Subject(s)
Bone and Bones , Erdheim-Chester Disease/diagnosis , Osteosclerosis/diagnosis , Aged , Arthritis, Rheumatoid/diagnosis , Biomarkers/analysis , Biopsy , Bone and Bones/diagnostic imaging , Bone and Bones/immunology , Bone and Bones/pathology , Diagnosis, Differential , Diagnostic Errors , Erdheim-Chester Disease/immunology , Female , Humans , Immunohistochemistry , Osteosclerosis/immunology , Predictive Value of Tests , RadiographySubject(s)
Mass Screening , Osteoporosis, Postmenopausal/diagnosis , Practice Guidelines as Topic , Female , HumansABSTRACT
A 59-year-old woman was admitted to the hospital with a fever and rigors for 2 days. She was on chemotherapy (docetaxel, carboplatin, and trastuzumab) for her stage II invasive ductal carcinoma of the breast. Her physical exam was unremarkable except for the fever. The white blood cells were 21,200/mm(3) with 92% of neutrophils. ESR was 106 mm/h. An extensive infectious workup was negative. On day 6, while still febrile, the patient complained of a left-sided neck pain. She exhibited tenderness over the left carotid artery. A CT scan of the neck without intravenous contrast showed perivascular inflammation of the left common carotid artery, without evidence of a collection, arterial thrombosis, aneurysm, or dissection. The etiology of this finding was possibly chemotherapy related. It dramatically responded to oral prednisone. A repeat CT scan of the neck with IV contrast 2 weeks later showed a remarkable improvement. Drug reactions can simulate systemic inflammatory diseases and should always be considered in the diagnosing process.
Subject(s)
Carotid Artery Diseases/chemically induced , Carotid Artery, Common/drug effects , Neck Pain/etiology , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Carotid Artery Diseases/diagnostic imaging , Carotid Artery Diseases/pathology , Carotid Artery, Common/diagnostic imaging , Carotid Artery, Common/pathology , Diagnosis, Differential , Female , Humans , Inflammation/chemically induced , Inflammation/diagnosis , Inflammation/pathology , Middle Aged , Neck Pain/pathology , Radiography , Vasculitis/chemically induced , Vasculitis/diagnostic imaging , Vasculitis/pathologyABSTRACT
The treatment of pemphigus vulgaris (PV) is generally regarded as challenging. Patients with the disease require long-term systemic therapy, creating concern for the toxicities of these treatments. Corticosteroids, as drugs of first choice, often must be combined with steroid-sparing agents to prevent hazardous long-term side effects. We describe a 62-year-old woman with long-standing PV whose cutaneous disease responded to therapy with the tumor necrosis factor alpha (TNF-alpha) antagonist etanercept, which was started for treatment of her inflammatory seronegative arthritis. To our knowledge, this is the first report of its efficacy in the treatment of PV.