Giant basal cell carcinoma in a non-sun exposed area with four years follow-up: a case report.

Basal cell carcinoma (BCC) is a low-grade malignant tumor that if properly managed has an excellent prognosis. Development of BCC outside the skin areas exposed to sun rays is infrequent. Giant BCC is a rare entity, especially in unexposed areas of the body. It carries a considerable implication on patients' quality of life because of the risk of being a source of infection that may progress to severe sepsis and/or metastasis. An old female presented with a long-standing solitary lesion measuring 7.5x6 cm overlaying the lumber 4-5 vertebral region about 2.5 cm from the line of the sacral promontory. No lymph nodes or distant metastases were detected. For many years, it was misdiagnosed by other physicians as eczema, psoriasis, and fungal infection and accordingly failed to respond to treatment. A histopathological examination of lesional punch biopsy assured the diagnosis of giant superficially spreading BCC. The lesion was excised with a circumferential safety margin of about 5 mm. During the follow-up period of 4 years, no recurrence was detected. Despite being a long-standing Giant basal cell carcinoma (GBCC) in a sun-hidden skin area, the growth behaved as a locally malignant lesion without metastasizing. A wide local surgical excision of the GBCC with 5 mm safety margins was feasible, safe, and with a good aesthetic outcome. Importantly, family practitioners should avoid such missed cases through accuracy in their diagnosis and early referral of any atypical cases to a dermatologist.

Crohn's Disease Previously Mistreated as Intestinal Tuberculosis Complicated with Ileocecal Lump: A Case Report.

In Southeast Asia, the higher prevalence of Intestinal tuberculosis (TB) challenges the diagnosis of Crohn's disease (CD) due to their overlapping symptoms. This case involves a 25-year-old male misdiagnosed with Intestinal tuberculosis presenting with abdominal pain, weight loss, and bowel ulceration. Recurrence after anti-tubercular therapy led to further investigation paving to right hemicolectomy and histopathological analysis confirming Crohn's disease. This case highlights the complexity of the diagnosis of Crohn's disease in tuberculosis-prevalent areas, stressing the clinical importance, advanced diagnostics tools, and multidisciplinary approach for effective intervention.

Case report: Mycobacterium chimaera-induced lymph node infection in a patient with chronic myeloproliferative neoplasm misdiagnosed as tuberculous lymphadenitis.

Herein, we report a case of lymphadenitis caused by Mycobacterium chimaera. A 54-year-old woman with chronic myeloproliferative neoplasm was admitted to the hospital with cervical lymphadenopathy. After preliminary exclusion of various diseases such as lymphoma, Epstein-Barr virus infection, and autoimmune disease, a lymph node biopsy specimen showed epithelioid granulomatous lymphadenitis with caseous necrosis, epithelial-like cells, and multinucleated giant cells as seen in tuberculosis (TB). Although Mycobacterium tuberculosis was never isolated, diagnostic anti-TB treatment was commenced. Following over 9 months of treatment, there was no significant reduction in the size of her cervical lymph nodes, and she continued to experience recurrent low-grade fevers. One sample from the fourth lymph node biopsy tested negative for metagenomic next-generation sequencing (mNGS), and another sample tested positive in the BACTEC MGIT960 liquid culture system, identifying the strains as Mycobacterium chimaera. Anti-non-tuberculous mycobacteria (NTM) therapy was initiated, and the patient achieved symptom improvement. In conclusion, NTM lymphoid infection is easily misdiagnosed as long-term etiologic negativity.

Ultra-early stage lower-grade gliomas: How can we define and differentiate these easily misdiagnosed gliomas through intraoperative molecular diagnosis.

