Sweet's syndrome is a rare acute febrile neutrophilic dermatosis accompanied by fever, neutrophilia, and asymmetrical distribution of tender erythematous skin lesions. The underlying biological pathways responsible for this inflammatory skin disorder are not yet clearly established. However, an association with autoimmune disease, neoplasm, and drugs could be indicative of unusual hypersensitivity involving proinflammatory cytokines. There are several case reports indicating an association between Sweet's syndrome and rheumatoid arthritis (RA). Proinflammatory cytokines are considered to play a vital role in the pathogenesis of both RA and Sweet's syndrome. Adalimumab works against proinflammatory cytokines and is considered a disease-modifying antirheumatic drug in RA; it is also reported to be effective in refractory Sweet's syndrome. While adalimumab has been proven to be beneficial in autoimmune disorders and inflammatory conditions, there are also reports of paradoxical development of Sweet's syndrome with adalimumab. In this report, we present a case of Sweet's syndrome in a 74-year-old adult patient with a history of seropositive RA who developed Sweet's syndrome within two months after the initiation of adalimumab therapy.

Statins have become the commonest lipid-lowering agent worldwide and have significantly reduced morbidity and mortality associated with cardiovascular diseases. Overall, statins are very well tolerated. However, in clinical practice, a wide variety of skeletal myopathic effects have been observed, ranging from asymptomatic patients with high creatine phosphokinase (CPK) to fatal cases of acute rhabdomyolysis. Recent reports suggest that statins are associated with immune-mediated necrotizing myopathy (IMNM), a unique autoimmune myopathy. Unlike other drug reactions, this can occur months to years after initiation of statin. It is a distinctive autoimmune myopathy where symptoms persist or even progress after statin discontinuation and requires immunosuppressive therapy. The presence of anti-hydroxy-methyl-glutaryl coenzyme-A reductase (HMGCR) antibody in serum strengthens the diagnosis of statinassociated necrotizing myopathy. Here we present a case of statin-associated IMNM in a 43-year-old Caucasian female who had statin-induced progressive deterioration of proximal muscle weakness with poor response to high-dose steroids and required further immunosuppressive therapy.

Spontaneous pneumomediastinum (SPM) is a benign and self-limiting condition more commonly seen in young adults. Radiology imaging of the chest, including X-ray or CT scan, is the gold standard for diagnosis. Ecstasy, also known as 3,4-methylenedioxymethamphetamine (MDMA) is a synthetic amphetamine derivative widely abused for an increased sense of well-being and euphoria. Marijuana is also abused for recreational purposes. SPM has been reported after both Ecstasy and marijuana use. SPM after these illicit drugs abuse usually has a benign and self-limiting course with supportive management. However, it is always important to rule out serious associated conditions like esophageal perforation. Here, we present a 22-year-old male who developed SPM after Ecstasy ingestion and marijuana inhalation.

Adult-onset Still's disease (AOSD), a rare systemic inflammatory disorder of unknown etiology, is considered in broad differential in patients with fever of unknown origin or unexplained lymphadenopathy. It is characterized by spiking fever, evanescent salmon-colored maculopapular rash, arthritis or arthralgia, and leukocytosis. Due to broad differentials and lack of any specific diagnostic tests, diagnosis of AOSD poses a great challenge. A concerned physician should have a high index of suspicion while dealing with patients presenting with clinical symptoms of this systemic disorder. We report a case of a 25-year-old African American female with the past medical history of AOSD, who presented with four weeks history of extensive cervical and axillary lymphadenopathy mimicking lymphoproliferative malignancy. Cases have been reported with the development of malignant lymphoma during the course of AOSD. Therefore, careful monitoring of patients with regular follow-up is vital as these patients may develop lymphoproliferative malignancy in the future.

No abstract