ABSTRACT
Waldenström macroglobulinemia (WM) is an indolent B cell lymphoproliferative disorder with monoclonal IgM secretion. We present a patient with WM who presented with multifocal acute cortical ischemic strokes and was found to have central nervous system (CNS) vasculitis. Workup was negative for cryoglobulins and hyperviscosity syndrome. Immunosuppression with intravenous steroids and cyclophosphamide stabilized the patient's mental status and neurologic deficits. On followup over 7 years, patient gained independence from walking aids and experienced no recurrences of CNS vasculitis. To our knowledge, CNS vasculitis in a WM patient, in the absence of cryoglobulins, has not been reported. Immunosuppression is the preferred treatment.
ABSTRACT
Parkinsonism in SLE is rare. Diffuse leukoencephalopathy is equally uncommon and is associated with a poor prognosis. We present a single case of a 50-year-old Filipino man who presented with a generalized discoid rash after starting lisinopril. The rash persisted despite discontinuation of lisinopril, and over the next three months, he developed rapidly progressive parkinsonism. Brain MRI showed symmetric confluent T2-hyperintensities involving the white matter and basal ganglia. Four of the 11 American College of Rheumatology criteria for the classification of SLE were met. A rheumatologist made a diagnosis of SLE with cutaneous and central nervous system involvement. Significant neurologic and radiologic improvement occurred following treatment with IV steroids followed by a prolonged taper. This report highlights a case of subacute parkinsonism with a diffuse leukoencephalopathy as an early manifestation of SLE which resulted in a good recovery following treatment with only immunosuppressive therapy.
ABSTRACT
Systemic lupus erythematosus (SLE) is rare in men, and significantly more common in women. Sex hormone influences are believed to a play a role in these gender differences. We present the unusual case of a transgender man who had been taking feminizing sex hormones, who later developed new onset SLE with cardiorespiratory and renal involvement. While not definitive, this case raises intriguing possibilities on the relationship between the use of feminizing sex hormones and the development of SLE.
Subject(s)
Feminization/chemically induced , Gonadal Steroid Hormones/adverse effects , Lupus Erythematosus, Systemic/chemically induced , Lupus Erythematosus, Systemic/diagnosis , Adult , Humans , Lupus Erythematosus, Systemic/therapy , MaleABSTRACT
Musculoskeletal infections are uncommon complications of monosodium urate and calcium pyrophosphate dihydrate (CPPD) crystal deposition disease, and frequently involve gram positive and negative organisms. Tumoral calcinosis (tophaceous pseudogout) is a rare manifestation of CPPD deposition disease. We describe a highly unusual case of an infection by Mycobacterium tuberculosis (TB) of a tophaceous pseudogout nodule in a patient with endstage renal disease. The highly destructive nature of this case of combined CPPD arthropathy and musculoskeletal TB underscores the urgency of diagnosing this infection in susceptible patients from countries with high prevalence rates of TB infection.