Thymoma-Related Paraneoplastic Syndrome Mimicking Reactive Arthritis.

Background and Objectives: Thymomas are associated with a high frequency of paraneoplastic manifestations. Paraneoplastic syndrome (PNS) with thymoma presents a challenge to clinicians because of the need to decipher the association between the presenting symptoms and the underlying tumor. The condition most commonly noted in patients with PNS with thymoma is myasthenia gravis. Other common autoimmune diseases that may present as PNS include systemic lupus erythematosus, pure red cell aplasia, and Good syndrome. Seventy-six percent of patients with PNS-associated thymoma experience resolution of PNS after curing thymoma. Materials and Methods: A 37-year-old man with a two-month fever accompanied by polyarthritis accidently found thymoma after contrast computed tomography scans of his chest. He accepted Video assisted thoracoscopic surgery with resection of thymoma. Results: Fever and polyarthritis resolved after operation but recurred in five days due to cytomegalovirus viremia, which might be predisposed by previous antibiotics treatment before the diagnosis of thymoma. Conclusion: Patients with a thymoma also have a high frequency of PNS, and the most frequent condition found in patients with PNS-associated thymoma is myasthenia gravis. Fever with polyarthritis has been rarely reported as a symptom of PNS-associated thymoma. Here we reported an unusual case of PNS mimicking reactive arthritis with thymoma, as diagnosed based on the patient's clinical progression, imaging examination, and laboratory tests. The patient died of his comorbidities, and his death may have been related to long-term antibiotic use and consequent intestinal dysbiosis. This challenging case may help to inform clinicians of the need for detailed work-up of fever with unknown origin in the presence of chronic polyarthritis to prevent the overdiagnosis of inflammatory arthritis or rheumatic disease and avoid further comorbidities. Detailed work-up should include the patient's history of infections, inflammation, and malignant or nonmalignant tumors.

Paget disease of bone in an elderly patient with chronic renal disease and weight loss: A case report.

RATIONALE: Asymptomatic Paget disease of bone (PDB) is mostly diagnosed by accidental finding of osteolytic lesion on the plain film. However, in elderly patient with chronic renal insufficiency and weight loss, it is crucial to differentiate PDB from metabolic and metastatic bone diseases for further treatment and better outcome. PATIENT CONCERNS: An 80-year-old man with chronic kidney disease presented to our emergency department due to fever with chillness for a day, while the abdominal fullness, anorexia, and weight loss had been noted for 3 months. Mixed osteoblastic and lytic changes in the pelvic bone were accidentally found on the abdominal plain film. DIAGNOSIS: The patient was diagnosed as asymptomatic PDB and urinary tract infection of Pseudomonas aeruginosa. INTERVENTIONS AND OUTCOME: The patient received 7 days intravenous and followed by 7 days oral antibiotic treatment, which lead to clinical improvement of his urinary tract infection. No pharmacological treatment was initiated for the asymptomatic and localized PDB. The patient was discharged under stable condition afterward. LESSONS: In patients with mixed osteolytic and blastic lesions, the differential diagnoses include metabolic and metastatic bone disease. Thorough understanding of the morphology of the bone lesions in high risk patient, not only helps to make differential diagnosis, but it also leads to precise treatment and better outcome.

Diameter change of common femoral arteries after percutaneous endovascular aortic repair with the use of the preclose technique.

OBJECTIVE: One of the major concerns regarding the preclose technique is its influence on the diameter of the accessed common femoral artery (CFA). The aim of our study was to evaluate the CFA diameter change after percutaneous endovascular aortic repair (PEVAR) with the use of the preclose technique. METHODS: From February 2012 to September 2013, 192 patients who underwent PEVAR with the preclose technique were reviewed. The patients were followed postoperatively with computed tomographic angiography 1, 6, and 12 months after PEVAR, and only those with complete computed tomography studies were included. For each access site, the inner diameter (ID) and outer diameter (OD) of the CFA were measured, and the diameters at various time periods were compared. In addition, the patient cohort was divided into four subgroups according to two parameters: the sheath size (12-16F and 18-24F) and the number of closure devices used for the preclose technique (two devices, more than two devices). The differences in diameter change between the subgroups were analyzed. The significance of the diameter change and the influences of the two parameters were analyzed statistically with the use of the paired t-test, one-way analysis of variance, and two-way analysis of variance. RESULTS: Fifty-eight patients fulfilled the study criteria. No significant influence on the ID of the accessed CFAs was observed at baseline and 1, 6, and 12 months (9.0 ± 1.75 mm, 9.1 ± 1.70 mm, 8.9 ± 1.72 mm, and 9.0 ± 1.68 mm, respectively). By contrast, a significant increase in initial OD occurred 1 month after PEVAR but gradually decreased in size in the following 11 months (13.0 ± 2.37 mm, 16.4 ± 3.44 mm, 14.2 ± 3.06 mm, and 13.5 ± 2.42 mm, respectively). Both the sheath size and the number of closure devices significantly affected the OD change (P < .001 and P = .037, respectively). The effect produced by the number of closure devices extended to 6 months after PEVAR, but the effect of the sheath size ceased before that time. CONCLUSIONS: This study demonstrates that PEVAR with the use of the preclose technique does not influence the ID of the accessed CFA, whereas the OD changes gradually over 1 year. These results may indicate that future endovascular interventions can be performed with the use of the same access without the risk of vascular narrowing.