Fever, arthralgias, skin lesions, and ischemic digits in a 59‐year‐old man

Abstract

Presentation of caseThe patient is a 59-year-old man who was admitted to an outside hospital. Two weeks prior to this admission he developed nausea, and 1 week prior to admission he developed polyarthralgias. The polyarthralgias began with severe left ankle pain, then progressed rapidly to involve most of his appendicular joints. He was treated initially with indomethacin with no relief of symptoms, and the medicine was then switched to naproxen. The patient developed increasing nausea, with vomiting and diarrhea. His joint pain worsened until he was bedridden. Naproxen was discontinued, and he was given prednisone (10 mg/day) 2 days prior to admission. On the day before admission, he developed an erythematous, crusting lesion on the right medial malleolus.The patient's medical history was noteworthy for Graves' disease (16 years before this admission), which was treated with propylthiouracil. Two years prior to this admission, he developed cramping abdominal pain and diarrhea. Endoscopy with small bowel biopsy was performed, and the diagnosis of Crohn's disease was made. This was believed to be quiescent prior to this admission. He also had a history of cholelithiasis and nephrolithiasis.Medications on admission included prednisone 10 mg/day, as well as sulfasalazine 2.5 g d d a y and azathioprine 50 mg twicelday, both of which he had been taking for 1 year. He had no history of recent or remote travel outside

Atrial myxoma in a primigravida presenting as Raynaud’s phenomenon

“…Vasculitic manifestations of cardiac tumors causing diagnostic confusion and leading to wrong diagnosis was previously reported. [4][5][6][7][8] Cutaneous manifestations of cardiac myxoma can be classified into 3 subtypes: i) embolic cutaneous signs; ii) non-embolic cutaneous signs associated with auto-immune symptoms; and iii) cutaneous signs of a complex syndrome. Cutaneous features may be associated with autoimmune symptoms including Raynaud's phenomenon, malar erythema, and vasculitis, which can be explained by myoxomal secretion of interleukin-6.…”

Atrial myxoma masquerading as Takayasu’s arteritis

“…10 201023FemaleHeadache, dizziness, lower limb weaknessTakayasu’s arteritisGravallese et al. 11 199559MaleFever, arthralgia, nauseaPolyarteritis nodosaTaylor and Deutsch 12 199263FemaleCollapse, hemiplegia, facial palsyGiant cell arteritisLeonhardt and Kullenberg 13 197719MaleArthralgia, myalgiaPolyarteritis nodosa…”

“…5,6 This is not the first time a patient with atrial myxoma has been diagnosed with vasculitis. [10][11][12][13] Table 2 summarises four other reports which have been published over the past 40 years in which diagnostic confusion led to the wrong diagnosis. The consequences of misdiagnosis are serious, and in the case reported here, led to steroids being started.…”

Polyarteritis Nodosa and Cutaneous Polyarteritis Nodosa

“…Other viruses that have been implicated in PAN include hepatitis C, cytomegalovirus, and parvovirus 15,27–29 ; systemic lupus erythematosus has been linked to PAN as well 15,30–32 . Sulfonamides and IV amphetamine intake have also been suggested as causes of these vasculitides 2,23 …”

“…The diagnosis of both PAN and CPAN is made via an excisional biopsy of the skin 6,23 . Necrotizing arteritis in the subcutaneous tissue or lower dermis is demonstrated.…”