Propylthiouracil-induced ANCA-negative cutaneous small vessel vasculitis.

Propylthiouracil (PTU) is a commonly used medication for the treatment of hyperthyroidism. PTU is known to cause different adverse reactions including autoimmune syndromes. PTU-induced autoimmune syndromes can be classified into drug-induced lupus or drug-induced vasculitis. Differential diagnoses could be very challenging. PTU-induced vasculitis is more common than PTU-induced lupus, and has a higher risk of morbidity and mortality. Usually it is limited to the skin in a form of cutaneous leukocytoclastic vasculitis, but may also affect organs including kidneys and lungs. Discontinuation of PTU should be a first step in the treatment and could lead to complete resolution of symptoms. Typically, lesions resolve spontaneously within 2-4 weeks, but chronic or recurrent disease may occur in up to 10% of patients. In cases without improvement after drug discontinuation, cases refractory to glucocorticosteroids, with necrotizing skin lesions or extracutaneous organ involvement referral to rheumatologist for more aggressive immunosuppressive treatment is indicated. Optimal duration of immunosuppressive therapy is unknown, but it is reasonable to gradually taper mediations and monitor clinical response. Frequent monitoring for side effects is mandatory for patients on PTU therapy. Treatment should be stopped immediately, if patient develops any of autoimmune syndromes. An accurate and prompt diagnosis is essential, because it determines further management. We report a rare case of antineutrophil cytoplasm antibody-negative cutaneous small vessel vasculitis as a result of longstanding exposure to PTU.

Gouty tophi.

Gouty tophi presenting as multiple large periarticular masses could be mistaken for rheumatoid nodules, neoplasm, neurofibroma, or infection. Aspiration of synovial fluid from inflamed joints or examination of whitish material expressed though breaks in skin usually assists with the diagnosis of gout.

McArdle's disease: a clinical review and case report.

McArdle's Disease is a rare glycogen disease involving deficiency in muscle phosphorylase. This deficiency can lead to rhabdomyolysis and subsequently renal failure. McArdle's Disease has a similar presentation as several other metabolic myopathies with exercise-induced fatigue, myalgias, weakness or unexplained rhabdomyolysis. Suspicion should be raised in the presence of unexplained symptoms, and muscle biopsy can be done to confirm the diagnosis.

A case of sclerosing mesenteritis with rheumatoid arthritis.

Sclerosing mesenteritis (SM) is an uncommon disorder characterized by chronic nonspecific inflammation involving the adipose tissue of the mesentery. The etiology remains unclear. It has been reported in association with and as an initial presentation in some autoimmune diseases. Its clinical presentation and laboratory findings are typically nonspecific and definitive diagnosis usually requires biopsy or surgical excision. We report a patient with a history of rheumatoid arthritis who was found to have an intra-abdominal mass suspicious for malignancy. A biopsy revealed the diagnosis of SM.

Transient thyrotoxicosis as an initial presentation of rheumatoid arthritis: a case report.

INTRODUCTION: Few reports in the literature describe the association of rheumatoid arthritis and transient thyrotoxicosis. We report a case of rheumatoid arthritis and painless thyroiditis presenting simultaneously and acutely with a cluster of symptoms that initially made the diagnosis of rheumatoid arthritis very challenging. CASE PRESENTATION: A 41-year-old Caucasian male presented with complaints of malaise and decreased range of motion in the left elbow. Physical examination and laboratory evaluation established the diagnosis of rheumatoid arthritis and painless thyroiditis. CONCLUSIONS: When patients with rheumatoid arthritis present with numerous "extra articular" and constitutional symptoms, evaluation of thyroid disorder with thyroid function test should be considered to help establish the correct diagnosis.