Pancreatitis, panniculitis and polyarthritis syndrome: A case report

BACKGROUND Pancreatitis,panniculitis,and polyarthritis(PPP)syndrome is a rare form of pancreatic disease.It is characterized by bullous erythematous skin lesions and arthritis,and both are triggered by pancreatic malfunction.Few cases have been described in the literature thus far.Due to the inconsistency in its clinical presentation,its diagnosis can be a challenge.Early therapy initiation is essential to reduce mortality;however,there is currently no gold standard for treatment.CASE SUMMARY A 66-year-old polymorbid male patient presented with several superficial abscesses on both lower legs and painful swelling in the knee.Treatment for septic arthritis and septic skin infection over several weeks failed.His general condition deteriorated gradually and worsened with sudden onset of abdominal pain.A diagnosis of necrotizing pancreatitis was made.He subsequently underwent a laparotomy and drainage of the pancreas.Eventually,our patient improved,and his abdominal complaints,knee pain,and dermal lesions resolved.CONCLUSION PPP syndrome is rare and easily misdiagnosed,as abdominal symptoms may be delayed or absent.Clinicians should consider PPP syndrome if they encounter refractory panniculitis in combination with joint infection.

Mycoplasma leachii causes polyarthritis in calves via the blood route but is not associated with pneumonia

Mycoplasma leachiiwas initially isolated from arthritic calves in South Queensland, Australia, and its ability to cause clinical polyarthritis in calves was demonstrated by experimental infection. However, the source of M. leachii infection in calves and its means of spreading are not well known. In this study, one-month-old calves were inoculated with cultures of M. leachii or joint fluid （collected from M. leachii-infected calves） through the intraarticular, intravenous, intratracheal, intranasal or oral routes. Multidisciplinary procedures, including clinical assessment, etiology assessment, pathology and immunohistochemistry （IHC）, were used to evaluate the pathogenicity of M. leachfi in calves and to elucidate the transmission route of M. leachii infection in calves. The results showed that all calves inoculated intraarticularly with cultured GN407 or joint fluid and two-thirds of the calves inoculated intravenously with joint fluid developed severe polyarthritis, and the M. leachfi antigen was detected in the joints of all infected calves by IHC and PCR. In contrast, calves inoculated with cultured M. leachfi or joint fluid through the intratracheal, intranasal or oral routes did not show any M. leachfi infection in the clinical assessment, etiology assessment, or pathology and IHC results. These results indicated that polyarthritis caused by M. leachii in calves is transmitted via the blood route; however, this disease is not transmitted through the respiratory or digestive routes. In addition, the M. leachii antigen was not detected in the lungs of all the inoculated calves using IHC and PCR, indicating that M. leachfi is not associated with pneumonia, even in the calves inoculated through the respiratory duct. These findings are important information for the prevention and control of calf polyarthritis caused by M. leachfi.

Pancreatitis, panniculitis, and polyarthritis syndrome caused by pancreatic pseudocyst: A case report

BACKGROUND Panniculitis, polyarthritis, and pancreatitis (PPP) syndrome is a triad comprising an extremely rare extra-pancreatic complication of pancreatic disease. Herein, we describe a patient with PPP syndrome caused by fistula formation between the inferior vena cava (IVC) and pancreatic pseudocyst. CASE SUMMARY A 64-year-old man visited the hospital with bilateral leg pain that began one week prior. He had no specific diseases, except hypertension. His vital signs were normal. Blood test revealed the following findings: White blood cell count, 28690/μL;amylase level, 9055 U/L;lipase level, 2089 U/L;and C-reactive protein level, 12.94 mg/dL. Computed tomography of the pancreas revealed recent acute pancreatitis. Nonsteroidal anti-inflammatory drugs were administered with no improvement. After steroid administration, pain slightly improved. Skin lesions were diagnosed as panniculitis. Bone scan and knee magnetic resonance imaging revealed osteoarthritis and bone marrow infarctions. Surgical treatment was considered;total pancreatectomy with splenectomy was performed. A pseudocyst was present posterior to the head of the pancreas, forming a fistula with the suprarenal IVC. After surgery, amylase and lipase levels decreased. However, the patient died of an uncontrolled infection on the 13th postoperative day. CONCLUSION PPP syndrome should be suspected when accompanied by skin and joint lesions. Delays in diagnosis could have catastrophic consequences.