BACKGROUND: Some lower-grade gliomas (LGG) are difficult to distinguish morphologically from glial cell proliferation or inflammatory changes during surgery, leading to a high risk of incorrect diagnosis. It is crucial to differentiate between the two for making surgical decisions. We define these critical cases as "ultra early stage lower-grade gliomas (UES-LGG)". METHODS: We analyzed 11 out of 13 cases diagnosed with "gliosis" or "inflammatory changes" during surgery who tested positive for isocitrate dehydrogenase (IDH). Additionally, we conducted qRT-PCR detection on 35 samples diagnosed with LGG during surgery and analyzed their DNA content within an effective circulating threshold range to infer the critical value between UES-LGG and LGG. We conducted experiments using five standardized samples to infer the limited range of accurate detection of UES-LGG during surgery. RESULTS: In the comparative analysis of 11 samples and 35 samples, it was found that while there was no significant difference in the average DNA detection concentration between the two groups (159.36 ± 83.3 ng/µL and 146.83 ± 122.43 ng/µL), there was a notable statistical variance in the detection threshold for positive mutations (31.78 ± 1.14 and 26.14 ± 2.69, respectively). This suggests that the IDH mutation rate may serve as an indicator for differentiation between the two groups. Subsequently, DNA was extracted from standardized IDH mutant samples and subjected to gradient dilution for detection purposes. The results indicated a consistent increase in detection threshold as detection concentration decreased. When the detection concentration fell below <0.1 ng/µL, it became impossible to carry out effective threshold range detections. To further identify the precise detection interval, we conducted gradient division once again and sought to simulate the functional relationship between DNA copy number and cycle threshold within this interval. The research revealed that when the minimum detection concentration exceeded 250 copies/µL, a 100% detection rate could be achieved. CONCLUSIONS: This article defines UES-LGG as a tumor type easily misdiagnosed in clinical practice due to its extremely low positivity rate during surgery. The popularization of qRT-PCR based intraoperative molecular diagnosis greatly reduces errors caused by manual detection and improves disease detection rates during surgery. It provides a theoretical basis for more accurate surgical plans for surgeons.

Adenomatoid tumor of the uterus: analysis of misdiagnosed cases and a literature review.

Adenomatoid tumors are rare, specific, benign tumors of the reproductive tract that originate from mesenchymal tissue. A patient was diagnosed with uterine fibroids 1 year previously when a mass of approximately 30 mm was found in the left adnexal region during a physical examination. At 1 year of follow-up, ultrasound showed that the mass in the left adnexal area had greatly increased to 61 × 45 × 50 mm. Contrast-enhanced pelvic magnetic resonance imaging (MRI) was performed before surgery and suggested a borderline tumor. Histopathology suggested signet ring cell carcinoma, and an immunohistochemical examination suggested a uterine adenomatoid tumor. Our suspicion of a borderline tumor was based mainly on the following features: the mass had increased in size within 1 year, the cancer antigen 125 concentration had increased, and several lymph nodes in the pelvic and groin regions showed positive signals on MRI enhancement. Uterine adenomatoid tumors are challenging to diagnose, especially adenomatosis with signet ring cells. However, the accuracy of diagnosing this disease can be greatly improved by combining ultrasound and MRI. This article describes the most comprehensive and reliable imaging features of ultrasound and MRI, which play an important role in diagnosing uterine adenomatoid tumors and provide useful information for clinicians.

Diagnostic and treatment pitfalls in glossopharyngeal neuralgia: evidence from a case series.

