Meningococcal Septic Oligoarthritis: An Unusual Presentation Revealing Concurrent Multiple Myeloma.

Meningococcal invasive disease is rare in immunocompetent hosts but may occur in patients with risk factors. Septic arthritis is an uncommon form of presentation and is usually due to surgical colonization or hematogenous dissemination. We present a case of a 73-year-old woman, who recently underwent knee replacement surgery, presenting with right knee and left shoulder pain, swelling, and reduced range of motion. Antibiotic therapy was promptly initiated, and the identification of invasive meningococcal disease with septic arthritis was possible through blood cultures and synovial fluid analysis.

Myopathy, what is the most likely diagnosis

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Dermatitis exfoliative with palmoplantar and face involvement

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Skin Rash and Fever of Unknown Origin A Diagnostic Challenge.

We report a clinical case of adult-onset Still's disease. In addition to the imaging features of the case, the following aspects are also briefly described: clinical presentation (prolonged fever associated with migratory polyarthritis and skin rash), treatment performed (resort to anti-inflammatory and corticoid), and clinical evolution of the patient after having performed the adult-onset. The treatment was found to be appropriate as the patient presented a favourable clinical evolution. LEARNING POINTS: Skin manifestations are associated with systemic diseases.Persistent febrile syndromes typically occur in young age.Adult-onset Still's disease is generally considered as a diagnosis of exclusion, as it presents with a combination of non-specific symptoms.

Olmesartan-Induced Sprue Like Enteropathy.

Chronic diarrhoea is a common clinical problem in gastroenterology practice and often it is difficult to diagnose the cause. Villous atrophy is not specific and the rarer possibility of drug-induced enteritis should always be considered. Olmesartan has recently been described as a cause of drug-induced enteropathy characterized by chronic diarrhoea and varying degrees of duodenal mucosa atrophy resembling celiac disease. We describe two cases of sprue-like enteropathy in patients treated with olmesartan for arterial hypertension several years before the onset of symptoms. Patients presented severe diarrhoea and significant weight loss, and both had histological evidence of intestinal villous atrophy. The clinical signs completely resolved after drug withdrawal. Olmesartan-induced enteropathy is a new clinical entity that must be included in the differential diagnosis of villous atrophy with negative celiac serology. The clinical and histological alterations easily and completely resolve after drug discontinuation, restoring quality of life to patients and avoiding unnecessary investigation.

A diarreia crónica é um problema clínico comum na prática de gastroenterologia e, muitas vezes, o diagnóstico da causa é difícil. A atrofia das vilosidades intestinais não é específica e a rara possibilidade de enterite induzida por fármacos deve ser considerada. O olmesartan foi recentemente descrito como uma causa de enteropatia induzida por fármacos caracterizada por diarreia crónica e graus variáveis de atrofia da mucosa duodenal semelhante á doença celíaca.Os autores descrevem dois casos de enteropatia tipo celíaca em doentes com história de hipertensão arterial medicada com olmesartan vários anos antes do início dos sintomas. Ambos os doentes apresentaram diarreia grave, perda ponderal significativa e evidência histológica de atrofia vilositária. Os sinais clínicos resolveram completamente após a interrupção do fármaco.A enteropatia induzida por olmesartan constitui uma nova entidade clínica que deve ser incluída no diagnóstico diferencial de atrofia vilositária seronegativa. As alterações clínicas e histológicas resolvem rápida e completamente após a suspensão do fármaco restaurando a qualidade de vida aos doentes e evitando, muitas vezes, investigações invasivas desnecessárias.