SAPHO Syndrome Masquerading as Metastatic Breast Cancer.

SAPHO syndrome is a rare clinical entity composed of synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO). We describe a case of SAPHO syndrome masquerading as metastatic breast cancer in a patient with localized breast cancer who presented with cord compression. There was no pathologic evidence of metastatic cancer; however, a bone scan indicated osseous involvement. After multidisciplinary review of images and with additional findings of pustulosis and acne, a clinical diagnosis of SAPHO was made.

Bronchiolitis obliterans organising pneumonia as an initial manifestation in a patient with systemic lupus erythematosus: a rare presentation.

Bronchiolitis obliterans organising pneumonia as an initial manifestation of systemic lupus erythematosus (SLE) is a rare and uncommon presentation. We describe a case of SLE presenting with shortness of breath, found to have pneumothorax, bilateral nodular infiltrates along with pleural effusions and pericardial effusion. Work-up suggested a diagnosis of active SLE with anaemia, thrombocytopenia, positive antinuclear antibodies (ANAs) and positive anti-double-stranded DNA. On retrospective review of patient records, from 8 years prior to presentation, lung biopsy histology consistent with bronchiolitis obliterans organising pneumonia with positive ANA serology was found, without any further autoimmune work-up. In our opinion, bronchiolitis obliterans organising pneumonia was the index presentation of SLE. Treatment with steroids and subsequent management with immunosuppressive therapy could have prevented subsequent hospitalisations. Prompt work-up for autoimmune diseases should be considered in patients with positive ANA and histological evidence of bronchiolitis obliterans organising pneumonia.

Rare Case of Olmesartan Induced Enteropathy.

Olmesartan (brand name Benicar) is an antihypertensive drug clinicians commonly use to treat high blood pressure. Olmesartan induced enteropathy (OSE) is a rare entity that authors first identified in 2012. The etiological basis of OSE remains unclear, although authors have suggested that this condition could be due to alternations in cell mediated immune responses induced by the drug. The objective of the case report is to describe a patient who presented with diarrhea and was eventually diagnosed with OSE. A female patient in her later 60s presented to an emergency room after two recent hospitalizations with profound diarrhea, generalized weakness and weight loss. She underwent a diagnostic workup including endoscopy and colonoscopy. The patient's endoscopy with duodenal biopsy revealed villous atrophy with attenuated and blunted villi with intraepithelial CD3 positive T lymphocytes, suggestive of gluten-induced enteropathy. When the patient's symptoms did not improve after the authors placed her on a gluten free diet for a few days, they further investigated her for secretory diarrhea, including Gastrin, Somatostatin and Vasoactive Intestinal Peptide lab values that they found to be within normal limits. Due to the patient's lack of improvement with initial treatment, the authors suspected OSE and stopped her olmesartan and the patients' symptoms gradually improved in three weeks.