Paecilomyces variotii was isolated from two subsequent cerebrospinal fluid (CSF) specimens of a cancer patient. Identification was confirmed through beta-tubulin and rDNA ITS sequencing. MICs were determined for seven antifungal agents; the isolate was found to be susceptible to amphotericin B (AMB), itraconazole (ITZ), ketaconazole (KTZ) and 5-fluorocytosine (5FC) but resistant to fluconazole (FLZ) and miconazole (MCZ). Despite antimycotic therapy, the infection proved to be fatal.

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Background Familial Mediterranean fever (FMF) is a clinical diagnosis and depends mainly on disease history of recurrent attacks of serositis. A history of recurrent arthritis with erythema over the involved joint (red arthritis) is considered an important feature of FMF and used as a tool in the clinic to distinguish it from other rheumatologic conditions. Objectives The aim of this study is to determine whether history of erythema over the joint would predict FMF compared to diseased controls. Methods We surveyed patients with FMF (n=100; M, F), gout (n=16), ankylosing spondylitis (AS) (n=55), inflammatory bowel disease (IBD), (n=51) rheumatoid arthritis (RA) (n=70), Behçet’s syndrome (BS) (n=50) and systemic lupus erythematosus (SLE) (n=50) followed in our rheumatology outpatient clinics. Only those who had joint involvement were analyzed. We used a 20-item questionnaire that sought details of joint involvement. All patients were shown a picture of erythema over the joint to confirm if they had experienced a similar condition. Results Demographic features and the number of patients with a history of erythema over the joint in each group are given in the Table. Erythema over the joint predicted a diagnosis of FMF compared to overall controls which included BS, SLE, RA, AS,IBD and gout with an odds ratio of 2.5 (95% CI 1.3-4.7) (p=0.002). When the odds ratio was calculated for each control group, erythema over the joint discriminated FMF from AS OR=3.2 (95% CI 1.2-9.0) (p=0.04) and RA OR=4.9 (95% CI 2.3-10.8) (p=0.001). If history of red arthritis with an onset before the age of 20 is considered, an OR of 22.8 (95% CI 8.8-61) is obtained, giving a sensitivity of 79.4% and a specificity of 85.4% for the diagnosis of FMF Table 1. Demographic characteristics and erythema over the joint frequency among the study groups Erythema over the joint,Erythema over the joint with an onset n (%)before the age of 20 FMF (n=57/100)37 (64.9)31 (54.3) 31/37 (83.7) RA (n=70/70)19 (27.14)3 (4.2) 3/19 (15.7) BD (n=23/50)13 (56.5)4 (17.3) 4/13 (30.7) SLE (n=25/50)13 (52)0 Gout (n=16/16)12 (75)0 AS (n=22/55)8 (36.3)1 (4.5) 1/8 (12.5) IBD (n=5/51)3 (60)0 Conclusions History of erythema over the joint (red arthritis) may discriminate FMF arthritis from certain arthritidies. The sensitivity and specificity improves significantly if age of onset of red arthritis is taken into consideration. This observation should be improved by including a control group consisting of other periodic fever syndromes. Disclosure of Interest None Declared

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BackgroundCase reports and series suggest that Takayasu's arteritis (TA) can co-exist with various inflammatory disorders.ObjectivesWe conducted a formal study to look specifically at the frequency of inflammatory disorders and symptoms in a large cohort of TA followed by a single tertiary center.MethodsThere were 238 patients registered with a diagnosis of TA. Of these, 19 died, 18 were lost to follow-up and 3 did not wish to response our questionnaire. The remaining 198 patients were called back at the outpatient clinic. A standardized form sought whether the patient was also diagnosed as inflammatory bowel disease (IBD), ankylosing spondylitis (AS), Behçet's syndrome (BS), amyloidosis, uveitis, rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), systemic sclerosis (pSS), Sjögren syndrome, psoriatic arthritis, inflammatory myositis, small vessel vasculitis, autoimmune/demyelinating or any other inflammatory disorder.ResultsOverall, 198 (175 F/ 23 M) patients were studied. The mean age at the time of TA diagnosis was 34±12 years. Subclavian artery was the most common involved artery (84%), followed by common carotids (78%) and aorta (65%). Currently, while 25 (16%) patients were off treatment, 72 (47%) patients were using glucocorticoids, 47 (31%) azathioprine, 32 (21%) methotrexate and 44 (29%) biological agents.We identified in total 37 (19%) patients with inflammatory diseases (IBD: n=12; AS: n=15; and BS: n=10). Table shows their demographic characteristics. Among the remaining 161 patients, the most frequent feature was inflammatory back pain (36%), followed by recurrent oral ulcers (15%), erythema nodosum (11%), arthritis (10%), papulopustular lesions (7%), uveitis (4%), and genital ulcer (1%). It was noted that inflammatory back was mostly located on the dorsal area. Regarding autoimmune diseases, we also observed RA (n=3), psoriasis (n=2), autoimmune hepatitis (n=2), SS (n=1) and SSc (n=1).Table 1.Demographic features of 37 TA patients with inflammatory bowel disease (IBD), ankylosing spondylitis (AS) or Behçet's syndrome (BS)Concomitant diseaseF/MMean age at TA diagnosis (SD)Mean age at concomitant disease (SD)Time of TA diagnosis in relation to concomitant disease AS (n=15)13/231±827±11Simultaneous (n=3)TA preceded (n=7)AS preceded (n=5)IBD (n=12)11/133±931±9Simultaneous (n=9)TA preceded (n=1)IBD preceded (n=2)BS (n=10)7/335±1332±13Simultaneous (n=5)TA preceded (n=1)BS preceded (n=4)ConclusionsTA does co-occur with IBD, AS or BS in about 1/5 of the patients, at least in a hospital setting and without a clear temporal pattern. This could be due to the close association of TA with MHC class-1 diseases. In addition, the high prevalence of inflammatory back pain in the dorsal spine in TA needs further scrutiny.Disclosure of InterestNone declared