Acute Tonsillitis Due To Monkeypox.

BACKGROUND: The emerging 2022 human mpox virus outbreak has presented with unique disease manifestations challenging prior case definitions. CASE REPORT: We present a case of a 42-year-old transgender woman with human immunodeficiency virus controlled on antiretroviral therapy, presenting with sore throat, who, after three emergency department visits, was found to have acute tonsillitis complicated by airway obstruction secondary to mpox. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Sore throat is a common presentation to the emergency department. mpox should be placed on the list of differential diagnoses when evaluating patients who present with pharyngitis to avoid complications or a missed diagnosis.

Life threatening retroperitoneal haemorrhage due to therapeutic fondaparinux.

We report the case of a patient with pulmonary embolism, treated with fondaparinux as bridging therapy until therapeutic levels were achieved on warfarin, who developed a non-traumatic massive retroperitoneal haematoma requiring substantial resuscitation with blood products and arterial embolisation. To our knowledge, this condition has not been reported with therapeutic doses of fondaparinux. Our patient, however, may have been more predisposed to bleeding due to the unpredictable pharmacokinetics of fondaparinux secondary to his morbid obesity, reduced clearance of the drug due to renal insufficiency and concomitant treatment with low dose aspirin and warfarin. Another consideration was the lack of a specific reversing agent for fondaparinux in the setting of a life threatening haemorrhage.

Limited Wegener's granulomatosis presenting as lung nodules in a patient with rheumatoid arthritis: a case report.

BACKGROUND: Rheumatoid arthritis has varied pleuroparenchymal manifestations. Wegener's granulomatosis can develop in an established case of rheumatoid arthritis and this association although previously reported is very rare. CASE PRESENTATION: A 60-year-old lady had been diagnosed with rheumatoid arthritis on the basis of her clinical symptoms and serological tests which were positive RA factor and anti-CCP antibodies. Her rheumatoid arthritis activity had been mild and well controlled with hydroxychloroquine and low dose prednisone. She presented with a productive cough and right-sided pleuritic chest pain. CT scan of the chest showed three lung nodules with increased uptake on PET CT scan, raising concerns for an inflammatory or malignant process. The differential diagnosis included rheumatoid nodules, infections or malignancy. A CT-guided needle biopsy of the largest nodule was undertaken which showed vasculitis typical of Wegener's granulomatosis. Stains and cultures of the biopsy specimen were negative for bacteria, fungi and acid fast bacilli. A panel of serological tests for vasculitis were checked and showed elevated titers of cANCA and anti-proteinase 3 antibodies. Urine analysis and CT scan of paranasal sinuses was normal. Since the upper respiratory tract and the kidneys were spared a diagnosis of limited Wegener's granulomatosis affecting only the lungs was made. Due to the toxicity of cyclophosphamide, her relatively mild disease sparing the kidneys and the underlying rheumatoid arthritis, weekly methotrexate was started and low dose prednisone was continued. She had marked symptomatic improvement and complete resolution of the nodules was documented on subsequent imaging. CONCLUSION: Wegener's granulomatosis developing in a patient with rheumatoid arthritis is very rare but should be considered as it warrants a different and possibly more aggressive treatment approach.