Background. Non-Hodgkin lymphomas (NHLs) comprise a group of haematologic malignancies with different histologic subtypes. The clinical picture varies from indolent to aggressive presentation and nodal (lymphadenopathy) to extranodal (central nervous system, gastrointestinal, cutaneous plaque, or ulcer) involvement. Digital gangrene is seldom reported. Here, we describe a patient with pain and blackening of all fingers and toes as presenting symptoms of NHL. Case Presentation. A 32-year-old male weaver had been smoking three to five cannabis-containing cigarettes daily for about ten years and methamphetamine four to five tablets daily for five years. He had no history of Raynaud’s phenomenon, fever, cough, weight loss, skin rash, joint pain, and atherogenic or thrombogenic risk factors. We found normal blood pressure and absent peripheral pulses in arms and legs, dry gangrene of all fingers and toes, generalized lymphadenopathy, and hepatomegaly with ascites. The chest X-ray was normal, as were blood sugar, lipid profile, and hepatic and renal function. Rheumatoid factor, antinuclear and antiphospholipid antibodies, C-ANCA and P-ANCA, hepatitis B and C, and HIV were negative. CT abdomen revealed hepatosplenomegaly with multiple intra-abdominal lymphadenopathies. The peripheral angiogram showed 90-99% stenosis of radial and dorsalis pedis arteries with normal proximal vessels. Diagnosis of non-Hodgkin lymphoma was confirmed by histopathology of cervical lymph node (diffuse type), immunohistochemically subtyped as peripheral T cell lymphoma (not otherwise specified). The digital ischemia worsened despite cessation of cannabis and methamphetamine and starting CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) treatment, making amputation necessary. Conclusion. We present, to our knowledge, the first report of peripheral T cell lymphoma, NOS presenting with gangrene in all digits complicated by methamphetamine and cannabis abuse. This uncommon vascular manifestation of non-Hodgkin lymphoma may cause a diagnostic dilemma and delayed initiation of treatment.

Inflammatory back pain is common among patients presenting with CLBP. The commonest cause of IBP is AS, followed by PsA and nr-axSpA.

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Background: Data pertaining to risk factors of nonspecific low back pain (NSLBP) among rural Bangladeshi is scarce. This study explored the risk factors associated with NSLBP among rural Bangladeshi adults. Methods: A community-based study was done in Sonargaon Upazila of Narayanganj district of Bangladesh. A total of 343 NSLBP patients were recruited as cases, based on the Bangla version of Community oriented program for control of rheumatic diseases (COPCORD) questionnaire. An equal number of age and sex matched subjects without any rheumatic disease were recruited from the same community. A total of 15 probable factors were analyzed. Age-sex adjusted univariate and age-sex with 13 risk factors adjusted multivariate conditional logistic regression analyses were done. Results: The mean age of the participants was 33.1 years old (standard deviation: 9.5). Out of 13 risk factors, history of chronic disease (OR 2.0, 95% CI 1.2 – 3.4), prolonged sitting (OR 4.6, 95% CI 2.0 – 11.0), squatting (OR 7.2, 95% CI 3.2 – 16.0), bending of the waist (OR 3.7, 95% CI 1.8 – 7.6), regular lifting or carrying a heavy load (OR 9.2, 95% CI 2.2 – 39.7), prolonged standing (OR 5.8, 95% CI 1.9 – 17.7), occupation related to strenuous physical activity (OR 0.2, 95% CI 0.1 – 0.8), overweight (body mass index >=25 kg/m2) (OR 3.1, 95% CI 1.8 – 5.2) and depression (OR 2.2, 95% CI 1.4 – 3.6) were found to be significantly associated with NSLBP. Conclusions: The study generated knowledge on associated risk factors for NSLBP in rural people of Bangladesh that may facilitate an evidence-based intervention for the target group.