BACKGROUND: Glossopharyngeal neuralgia (GN) is a rare pain syndrome often underdiagnosed. This study aimed to assess the challenges in diagnosing GN and identify patients at risk of misdiagnosis. METHODS: Between 2010 and 2019, nine patients underwent microvascular decompression (MVD) of the glossopharyngeal nerve at two tertiary care hospitals. A retrospective analysis examined symptom characteristics, time to correct diagnosis, operative technique, and clinical outcomes. Barrow Neurological Institute (BNI) pain scores were assessed before surgery and on follow-up. RESULTS: Six women and three men, aged 55 ± 14.3 years, with unilateral GN were included. Pain was predominantly in the ear (otalgic type) in four patients (44.4%), the pharynx or base of the tongue (pharyngeal type) in four (44.4%), and mixed in one (11.1%). Five patients reported pain radiating to the mandible, all initially misdiagnosed with trigeminal neuralgia (TN) and treated for 2.4(± 3.1) years before presenting to our institution. One case resulted in MVD of the trigeminal nerve and subsequent thermocoagulation of the Gasserian ganglion due to persistent pain. The correct diagnosis of GN was established later in patients with otalgic or mixed pain (3.8 ± 3.4 years) compared to those with pharyngeal pain (0.5 ± 1.0 years), showing a trend (U = 17.0, p = 0.07). There was a significant association between pain radiation to the mandible and misdiagnosis (x2 = 9.00, p = 0.003). Endoscopically assisted MVD via the median suboccipital subtonsillary approach was performed, resolving neurovascular conflicts with the PICA (9/9) and vertebral artery (3/9). Follow-up after 15.7(± 18.2) months showed significant pain reduction according to the BNI (preoperative BNI = 5.0 ± 0.0, postoperative BNI = 1.7 ± 1.0,t (8) = 10,CI [1.6-5.1], p < 0.001). No permanent surgery-related deficits occurred. CONCLUSION: Patients with GN, especially those with predominant otalgic pain and pain radiating to the mandible, are at higher risk of misdiagnosis due to similarities with TN. Despite the rarity of GN, increased awareness of its various pain manifestations may lead to earlier correct diagnoses, which is crucial for surgical treatment.

Overdiagnosing giant bullous emphysema as metastatic adenocarcinoma: a case report.

BACKGROUND: Giant bullous emphysema is characterized by large bullae occupying at least one-third of the hemithorax and leading to compression of the surrounding lung parenchyma. Overdiagnosis can occur because of the atypical appearance of hyperplastic type II pneumocytes, which may be mistaken for malignant cells. CASE PRESENTATION: A 48-year-old male with a history of smoking and occupational exposure presented with dyspnea and drowsiness. Initial chest X-ray revealed a tension pneumothorax, and subsequent chest CT revealed extensive bullous emphysema and lung cancer in the right middle lobe (RML). Pathologic examination initially indicated resected bullae to metastatic adenocarcinoma, but upon review, it was determined that the reactive alveolar cells were misdiagnosed as malignant. CONCLUSIONS: This case emphasizes the need for thorough histopathological assessment and prudent interpretation of atypical cellular morphology.

High altitude impact on serum bicarbonate in healthy Mexican children: concerning the overdiagnosis of renal tubular acidosis.

BACKGROUND: Altitude influences bicarbonate levels, it is a variable that is hardly considered in diagnosing Renal Tubular Acidosis (RTA), so it should be a factor to consider when diagnosing this pathology, especially at 2250 mts over the sea level as it is the case of Mexico City. RTA is most often misdiagnosed. Regarding of this, the present study established reference limits for bicarbonate levels in healthy children without pathologies associated with alterations in the acid-base balance in Mexico City and it´s metropolitan area. METHODS: A total of 267 healthy pediatric patients were included, within normal estimated glomerular filtration rate (eGFR), and without any associated pathology of any alteration in the acid-base balance. RESULTS: Compared to older children, children younger than two years of age showed statistically higher levels of calcemia and cystatin C. On the other hand, this same group showed lower values of creatininemia, pCO2, and HCO3-. Percentile 50 of bicarbonate in children under two years of age were 19.9 mEq/L and 21.9 mEq/L in those over that age. A correlation was identified between HCO3- levels and pCO2 (r = 0.68; p < 0.001). CONCLUSIONS: In the study population, an effect of altitude on blood levels of pCO2 and HCO3- was observed.

