A 57-year-old Ghanaian woman was referred to our rheumatology practice with acute, left elbow swelling and pain. The referring oncologist suspected gout, because the patient had hyperuricemia. Six months before, the patient was diagnosed with stage IV human T-lymphotropic virus type 1 (HTLV-1)-associated adult T cell lymphoma (ATLL). Her initial oncologic manifestations included multiple thoracic,…
Research has shown that anticonvulsants are teratogens and pose a risk for fetal malformations. Meadow was the first to note a possible link between congenital abnormalities and maternal use of anticonvulsive drug in 1968.1 In 1974, Barr et al noted hypoplasia and irregular ossification of the digital distal phalanges with nail dystrophy in children born to…
Limited data exist on the clinical presentation of Muckle–Wells syndrome (MWS) during pregnancy. The purpose of this case report is to highlight the diagnosis of MWS in a pregnant woman. Many rheumatic diseases affect women of childbearing age, and their management during pregnancy can be challenging. Case A 33-year-old, 18-weeks’ pregnant woman was hospitalized for…
CHICAGO—Joseph Breen, PhD, program officer at the National Institutes of Health in Bethesda, Md., opened the chronic fatigue syndrome (CFS) session at the Federation of Clinical Immunology Societies (FOCIS) 2017 meeting by asking presenters to describe the current state of the science to the key immunology stakeholders gathered in the room. The hope was that…
A 51-year-old Caucasian female was referred by a local rheumatologist to the Center of Autoinflammatory Diseases at Stony Brook University, N.Y., for an unusual disease presentation. The patient had had recurrent polyarthritis, fever and rash for the previous three years. She described having a migratory polyarthritis affecting the shoulders, knees, ankles and bilateral forefoot, with…
An Unforgettable Story Her name was unforgettable. Not only did we share our given names—Simon and Simone, but her French-Canadian surname was based on this appellation, too. I was the junior resident working on our hospital’s nephrology service when she was admitted for evaluation of progressively worsening kidney disease and an overall failure to thrive….
The patient was a 48-year-old woman who saw her primary care physician for a flu-like illness three months prior to admission. Her symptoms initially improved, but recurred one month later; she was treated symptomatically, and again symptoms resolved. Two months later, she presented to an outside facility’s emergency department with fever to 103ºF, with associated…
As a manifestation of hyperuricemia, inflammatory bullous lesions have rarely been described in the past century. A more classic presentation of hyperuricemia is acute inflammatory gouty arthritis, characterized by the deposition of monosodium urate crystals. Other complications of chronic untreated hyperuricemia may include polyarticular arthritis, tophus formation and possible chronic destructive lesions of the bone,…
First Appearances I watched the old man, his back painfully bent, shuffle toward the scale. A blocky rigidity draped over him. His feet seemed stuck to the floor. His head hung heavily over his chest. Observing him from the end of the hallway, instead of a face, I saw only a mound of shaggy, matted…
Ipilimumab (Yervoy) is a monoclonal antibody directed against cytotoxic T-lymphocyte antigen 4 (CTLA-4). It was the first drug to demonstrate a survival benefit in advanced melanoma and was approved by the FDA in 2011.1 By blocking the CTLA-4 receptor, ipilimumab enhances the immune response against tumors via cytotoxic T lymphocyte activation and proliferation.2 However, immunopotentiating…