Reactive arthritis (ReA) with the classic triad of arthritis, conjunctivitis and urethritis, previously termed Reiter’s syndrome, is a systemic illness, usually induced by genitourinary or gastrointestinal infections. However, it can be a rare complication of intravesical Bacillus Calmette-Guérin instillation (iBCG), a therapy prepared from attenuated strains of Mycobacterium bovis, a common and effective treatment for carcinoma in situ of the bladder (CisB). We report a case of a patient with CisB who developed ReA after iBCG. The symptoms resolved completely with corticosteroids. iBCG was stopped with no recurrence of carcinoma within 2 years.

Occam's razor, the principle that a single explanation is the most likely in medicine, assumes that when a patient has multiple symptoms the clinician seeks a single diagnosis rather than diagnosing multiple and different ones. However, as proposed by Hickam’s dictum, sometimes rare different diseases occurred in only one patient. We present a patient with a simultaneous diagnosis of two rare tumours, a cardiac hemangioma (primary cardiac tumour, often misdiagnosed as myxoma) and an appendiceal mucocele (a lesion of the appendix that can be neoplastic or not). A 71-year-old male presented with anorexia, asthenia, fever and weight loss for about one month. During the etiological investigation, a cardiac mass and an appendiceal lesion were detected and both lesions required surgical intervention. Cardiac and abdominal surgeries were uneventful and full recovery was achieved. The histological examination showed a cardiac hemangioma and a neoplastic appendiceal mucocele.

ANCA - associated Vasculitis (AAV) positive biopsy is supportive of vasculitis diagnosis, the aim of this manuscript is that renal biopsy is not always compulsory in the diagnosis and management of AAV. 79 years old, Caucasian women, admitted with AAV suspicion, MPO positive. A Microscopic polyangiitis with a pulmonary – renal syndrome was diagnosed after other AAV were excluded. Remission induction and maintenance therapy was made. In 6 months the patient presented a considerable improvement with lower MPO value, ESR and a stabilization of kidney function. Renal biopsy has to be performed in the majority of patients with the suspicion or renal AAV, although in this case it was not performed considering that the patient was on chronic anticoagulation and renal biopsy was not essential for the diagnosis. We suggest that renal biopsy is a valuable method in establishes the aetiology of kidney disease and that it could be dismissed in AAV with suggestive clinical presentation and low suspicion for secondary vasculitis.

Felty's syndrome (rheumatoid arthritis with neutropenia and splenomegaly) is a rare condition with poor long-term prognosis, mainly as a result of severe infection risk. An effective treatment strategy has not been developed so far and current treatment options are based upon case reports, small series and clinical experience since no randomized clinical trials are available. The authors describe the case of a 53-year-old female patient with a 14-year history of rheumatoid arthritis presenting with fever, neutropenia and splenomegaly. Broad-spectrum antibiotics and granulocyte colony-stimulating factor were administered with good clinical outcome and low dose methotrexate for disease control was successfully initiated after discharge. We would like to highlight the importance of being aware of this syndrome in the differential diagnosis of long term rheumatoid arthritis patients presenting with febrile neutropenia.