Errores en la interpretación de la radiografía de tórax en el lactante: ¿qué tenemos que saber de la técnica? / Errors in the Interpretation of chest X-rays in Infants: what do we need to know about the technique?

La radiografía de tórax sigue siendo fundamental para la evaluación de patologías torácicas en lactantes. Antes de iniciar su interpretación, muchos autores sugieren revisar la técnica radiológica, ya que a esta edad se presentan varias particularidades técnicas que deben tenerse en cuenta para evitar errores interpretativos y no confundir hallazgos técnicos con patologías. Entre estas particularidades técnicas se deben evaluar: el centraje transversal o rotación, el centraje longitudinal o posición lordótica, el grado de inspiración, la posición de la vía aérea superior, la penetración o exposición de la radiografía, tipos de proyecciones y el movimiento. El objetivo de esta revisión es comentar y ejemplificar las peculiaridades técnicas que presenta la radiografía de tórax en lactantes y que pueden llevar a interpretaciones erróneas.

The chest X-ray remains essential for evaluating thoracic pathology in infants. Before beginning its interpretation, many authors recommend assessing the radiographic technique, as several technical peculiarities must be considered at this age to avoid interpretive errors and prevent mistaking technical artifacts for pathology. The technical aspects to be evaluated include transverse centering or rotation, longitudinal centering or lordotic position, degree of inspiration, upper airway positioning, radiograph penetration or exposure, projection types, and movement. The objective of this review is to discuss and illustrate the technical peculiarities of infant chest X-rays that can lead to erroneous interpretations.

Prostate tuberculosis mimicking malignancy on 18F-FDG PET/CT in a patient with diffuse large B-cell lymphoma: A case report.

BACKGROUND: Prostate tuberculosis (TB) is a rare and often underdiagnosed condition due to its nonspecific symptoms and imaging features, which can mimic malignancies on 18F-fluorodeoxyglucose positron emission tomography (PET) scans. This resemblance poses a challenge in differentiating TB from prostate cancer, especially in patients with preexisting tumors such as diffuse large B-cell lymphoma. The purpose of this study is to highlight the importance of considering TB in the differential diagnosis of patients with atypical imaging findings, even in the presence of known malignancies. CASE: We present a case of a 60-year-old man with diffuse large B-cell lymphoma who was initially misdiagnosed with a prostate tumor based on 18F-fluorodeoxyglucose PET/computed tomography scans. The subsequent ultrasound-guided prostate biopsy confirmed the presence of prostate TB, not malignancy. CONCLUSIONS: This case report underscores the critical role of considering TB as a potential diagnosis in patients with hematological tumors and atypical imaging results. It serves as a reminder for clinicians to exercise caution when interpreting PET/computed tomography scans and to incorporate TB into their differential diagnoses, thereby avoiding misdiagnosis and inappropriate treatment.

Spontaneous rupture and hemorrhage of renal epithelioid angiomyolipoma misdiagnosed to renal carcinoma: a case report.

BACKGROUND: Renal epithelioid angiomyolipoma is a rare and unique subtype of classic angiomyolipoma, characterized by the presence of epithelioid cells. It often presents with nonspecific symptoms and can be easily misdiagnosed due to its similarity to renal cell carcinoma and classic angiomyolipoma in clinical and radiological features. This case report is significant for its demonstration of the challenges in diagnosing epithelioid angiomyolipoma and its emphasis on the importance of accurate differentiation from renal cell carcinoma and classic angiomyolipoma. CASE PRESENTATION: A 58-year-old Asian female presented with sudden left flank pain and was initially diagnosed with a malignant renal tumor based on imaging studies. She underwent laparoscopic radical nephrectomy, and postoperative histopathology confirmed the diagnosis of epithelioid angiomyolipoma. The patient recovered well and is currently in good health with regular follow-ups. This case highlights the diagnostic challenges, with a focus on the clinical, radiological, and histopathological features that eventually led to the identification of epithelioid angiomyolipoma. CONCLUSIONS: Epithelioid angiomyolipoma is easily misdiagnosed in clinical work. When dealing with these patients, it is necessary to make a comprehensive diagnosis based on clinical symptoms, imaging manifestations, and pathological characteristics.

