Ultrasonography of occipital arteries to diagnose giant cell arteritis: a case series and literature review.

We describe four cases of giant cell arteritis (GCA) that presented with occipital headache in the last 6 months. Typical ultrasound features of GCA were found in the occipital arteries which helped to confirm the diagnosis. One patient had already suffered significant visual loss by the time the diagnosis was made, reflecting the similarity in prognosis to the more typical GCA patients. These cases prompted a review of the literature to evaluate the evidence regarding the use of occipital artery ultrasonography in the investigation of GCA. We searched PubMed, Google Scholar and Web of Science and identified 17 papers but only four of these were relevant studies. The studies available show that typical features of GCA can be detected in the occipital arteries using ultrasonography. They also suggest that ultrasonography can detect changes in the occipital arteries when temporal arteries are not involved. However, occipital artery abnormalities were less common than temporal artery abnormalities in GCA. We advocate maintaining a high index of suspicion for GCA in patients presenting with atypical features, such as occipital headache. Ultrasonography has a vital role to play in the diagnosis of these patients. We recommend priority imaging of the affected area to facilitate prompt and accurate diagnosis of GCA, especially when atypical vessels are involved.

Tuberculous osteomyelitis of the midfoot: a case report.

INTRODUCTION: The prevalence of tuberculosis is increasing and musculoskeletal tuberculosis, although currently rare, may become an important problem. CASE PRESENTATION: We report the case of a 20-year-old Somalian man, who presented with an inversion injury to his ankle. When further history was taken, it transpired that he had sustained trauma to his ankle in Somalia 4 years previously, complicated by a non-healing wound. His foot pain and swelling had been present ever since. Diagnosis of tuberculosis was made by bone biopsy, histology of which demonstrated caseating granulomas. Tissue culture yielded growth of tuberculous bacilli. The patient made a full recovery on anti-tuberculous treatment. CONCLUSION: Musculoskeletal tuberculosis can be difficult to diagnose as only about one third of patients have respiratory symptoms. Synovial fluid aspirate is relatively unlikely to lead to definitive diagnosis, and a bone biopsy should always be taken for culture and histological examination.

Aseptic meningitis in a patient taking etanercept for rheumatoid arthritis: a case report.

BACKGROUND: We report a case of a 53 year old lady recently commenced on etanercept, an anti-TNF (tumour necrosis factor) therapy for rheumatoid arthritis presenting with confusion, pyrexia and an erythematous rash. CASE PRESENTATION: A lumbar puncture was highly suggestive of bacterial meningitis, but CSF cultures produced no growth, and polymerase chain reactions (PCR) for all previously reported bacterial, fungal and viral causes of meningitis were negative. CONCLUSION: This case report describes aseptic meningitis as a previously unreported complication of etanercept therapy, and serves as a reminder of the rare but potentially life-threatening risk of serious infections in patients taking anti-TNF therapy for a variety of conditions.