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BACKGROUND Ledderhose's disease is part of a group of benign fibroblast proliferations called fibromatosis, which superficially affects the plantar fascia and, in some cases, the hands. It is a rare disease, with higher incidence in males aged 30-50 years. Its etiology is unknown, but there is multifactorial evidence, including genetics, microvascular trauma, use of anticonvulsants and immunological reactions. It is characterized by subcutaneous nodules of slow proliferation, more frequently located in the central and medial portions of the plantar fascia, and up to half of the cases affects both feet. Most clinical conditions are asymptomatic, but pain can be triggered after periods of walking. Also, when the nodules invade structures like nerves and muscles, symptoms may become more specific.

BACKGROUND Giant cell arteritis (GCA) is the most common systemic vasculitis in Western countries. It mainly affects individuals older than 50 years, basically involves vessels of great caliber, and has an incidence rate of about 200 cases per 100,000 inhabitants, with women affected 2-6 times more than men. GCA has great clinical relevance, and its main and most common complication is the large-vessel stenosis, rarely presenting aneurysmal lesions. CASE REPORT A 65-year-old woman complained of daily night fever, temporal headache, jaw claudication, weight loss (3 kg), and night sweats for approximately 60 days. She also presented intense pain in the scapular and pelvic girdles. The patient had multiple negative blood cultures and underwent empiric antibiotic therapy for one month, showing no improvement. Initial tests showed hemoglobin (Hb) of 9.8 g/dL, erythrocyte sedimentation rate (ESR) of 110 mm/hr, Creactive protein (CRP) of 26 mg/L, normal liver enzymes and renal function tests. Aortic arch CT angiography revealed an ulcerated and inflamed aneurysm lesion (figure 1 and 2). Abdominal CT showed no abnormalities. Doppler ultrasound of carotid arteries showed bilateral slight thickening of the common carotid artery, with no evidence of active inflammation. After excluding the most common neoplastic causes, the diagnosis of GCA was assumed. We started treatment with prednisone 1 mg/kg, yielding response in 24 hours, with improvement of the general condition, anemia, fever, headache, and body aches. ESR examination showed improvement, with return to baseline levels. A weekly dose of 15 mg methotrexate was added to the treatment, with subsequent increase to 25 mg because of fever relapse and increase in ESR whenever doses of prednisone were reduced. After six months of follow-up and treatment, new CT angiography showed doubling of aortic aneurysm size, with imminent rupture, lesion without active inflammatory activity, normal ESR, and absence of anemia. The patient, in joint follow-up with a cardiologist, presented emergency surgical indication and was referred to the cardiovascular surgery team. CONCLUSION Although aneurysmal lesions are not frequent in cases of GCA, being classified as rare, these injuries and their inflammatory nature should be part of the clinical suspicion, especially when differential diagnoses such as syphilis and tuberculosis are excluded.

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BACKGROUND Cocaine acts predominantly in the central nervous system, enhancing the release and duration of action of dopamine, noradrenaline and serotonin, the latter two related to mood, cognition and eventual pain functions. Withdrawal syndrome (WS) usually starts 4 to 10 days after cocaine has been discontinued and may also occur indefinitely in a minority of cases, being characterized by psychiatric effects such as depression and, rarely, pain. Similarly, fibromyalgia (FM) is a condition that imposes differential diagnosis. Infrequent FM incidence in men is worth mentioning. CASE REPORT A 22-year-old man had been a cocaine user for a year and a half. Forty days after the definitive suspension of the drug, he began to present diffuse and intense pain throughout the body, in addition to sadness, insomnia and non-repairing sleep. Laboratory tests excluded other differential inflammatory diagnoses. After eight months, the patient maintained the clinical condition without improvement, using escitalopram and alprazolam, besides undergoing psychiatric follow-up. Patient diagnosis was compatible with FM by the old (16/18 tenders) and new (WPI 18 and SS 11) criteria. Duloxetine therapy with cyclobenzaprine was initiated, escitalopram was suspended, and regular physical activity was introduced. Despite 100% improvement in the condition, the patient abandoned treatment and relapsed after 3 months. With the patient abstained for almost a year, the regimen for diffuse pain (DP) was restarted, with great sequential improvement. CONCLUSION The rheumatologist should not ignore the differential diagnosis conditions associated with FM-like symptoms. Its incidence in young men should stimulate further investigation of secondary causes such as substance abuse and WS. Despite the difficulty of differentiating between FM as a trigger to the suspension of cocaine use and the symptoms of WS with painful manifestation, regardless of the time of late onset, the DP and humoral treatments occur in the same way.