Pulmonary Crystal-Storing Histiocytosis Misdiagnosed as Lung Cancer.

BACKGROUND: Crystalloid storage histiocytosis (CSH) is a rare clinical condition characterized by abnormally high numbers of histiocytes with a large accumulation of crystalline immunoglobulins. Due to its relative rarity, clinical diagnosis of it is frequently incomplete or incorrect. We report a case with pulmonary crystal-storing histiocytosis that was mistakenly identified as lung carcinoma. METHODS: Percutaneous lung biopsy, bronchoscopy. RESULTS: Percutaneous lung biopsy pathology shows granulomatous inflammation with massive eosinophilic infiltration, immunohistochemistry shows CD68, kappa positive, S-100, desmin, myogenin, lambda negative. The final diagnosis is pulmonary crystal-storing histiocytosis. CONCLUSIONS: To get pathology tissue for a definitive diagnosis, patients with pulmonary nodules who have changes in tumor markers or nodule size should have bronchoscopy or percutaneous lung biopsy done as soon as possible.

Misclassification of Eyes With Progressive Keratoconus Using the KISA% Index.

PURPOSE: To determine the misclassification rate of the keratoconus percentage (KISA%) index efficacy in eyes with progressive keratoconus. METHODS: This was a retrospective case-control study of consecutive patients with confirmed progressive keratoconus and a contemporaneous normal control group with 1.00 diopters or greater regular astigmatism. Scheimpflug imaging (Pentacam HR) was obtained for all patients. KISA% index and inferior-superior (IS) values were obtained from the Pentacam topometric/keratoconus staging map. Receiver operating characteristic curves were generated to determine the area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity values. RESULTS: There were 160 eyes from 160 patients evaluated, including 80 eyes from 80 patients with progressive keratoconus and 80 eyes from 80 control patients. There were 20 eyes (25%) with progressive keratoconus misclassified by the KISA% index, with 16 eyes (20%) of the progressive keratoconus cohort classified as normal (ie, KISA% < 60). There were 4 eyes (5%) with progressive keratoconus that would classify as having "normal topography" using the published criteria for very asymmetric ectasia with normal topography of KISA% less than 60 and IS value less than 1.45. All controls had a KISA% index value of less than 15. The optimal cut-off value to distinguish cohorts was 15.31 (AUROC = 0.972, 93.75% sensitivity). KISA% index values of 60 and 100 achieved low sensitivity (80% and 73.75%, respectively). CONCLUSIONS: The KISA% index misclassified a significant proportion of eyes with progressive keratoconus as normal. Although highly specific for clinical keratoconus, the KISA% index lacks sensitivity, does not effectively discriminate between normal and abnormal topography, and thus should not be used in large data analysis or artificial intelligence-based modeling. [J Refract Surg. 2024;40(9):e614-e624.].

[Overseas imported cystic echinococcosis misdiagnosed as pulmonary and hepatic cysts: a case report].

Cystic echinococcosis, a zoonotic disease that poses a significant threat to human health and animal husbandry development, is prevalent across the world and predominantly occurs in agricultural and pastoral regions. However, cystic echinococcosis cases are rare in non-endemic areas, which is likely to cause misdiagnosis or missing diagnosis, resulting in delay in treatment. This report presents an overseas imported cystic echinococcosis case misdiagnosed as pulmonary and hepatic cysts, so as to provide insights into diagnosis and treatment of cystic echinococcosis in non-endemic areas.

Pediatric mediastinal lymphatic malformation: misdiagnosis analysis and literature review.

