Flare up of rheumatoid arthritis associated with VogtKoyanagi-Harada syndrome treated with leflunomide

Dear Editor,We present a case of"Flare up of rheumatoid arthritis associated with Vogt-Koyanagi-Harada(VKH)syndrome treated with leflunomide".To our knowledge,this is the first case of uveitis and arthritis inflammation active at the same time and no treatment for this condition has been described in the literature.

Monoclonal B-cell Lymphocytosis in a Patient with Wegener Granulomatosis： A Case Report and Update on 2016 World Health Organization Classification

The association between autoimmune disease and risk of monoclonal malignancy is well studied. Howeven monoclonal B-cell lymphocytosis （MBL） in patients with autoimmune diseases has rarely been reported. The newly published 2016 revision of the World Health Organization （WHO） classification of lymphoid neoplasms has officially accepted MBL as an independent disease entity Herein, we present a case of Wegener granulomatosis （WG） with MBL.

Nodular Panniculitis with Hemophagocytic Lymphohistiocytosis

To the Editor:A 27-year-old Chinese man presented to the hospital complaining of red nodules on the chest and back that gradually enlarged with spiking fever up to 39℃.He had nodular panniculitis when he was 21 years old.The family history was silent.Physical examination on admission revealed skin pigmentation,skin nodules (four,2cm × 2cm,without movement and tenderness), and red rash without pain and pruritus over the body.Laboratory tests showed pancytopenia,especially for white blood cell (WBC) and platelet (PLT),raised triglycerides (TGs)and ferritin levels, liver enzyme abnormalities,decreased albumin value,and deranged coagulation profile.

Severe anemia caused by hereditary hemorrhagic telangiectasia in a patient with Sjogren’s syndrome and primary biliary cirrhosis

To the Editor:A 63-year-old Chinese woman was presented to West China Hospital complaining of dry eyes and mouth for 40 years and repeated epistaxis for 2 years.She was diagnosed with iron deficiency anemia(IDA)9 years ago,and primary Sjogren’s syndrome(pSS)and primary biliary cirrhosis(PBC)3 years ago.In the past 3 years,she was diagnosed and treated in West China Hospital for severe IDA.Repeated red blood cell suspension and iron sucrose supplementation showed no effect.She received gastroscopy 2 years ago and telangiectasia in the antrum was found.Thus,two argon plasma coagulations(APCs)were given.She had no abnormal family history.Physical examinations on admission showed tongue telangiectasia and dry eyes and mouth[Figure 1A].

Reply to： Correspondence Regarding the Study by Chen-Lu Yang et al. Published in the Chinese Medical Journal, 129（18）：2258-9

We are pleased to receive the letter from the reader about our article Herein, we are willing to respond to some of their comments. In our case, we reported a senile Chinese man with a 2-month history of fever accompanied by hearing loss, myalgia, elevated serum globulin, and erythrocyte sedimentation rate.

Sacroiliitis and Spondylitis with Sternoclavicular yperostosis： SAPHO or an Ankylosing Spondylitis Variant？

To the Editor： SAPHO syndrome is a heterogeneous disorder characterized by synovitis, ache, pustulosis, hyperostosis, and osteitis. Its diagnosis can be difficult if there are no typical skin manifestations. We reported a case of SAPHO syndrome which also fulfills the current diagnostic criteria, for ankylosing spondylitis （AS）.

A case report of pseudo–pseudo Meigs’ syndrome

A 24-year-old female patient was admitted to our department with complaints of fatigue and pedal edema. She was diagnosed with systemic lupus erythematosus (SLE) 4 years ago and thus the diagnostic criteria could not be traced. She had been treated with prednisolone, hydroxychloroquine, and cyclophosphamide for 2 years, and her disease was controlled in stable condition. Occasionally, pain on her lower extremity was her only complaint, which could be relieved by prednisolone. Eight months before admission to our hospital, she got progressive abdominal distension and edema of lower extremities. Abdominal ultrasonography at the local hospital showed ascites;so the patient was treated with diuretic, which made her feel much better. But the patient presented herself with shortness of breath to the local hospital 5 months later. Computed tomography (CT) scan of the thorax showed bilateral pleural effusion. Again, she took diuretic but no significant relief was achieved. In March 2017, the patient was admitted to our department. On physical examination, she had a normal temperature and blood pressure. She was identified with diminished breath sounds, ascites, and edema of the two legs. Her ankles were swollen and tender. Laboratory findings were as follows: white blood cell (WBC) was 1340/mm3, but there was no anemia or thrombocytopenia. C-reactive protein was 14 mg/dL. The antinuclear antibody titer was 1:320 (granular type), whereas anti-double-stranded DNA antibody, anti-Sm antibody, anticardiolipin antibodies, and lupus anticoagulant were negative. Complement C3 was 45.1 mg/dL (normal range 78.5–152.0 mg/dL) and C4 was 4.84 mg/dL (normal range 14.5–36 mg/dL). Coombs test was positive. Proteinuria was quantified at 0.36 g/24 h and kidney function was normal. Albumin was 3.35 g/dL and ferritin was 42.49 ng/mL. CA125 was 949 IU/mL (normal range 0–35 IU/mL), whereas other tumor markers including alpha fetoprotein (AFP), carcino-embryonic antigen (CEA), and CA199 were normal. CT scan of the thorax showed pleuropericardial effusions, and abdominal ultrasonography showed massive ascites and splenomegaly.