No abstract

A 70-year-old Chinese male presented with unexplained fever, relapsing polychondritis, macrocytic anemia, acute necrotising lymphadenitis, skin papules that were in keeping histologically with Kikuchi-Fujimoto disease, and pulmonary embolism secondary to extensive unprovoked right lower limb deep vein thrombosis. Given the recent discovery of VEXAS (vacuoles, E1 enzyme, X-linked,

Little is known about the transmissibility of COVID-19 from patients with atypical presentations. Five COVID-19 patients presenting without acute respiratory symptoms exposed 247 contacts during their hospital stay. After 14 days of close surveillance, 19 contacts developed respiratory symptoms and were screened for SARS-CoV-2. None were infected with COVID-19.

We report a case of a woman who was admitted with a suspicion of metastatic malignancy of unknown primary origin. A few months prior to her admission, she presented to a rheumatologist with acute anterior uveitis, psoriasiform rashes and polyarthritis. A diagnosis of psoriatic arthropathy was made and she was treated accordingly. Soon after she presented with persistent back and right upper quadrant abdominal pain for which she had a CT scan done with evidence of hilar lymphadenopathy, liver hypodensities and lytic-sclerotic bone lesions. She was referred to our hospital for further investigations and management. After re-exploring her clinical presentation and further investigations (including a liver biopsy), a diagnosis of multisystemic sarcoidosis with ocular, reticuloendothelial, hepatic and skeletal involvement was made. The patient was started on systemic glucocorticoids and second line immunosuppressants and demonstrated significant clinical improvement with resolution of her liver granulomata on imaging and improvement in her back pain. The case illustrates the importance of a thorough clinical assessment, review of investigations and an open mind in the evaluation of a patient.