OBJECTIVES: Mediastinal cystic lymphatic malformation (MCLM) in children is prone to misdiagnosis as cystic teratoma. We compared the clinical and radiologic features between the two diseases and performed a cross-comparison with previous research on adult cases. This study aims to identify characteristic pediatric manifestations to improve diagnostic accuracy. METHODS: A retrospective study of clinical and radiologic data was conducted on 12 MCLM and 20 cases of cystic teratomas confirmed by pathology or intervention biopsy. Clinical characters and radiology features (mass location and morphology, density, component, secondary complication) were recorded and compared. We reviewed clinical studies on MCLM published in the past decades, analyzing radiological differences and comparing pediatric MCLM cases at our hospital with those in the literature. RESULTS: Group comparison in pediatrics between MCLM and cystic teratomas: There were significant age differences (p = 0.036), shape (p = 0.003), CT difference value (p < 0.001), CT difference ratio (p < 0.001), calcification (p < 0.001), fat (p < 0.001), and typing (p < 0.001) between the two diseases. An analysis of literature data on MCLM cases involved 16 studies. CONCLUSION: The absence of internal fat or irregular morphology, along with a minimal CT difference value, may suggest the diagnosis of MCLM. In pediatric cases, anterior mediastinal diseases tend to extend toward the neck, and the presence of the thymus can complicate the component analysis, thereby increasing the risk of misdiagnosis. Clinical diagnosis and differential diagnosis of pediatric MCLM rely heavily on imaging evaluation.

Pulmonary actinomycosis misdiagnosed as lung cancer: a case report.

Pulmonary actinomycosis is a rare pulmonary infectious disease that is often challenging to diagnose early and has a high misdiagnosis rate. In some cases, it can be particularly difficult to distinguish pulmonary actinomycosis from lung cancer. We herein report a rare case of pulmonary actinomycosis in which the preoperative examinations strongly suggested lung cancer, leading to the patient undergoing right upper lung resection and bronchoplasty. The patient had a good postoperative recovery; however, the postoperative pathology report indicated pulmonary actinomycosis. In this report, we summarize the key aspects of the diagnosis and treatment of pulmonary actinomycosis to aid clinicians in reducing the likelihood of misdiagnosis.

Misidentified Metastases: Diagnosing and Managing Pyogenic Liver Abscesses in a Breast Cancer Survivor.

BACKGROUND Pyogenic liver abscesses are collections of pus of varying sizes within the liver. They are rare and often overlooked in developed countries, and if left untreated, they can be life-threatening. Therefore, early detection and treatment are crucial for favorable outcomes. Due to the atypical presentation, a high level of suspicion is necessary, as seen in our patient's case. CASE REPORT This report pertains to a 76-year-old woman who was diagnosed with sepsis resulting from multiple hepatic abscesses. Initially, the abscesses were mistaken for metastatic breast cancer liver disease due to her history of breast cancer in remission for 3 years. However, further imaging and biopsy revealed the initial diagnosis to be incorrect. She had initially presented with nonspecific abdominal pain and diarrhea. The initial computed tomography (CT) scan of the abdomen indicated the development of extensive hepatic lesions, thought to be associated with breast cancer, but subsequent magnetic resonance imaging (MRI) suggested liver abscesses. Ultrasound-guided aspiration confirmed the presence of liver abscesses, and subsequent culture of the aspirate revealed the growth of Streptococcus intermedius. The patient responded well to a 4-week course of antibiotic therapy. CONCLUSIONS This case report reviews the clinical presentation, risk factors, diagnosis, and management of multiple pyogenic liver abscesses, and shows the importance of using sound clinical reasoning in addressing diagnostic challenges of this nature.

[SFBC Working Group on sources of errors in laboratory medicine: objectives and key areas of work]. / Groupe de travail SFBC Sur les sources d'erreurs en biologie clinique: Objectifs et axes de travail.

