We describe a patient with Klinefelter syndrome presenting with recurrent arterial thromboses secondary to the antiphospholipid syndrome. Previous case reports noted association of Klinefelter syndrome with systemic lupus erythematosus including some cases with antiphospholipid syndrome. Clinicians should consider autoimmune processes, including the antiphospholipid syndrome, when patients with Klinefelter syndrome present with recurrent thrombosis or additional features of a systemic autoimmune disorder.

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Stress fractures can occur if normal bone is exposed to repeated abnormal stress (fatigue fractures) or if normal stress is placed on bones with compromised elastic resistance (insufficiency fractures). This article describes two patients without a history of excessive stressful activity or apparent metabolic bone disease who developed bilateral distal tibial stress fractures. Different etiologies, clinical presentation, differential diagnosis, and diagnostic imaging modalities of stress fractures are discussed.

A 31-year-old Army specialist was evaluated at Walter Reed Army Medical Center for an acute attack of arthritis in the left hand. After an initial evaluation, the patient was referred to the rheumatology service, and gout was diagnosed on the basis of synovial fluid analysis. This case demonstrates an uncommon presentation of a common disorder in an active duty soldier. The discussions presented following the clinical data are meant to expand diagnostic considerations for patients with similar symptoms, to address risk factors for gout relevant to the military, and to clarify the management of gout.

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