Camurati-Engelmann disease (CED) is a rare disorder included in the group of craniotubular hyperostosis diseases. Corticosteroids are used for pain management in CED, but in refractory or corticosteroid-non-tolerant patients, pain management is limited. We report the case of a woman with CED diagnosed in early infancy whose initial complaints included persistent bone pain associated with progressive functional disability. She was treated with steroids but over time became dependent on higher doses with only mild pain relief. In her third decade, she was diagnosed with ulcerative colitis (UC) and was treated with mesalazine, azathioprine and prednisolone. Due to recurrent exacerbations of UC, treatment was changed to infliximab, an antitumour necrosis factor-alpha (TNFα). Remission of UC was achieved and CED-associated pain also improved with infliximab. This is the first report showing a possible role of anti-TNFα in pain management in CED with unsatisfactory response to steroids.

Good's syndrome is extremely rare and refers to an acquired B and T cell immunodeficiency in thymoma patients. The authors of this article present a case report of a 75-year-old, caucasian male patient previously subjected to examinations for secondary dementia and recurrent infections, which revealed paraneoplastic syndrome arose from thymoma. He underwent thymectomy, while his immunodeficiency syndrome sustained with frequent opportunistic infections, constantly requiring intravenous immunoglobulin treatment.

A 62 years old, post-menopausal female was admitted to the Internal Medicine Ward due to dyspnoea, cough and sputum of at least 2 months. Shortness of breath, cough and hypoxaemia persisted and the patient was submitted to a pulmonary angiogram ct which revealed numerous thinwalled air cysts affecting upper and medial zones of both lungs, typical images of pulmonary lymphangioleiomyomatosis. After discharge to Internal Medicine Consultation Service with Metilprednisolone, the patient was no longer hypoxaemic and remained asymptomatic, even after withdrawal of oral corticosteroid to inhalatory formulation. Further surveillance in short time was scheduled in order to implement rapid imunossupressive treatment when necessary.

Introduction Chest wall masses are caused by various entities and have diverse aetiologies. A careful history and physical examination are crucial to establish the correct diagnosis. Case report A 77-year-old man presented with depressive mood, anorexia (weight loss of 20 kg) and a 1-month history of a non-painful breast lump with well-defined contours, which was about 6 cm in diameter. There was no history of trauma. Computed tomography of the thorax revealed a collection of liquid in the left anterior thoracic wall, associated with discontinuity of the 4th left costal cartilage, and upper left lobe cavitation, suggesting pulmonary tuberculosis. The patient was started on quadruple therapy with anti-tuberculosis drugs and discharged after a negative smear. Conclusion In this case, the indolent onset of unspecific symptoms made it difficult to reach a diagnosis of pulmonary tuberculosis, which was confirmed by positive culture and imaging. A breast lump in an elderly patient with unspecific clinical manifestations is an unusual presentation of pulmonary tuberculosis. It is important to be aware of rib invasion and exclude tuberculosis in a patient with a chest wall mass. As tuberculosis is treatable, early diagnosis is vital as diagnostic delay can lead to contagion. LEARNING POINTS Chest wall tuberculosis is a rare complication of pulmonary tuberculosis. As smears and acid-fast bacilli cultures are often negative, polymerase chain reaction and imaging should be performed. Tuberculosis should be treated with first-line drugs; the role of surgery is still controversial.