Reviews & Analysis

Septic costochondritis is a rare presentation that is usually seen in intravenous drug users, patients with diabetes or those receiving long-term hemodialysis. In this Case Study, the authors describe the diagnosis and management of this condition in a previously healthy patient without any of the established risk factors.

In this Case Study, the authors describe a patient with Poncet disease, a rare form of polyarthritis associated with tuberculosis infection. They discuss their application of interferon-γ-release assays and PCR specific for DNA of theMycobacteria tuberculosis complex to make the diagnosis, despite a negative M. tuberculosisculture.

Song and colleagues describe the diagnosis and treatment of a 50-year old man with pansclerotic morphea with immune-mediated bone-marrow failure and cytopenias. Although standard therapies for fibrotic skin disorders were ineffective, the patient responded to T-cell-targeted treatment with antithymocyte globulin.

This Case Study presents a 70-year-old woman who was administered etanercept to treat rheumatoid arthritis that was active, despite therapy with conventional DMARDs. During follow-up, the patient's symptoms improved but she developed weakness and numbness in her arms and legs. Investigations revealed a mass in her cervical spine, which was histopathology confirmed to be a benign meningioma.

This Case Study describes a postmenopausal woman who sustained a vertebral compression fracture 1 year after discontinuing long-term alendronate therapy for osteoporosis. A bone biopsy specimen revealed numerous giant, multinucleated osteoclasts, in contrast to the current opinion that alendronate therapy reduces the number of osteoclasts. In the context of this case, the authors highlight diseases that might be associated with giant osteoclasts, and discuss how to discriminate between them in order to avoid unnecessary tests and referrals.

In this Case Study, the authors describe the unusually fulminant course of T-cell lymphoma in a 57-year-old Afro-Jamaican woman with an 8-year history of SLE, from the first presentation of symptoms to the patient's death shortly after the start of chemotherapy. The patient's ethnic and geographic background ultimately raised the suspicion of infection with an oncogenic virus.

Interstitial lung disease is a common manifestation of systemic sclerosis, and often leads to death in these patients. These authors describe the case of a previously healthy woman with acute systemic sclerosis who experienced an unusually fulminant course of interstitial lung disease, which did not respond to treatment with intravenous cyclophosphamide.

The authors present the case of a 49-year-old man diagnosed with chronic unilateral sacroiliitis who did not respond to conventional therapy with corticosteroids and NSAIDs. A single intra-articular injection of the tumor necrosis factor inhibitor infliximab resulted in gradual and steady improvements in pain, stiffness and inflammation.

This Case Study of a 14-year-old boy with juvenile-onset ankylosing spondylitis discusses the complexities of the nomenclature, classification, and diagnosis of the spondyloarthropathies in children, and how these matters have important implications for treatment.