[An unusual cause of the hand cyst: finger dirofilariasis]. / Ujjon lévo cystosus elváltozás hátterében diagnosztizált dirofilariosis.

Dirofilariasis is a zoonosis affecting dogs and cats. It can be transmitted to human by mosquito bites. Because of the local inflammation caused by the parasite, a lump may develop. The authors present a case of a 13-year-old boy, who was diagnosed with dirofilariasis in association with a cyst located on the middle finger of the right hand. During physical examination, a lump on the extensor surface of the middle phalanx of the right middle finger was found. Soft tissue ultrasound was performed, which indicated the presence of a worm in the cyst. The cyst was surgically removed under local anesthesia and with parasitology test Dirofilaria repens infection was confirmed. The child had no complains or symptoms during recovery after the surgery. A solitary growth developing on the fingers of the hand often presents a differential diagnostic problem. Ultrasound can be greatly helpful in the preoperative diagnosis. Orv. Hetil., 2016, 157(39), 1571-1574.

[Large deep venous thrombosis in childhood--three cases]. / Gyermekkori nagy kiterjedésû mélyvénás trombózis három eset kapcsán.

Deep venous thrombosis is a rare disease in children under the age of 18, with an estimated incidence of 1/100,000 per year in Hungary. Its typical localization in children is in the extremities, usually occurring in newborns and in teenagers. Both congenital and acquired risk factors can be in the background. Although it is a rarity, we should think of it, because late diagnosis can cause life-threatening conditions like pulmonary embolism or central nervous system thrombosis. Detailed medical history can help the diagnosis. Etiology, possible congenital and acquired risk factors, as well as diagnostic and therapeutic options are discussed through three cases of teenage children. Diagnostic difficulties of deep venous thrombosis in childhood are the following: the occurrence is rarer than in adulthood therefore it is often forgotten as a possible diagnosis, coagulation parameters are age-dependent, and diagnosis with imaging techniques is more difficult.

Occurrence of pulmonary rheumatoid nodules following biological therapies.

In rheumatoid arthritis (RA), disease activity is generally determined by the joint involvement, but the treatment outcome is often influenced by extra-articular manifestations. Authors present a 74-year-old female patient's case history, who was treated with seropositive RA. Marked disease activity was observed even following combined traditional disease-modifying antirheumatic drug (DMARD) treatment (disease activity score in 28 joints (DAS28) = 6.6). Therefore, the patient received TNF-α antagonist therapy. Golimumab was administered subcutaneous (SC) once monthly which resulted in significant improvement in both clinical and laboratory signs (DAS28 = 3:43). However, the follow-up chest x-ray indicated multiple intrapulmonary foci and enlarged lymph nodes. Biopsies and histology excluded malignancy; rheumatoid nodules were confirmed. Anti-TNF therapy was discontinued and tocilizumab treatment was initiated. The IL-6 receptor inhibitor suppressed arthritic activity, and 2 months later, the follow-up chest x-ray showed a regression of chest nodules. Our cases, as well as reports from other centers, suggest that TNF blockade may induce rheumatoid nodulosis and the use of alternative biologics may be feasible as further treatment of RA.