Unravelling the NERDS syndrome

Abstract

A 22-year-old man presented with symmetric polyarthritis, pruritus and deviation of angle of mouth to the right side since the last 7 years. His symptoms were persistent despite receiving ayurvedic medications and symptomatic therapy. Examination revealed dry skin, cutaneous nodules, xanthelasma, periarticular non-tender swellings, pitting oedema of hands and feet and lower motor neuron type right facial palsy. Haematological investigations revealed eosinophilia and skin biopsy had cutaneous eosinophilic infiltration. The constellation of above findings comprises the nodules, eosinophilia, rheumatism, dermatitis and swelling syndrome. It a rare syndrome with few reported cases in literature. The patient was started on oral corticosteroids which was subsequently tapered and methotrexate therapy. His polyarthritis and skin rashes resolved with therapy. He has been followed-up for 2 years and is presently asymptomatic for the last 1 year.

Eosinophilic arthritis—A case report

“…Differential diagnosis considered for the patient with arthritis and eosinophilia was summarized. 4 It has been reported that some drugs cause drug-induced hypersensitivity syndrome with eosinophilia and arthritis. 5 However, our patient did not take any medicine before experiencing symptoms of eosinphilic arthritis.…”

“…Our patient did not have allergies or helminthic infections. Differential diagnosis considered for the patient with arthritis and eosinophilia was summarized 4 . It has been reported that some drugs cause drug‐induced hypersensitivity syndrome with eosinophilia and arthritis 5 .…”

The challenge of diagnosing and classifying eosinophilia and eosinophil disorders: A review

“…Swelling of hands or feet and osteoarticular pain result from nodules of tenosynovium. In the peripheral blood elevated values of IgE and eosinophil-derived proteins are noted [ 68 ]. Moreover, when eosinophilia and angioedema occur, two entities with different pathophysiology should be considered – the episodic angioedema with eosinophilia syndrome (Gleich’s syndrome) and non-episodic angioedema with eosinophilia [ 69 ].…”