. We discuss the clinical, radiologic and histologic characteristics of BPOP of the hand since its first report in 1983 and present its main differential diagnosis. We reviewed 184 cases. Female were affected in 52% and male in 48%. Pro ximal phalanges were most commonly affected, followed by middle phalanges and metacarpals. Pain was reported in 47,9 % of all reported papers. The most common surgical treatment was by excision, and the rate of recurrence was 47.3%.