Blindness in a pulseless young woman: lessons learned.

PURPOSE: To report a young woman who presented with blindness secondary to ocular ischemic syndrome (OIS) as the initial presenting feature of Takayasu arteritis (TA). DESIGN: Case report. METHODS: Computer tomography (CT) aortogram showed severely stenosed aortic branches. Fundus fluorescein angiography showed diffuse capillary nonperfusion. RESULTS: With conventional medical therapy of initial pulse of intravenous methylprednisolone followed by oral steroids and methotrexate, her headache, fatigued feeling, and inflammatory markers improved. However, the visual recovery remained poor. CONCLUSIONS: OIS in TA may present subacutely and the visual outcome can be poor despite aggressive immunosuppressive therapy.

Dermatomyositis masquerading musculoskeletal tuberculosis.

Dermatomyositis is a rare rheumatic disease which predominantly affects the muscles and skin requiring a protracted course of immunosuppressants which may predispose the patients to opportunistic infections. A 49-year-old lady was diagnosed to have dermatomyositis in August 2010 based on history, significantly raised creatine kinase level and muscle biopsy findings. She had recurrent admissions due to fever, myalgia and muscle weakness. She had spiking temperature despite high dose steroids, broad-spectrum antibiotics and antifungal agents. This prompted extensive investigation which leads us to the additional diagnosis of disseminated tuberculosis involving the lungs, muscles and bones. This case demonstrates the challenge in controlling the disease activity of dermatomyositis with immunosuppressants in the setting of disseminated tuberculosis.