Laboratory medicine plays a crucial role in patient care, contributing to approximately 70 % of clinical decisions. In collaboration with clinicians, laboratory medicine specialists perform analyses that are useful for diagnosis, screening and prevention. Laboratories are known for their efficiency, which is reached through a rigorous quality system. However, errors can occur, especially given the complexity of the total testing process. These errors may lead to severe consequences, such as incorrect diagnoses or delays in treatment. Errors can occur at every stage of the total testing process, those related to the pre-analytical phase being the most prevalent. To reduce medical errors related to laboratory processes, it is essential to provide training for medical and paramedical staff, optimize production automation, and leverage technological advancements. These considerations have led to the creation of a French Working Group on Sources of Errors in Laboratory Medicine, under the aegis of the French lean society of clinical chemistry and laboratory medicine (Société Française de Biologie Clinique - SFBC). The objectives of this working group are to produce an educational handbook on sources of errors in laboratory medicine, provide training for clinical chemists, and conducting applied research projects to better understand the mechanisms behind specific errors. Ultimately, the aim is to minimize errors and enhance the quality of laboratory tests.

Inflammatory bowel diseases and spondyloarthritis: a focus on female patients.

OBJECTIVE: Ulcerative colitis and Crohn's disease are chronic inflammatory diseases and represent the two most important types of inflammatory bowel diseases (IBD), while spondyloarthritis (SpA) comprises a heterogeneous group of systemic inflammatory chronic rheumatic diseases, including peripheral SpA and axial SpA. Joint manifestations are the most commonly observed extraintestinal manifestations, and they can precede or not the diagnosis of IBD. Notably, in women, misdiagnoses of IBD as irritable bowel syndrome and SpA as fibromyalgia are common, leading to delayed diagnoses, increased disease burden, and poorer prognoses. This narrative review emphasizes the critical role of diagnostic tools in facilitating early referrals of IBD patients with suspected SpA and vice versa to rheumatologists and gastroenterologists, respectively. Special attention is given to the multidisciplinary approach for more effective management of these conditions, particularly in female patients. METHODS: In this narrative review, we critically evaluated the literature on this topic, focusing on papers written in English that address female issues in IBD and SpA. RESULTS: IBD and SpA are chronic inflammatory disorders often occurring in the same patients. Female patients are often misdiagnosed, and this delay in diagnosis is associated with a higher disease burden and a poorer prognosis. CONCLUSIONS: A multidisciplinary approach is needed to enable early referral between gastroenterologists and rheumatologists, as this means a better prognosis for patients with a reduction in the economic and social burden associated with IBD and SpA.

Ultrasound as a tool for the diagnosis of spondylarthritis in women.

OBJECTIVE: The journey to a diagnosis of spondyloarthritis (SpA) can be difficult for women, who often experience delays in receiving the correct diagnosis as their symptoms are frequently misinterpreted due to other conditions like osteoarthritis, fibromyalgia, or other psychosomatic disorders. The purpose of this article is to examine the challenges in the diagnosis of SpA in women and the possible role of musculoskeletal ultrasound in early diagnosis and in avoiding misdiagnosis. METHODS: We have performed a narrative review of the currently available literature on the subject. RESULTS: The complexity of diagnosing SpA in women is compounded by the misconception that the disease predominantly affects men. To facilitate early diagnosis and prevent misdiagnosis, it is crucial not to overlook gender differences in the clinical presentation of SpA. Since women have more peripheral and enthesitic involvement, performing an ultrasound of entheses, tendons, and joints in women with musculoskeletal symptoms that could refer to SpA may help both in the early and differential diagnosis. CONCLUSIONS: There is a need to increase awareness among physicians of the existence of a different clinical presentation of SpA between men and women. The use of musculoskeletal ultrasound, which allows the detection of even subclinical inflammation and structural damage since early disease at the level of joints, tendons, and entheses can help make an early diagnosis and avoid misdiagnosis. Early diagnosis and timely treatment of SpA are crucial to reducing irreversible damage.