Idiopathic eosinophilic synovitis. Case report and review of the literature.

Eosinophilia of synovial fluid is an uncommon condition. The majority of the reported cases are associated to diseases such as rheumatoid arthritis, parasitic disease, hypereosinophilic syndrome, Lyme disease, and allergic processes as well as hemarthrosis and arthrography. Presently there are only four cases of eosinophilic synovitis with unknown cause. We are reporting a patient with oligoarthritis of the knees, massive eosinophilia, and Charcot-Leyden crystals in synovial fluid without associated cause. We review the clinical and biological features of eosinophilic synovitis and discuss its pathogenesis.

Amyloid goitre: CT and MR findings.

Two cases of amyloid goitre presented as an enlarged thyroid mass with cystic components. Solid parts of the goitre showed high attenuation on computed tomography (CT) and moderate hypointensity on T1 and T2-weighted images. Fine needle aspiration was negative for amyloid, but pathological studies of surgical specimens demonstrated amyloid infiltration of the thyroid interstitium and regressive colloid cysts. In a patient at risk for systemic amyloidosis, thyroid enlargement with a cystic component suggests amyloid goitre. In this case, needle biopsies should be directed to solid areas of the mass because amyloid material may not be present in the cysts.

[Study of 94 cases of sarcoidosis with special reference to erythema nodosum]. / Estudio de 94 casos de sarcoidosis con especial referencia al eritema nudoso.

We studied 94 patients diagnosed of sarcoidosis in order to establish the incidence of erythema nodosum (EN), in the course of sarcoidosis, in our setting and to check if it induces different clinical and analytical characteristics in patients. 37 patients (39%) showed EN with a mean age of 41 +/- 1.62 years and with a marked female predominance (81%). Its presence was associated with a higher frequency of general symptoms (p less than 0.01), articular manifestations (p less than 0.001), specially in knees and ankles (p less than 0.01), subacute evolution (p less than 0.001), raise in GSR and of alpha-one-globulin (p less than 0.01) and hypoalbuminemia (p less than 0.05). On the other hand, those patients without EN showed higher frequency of dermal lesions different from EN (p less than 0.001) and the articular manifestations were localized preferentially in knees and proximal interphalangeal articulations of hands (p less than 0.05). We underline the high incidence of EN in sarcoidosis in our setting, which originates a more benign clinical type with a more favorable prognostic, embedded in the course of sarcoidosis, to which EN would transfer its clinical, analytical and immunopathogenic characteristics.

[The bone manifestations in 94 cases of sarcoidosis]. / Manifestaciones óseas de 94 casos de sarcoidosis.

94 patients diagnosed as having sarcoidosis were studied in Galicia in order to evaluate the frequency of bone manifestations, as well as to analyse the clinical and radiological features. Bone lesions were found in 10 patients (10.6%) with a median age of 47.4 years, the predominant sex being female in this group (70%). The lesions were of two types: a) osteolytic on metacarpal (4 cases), nasal bones (1 case), sacrum (1 case), femur (1 case); b) osteosclerosis on femur and fibula (1 case), acrosclerosis (3 cases), metacarpal (1 case). The first lesions were associated to chronic types of sarcoidosis with skin and lung involvements. The second lesions were associated to a sub-acute type of Löfgren. We highlight the behaviour of both types of bone lesions and comment on the physiopathology of the sclerotic lesions.

[Erythema nodosum: a study of 160 cases]. / Eritema nudoso: estudio de 160 casos.

We have evaluated 160 patients diagnosed of erythema nodosum (EN) on the basis of clinical and/or histopathological criteria to assess their etiology and their major epidemiological, clinical and laboratory features in our area. Mean age was 37.5 years and 86% of patients were females. The etiology could be determined in 67.5% of cases: sarcoidosis (20.6%), drugs (18%), streptococcal infection (16.3%), tuberculosis (6.3%), pregnancy (1.9%), Crohn's disease (1.3%), Behçet's disease (1.3%), lymphoma (0.6%), adenocarcinoma (0.6%), and toxoplasmosis (0.6%). 32.5% of cases were idiopathic. We found significant differences between the different etiological factors regarding mean age, fever, joint disease, ESR, leukocytosis and serum proteins. We compare our results with those from other series and we emphasize the need for a systematic workup in all patients with EN to facilitate their etiological diagnosis.

Laminar periostitis and multiple osteonecrosis in systemic lupus erythematosus.

Bone affectation in systemic lupus erythematosus (SLE) is caused both by the disease itself and by the treatment used. We report the case of a woman diagnosed of SLE, who, in the course of her illness, develops multiple aseptic osteonecrosis (AON) and laminar periostitis, radiologically compatible with the diagnosis of hypertrophic osteoarthropathy (HOA), with no evidence of acropaquia. In this case, the patient shows all the risk factors involved in the pathogenesis of the development of ischemia in bone microcirculation.