Orthopedic Disorders

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• RS3PE syndrome with subsequent PMR caused by long-term DPP-4 inhibitor use Yuichi Takahashi, Gautam Deshpande, Yoshinori Kanai, Kwang-Seok Yang, Toshio Naito Views: 507 HTML: 62 PDF: 433

  Remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) syndrome has been reported in patients treated with dipeptidyl peptidase-4 inhibitors (DPP-4i). We experienced a case of RS3PE syndrome in a 73-year-old man with a history of type 2 diabetes, who developed RS3PE as a side effect of vildagliptin. Further to this, the patient developed polymyalgia rheumatica (PMR), the first such case associated with long-term DPP-4i use.

• Focal myositis of the sternocleidomastoid muscle: a rare and uncommon cause of cervical mass Léa Docquier, Xavier Jannot, Zaida Córdoba-Sosa, Léa Pierre, Pierre Alexis Austrusseau, Emmanuel Andres, Noel Lorenzo Villalba Views: 553 HTML: 50 PDF: 440

  We report on a 70-year-old male patient admitted to the internal medicine department for evaluation of a right cervical mass. He had been treated with antibiotics as an outpatient by his primary care doctor. Upon admission the patient was asymptomatic, but within a few hours his cervical mass enlarged; this enlargement was confined to the right sternocleidomastoid muscle. Complete blood investigations including serology and autoimmunity were negative. The neck scan and MRI were in favour of myositis. No other lesions were found either in the nasal fibre-optic exam or in the thoracic-abdominal-pelvic scan. The biopsy of the muscle showed a lymphoplasmacytic inflammatory infiltrate of the perimysium. The diagnosis of focal myositis was made. The patient clinically improved during hospitalisation with complete resolution of symptoms without any specific intervention.

• Intestinal pseudo-obstruction with life-threatening hypokalaemia in a patient with adult-onset Still’s disease Pierre Rossignon, Alain Soupart Views: 265 HTML: 45 PDF: 265

  Adult-onset Still’s disease (AOSD) is a rare autoinflammatory disorder that can lead to a cytokine storm, causing a range of symptoms. Acute intestinal pseudo-obstruction is another rare condition that results in intestinal obstruction without anatomical cause. Although the two conditions are rarely reported together, we present the case of a 62-year-old male who developed acute intestinal pseudo-obstruction in the context of an AOSD flare. This led to severe hypokalaemia and a critical condition. Other symptoms included a high-spiking fever lasting for weeks, polyarthralgias and a typical salmon-coloured rash. After ruling out other potential causes, the patient was diagnosed with AOSD. Our findings suggest that the cytokine storm associated with this disease triggered the acute intestinal pseudo-obstruction and life-threatening hypokalaemia, establishing a causal relationship.
  Only four other cases of AOSD complicated by intestinal pseudo-obstruction have been reported, and this is the first to present with life-threatening hypokalaemia. This case serves as a crucial reminder that, despite being a diagnosis of exclusion, Still’s disease should be considered as a potential cause of intestinal pseudo-obstruction, as prompt recognition and treatment of the underlying cause is crucial in managing this potentially life-threatening condition.

• Cryptic presentation of cryptococcal osteomyelitis in an apparently immunocompetent individual Hariharan Subramony, Balagurunathan Raghavan, Eswer Subbaiyan, Manjunatha Gajanana Hegde, Kartik Ramanathan Views: 303 HTML: 43 PDF: 291

  Cryptococcosis is an opportunistic fungal infection seen in immunocompromised individuals. It is caused by the yeast-like fungus Cryptococcus and predominantly affects the lungs and central nervous system. Immunocompetent individuals very rarely develop bone involvement and only a few cases of cryptococcal osteomyelitis in patients without other comorbid conditions have been described. Only one other case of pelvic involvement, which was accompanied by lymphopaenia, has been reported. We describe the case of a 42-year-old immunocompetent man with cryptococcal hip osteomyelitis.

• Not so Mutually Exclusive Diseases: A Case of Co-occurrence of Inflammatory Spondyloarthritis and Diffuse Skeletal Hyperostosis in a Young Patient Filipa Taborda, Duarte André Ferreira, Teresa Mendonça, Fátima Farinha Views: 475 HTML: 81 PDF: 377

  Diffuse idiopathic skeletal hyperostosis (DISH) and axial spondyloarthritis (axial SpA) are differential diagnoses of lower back pain. While the latter is considered to be an inflammatory disease, DISH is thought to be a metabolic condition. The authors report a case of a 34-year-old man who presented with a one-year history of axial lower back pain associated to migratory polyarthritis, buttock and heel pain. Imaging revealed contiguous calcification of the anterior longitudinal ligament of the cervical segment, meeting major criteria for DISH. However, he also exhibited signs of bilateral sacroiliitis highly suggestive of axial SpA for which he initiated biological therapy.