Culture Negative Disseminated Septic Polyarthritis Complicating Rat-Bite Fever in an Immunocompetent Adult

Rat-bite is uncommon worldwide, excluding developing countries. The history of a bite is usually missed if not meticulously asked for in history, proper exposure and examination. Today we report a case of culture-negative rat-bite fever with poly septic arthritis resembling a rheumatoid arthritis-like picture in a 64-year-old gentleman. The presentation at first imitated an arthritis-like picture which was polyarthritis affecting the right ankle, right knee, right wrist, right proximal interphalangeal, left metacarpophalangeal and proximal interphalangeal joints.

A seropositive nodular rheumatoid polyarthritis without arthritis, does it exist?

Introduction: The rheumatoid polyarthritis is the most frequent chronic polyarthritis. It affects essentially woman between 40 and 60 years old. Rheumatic subcutaneous nodules and tenosynovitis are usually associated with seropositive symptomatic rheumatoid polyarthritis. However, it is rare that they constitute the essential clinical expression of the disease. Case report: A 60-year-old woman was hospitalized for tumefaction of the dorsal face of the right hand evolved two months before. The clinical examination was found isolated subcutaneous nodules. The anatomopathological exam of one nodule ended in its rheumatoid origin and the MRI of a second one confirmed a tenosynovitis. Anti-CCP antibodies were positive. The patient has never suffered from arthralgias. The evolution was favourable under corticosteroid therapy, methotrexate and colchicine. Discussion: Rheumatic subcutaneous nodules and tenosynovitis are usually associated with seropositive symptomatic rheumatoid polyarthritis. It is rare that they constitute the essential clinical expression of the disease. Conclusion: The extra-articular appearances of the rheumatoid polyarthritis must not be underestimated especially since they can constitute—even rarely—the essential clinical expression of the disease.

Multiple myeloma presenting with amyloid arthropathy as the first manifestation:Two case reports

BACKGROUND Multiple myeloma(MM)can be accompanied by amyloidosis,which occurs in a small number of patients and is characterized by deposition of light chains in the joints,leading to multiple myeloma-associated amyloid arthropathy(MAA).As a rare complication of MM,clinical manifestations of MAA are often similar to those of rheumatoid arthritis,and the two are easily confused.CASE SUMMARY In recent years,our center treated two patients of MM with amyloid arthropathy as the first manifestation,both of whom presented with polyarthritis.After treatment for MM,both patients achieved complete remission.However,subsequently,the two patients underwent hip arthroplasty for femoral neck fractures.Congo red staining and immunofluorescence of the joint tissues confirmed MAA after surgery.Eventually,one of the patients died of MM recurrence,while the other survived.CONCLUSION MAA should be regarded as an initial symptom of MM and should be taken seriously.

Connective Tissue Diseases on the Elderly Population in Dakar Hospital Setting

Introduction: Immunosenescence contributes to the development of auto-antibodies. However, while the prevalence of some autoantibodies increases with age, the incidence of connective tissue diseases decreases with age. This study aims to determine the clinical and paraclinical characteristics of connective tissue diseases in the elderly population. Materials and Methods: We conducted a retrospective and descriptive study, from March 2010 to March 2021, in the Internal Medicine Department of Aristide Le Dantec Hospital, including all the medical records of patients followed up for connective tissue disease and whose symptomatology began at an age greater than or equal to 65 years. Epidemiological, clinical, paraclinical, therapeutic and evolutionary data were collected from a pre-established survey form and then processed using SPSS software. Results: Overall, 22 cases were collected out of 275 seen on consultation. They involved 16 women and 6 men, aged between 65 and 85 years with a median of 70 years. The mean duration of the clinical picture was 15.7 months with extremes of 1 and 96 months. The clinical symptoms were joint pain in 21 patients associated with dry eye and mouth syndrome in seven cases and one patient underwent isolated dry eye and mouth syndrome. Joint involvement was deforming in 13 patients. Poor general condition was noted in 20 patients. Biology showed anemia in 14 patients, hyperleukocytosis (2 patients) and thrombocytosis (5 patients). The sedimentation rate (SR) was accelerated in 9 patients and the C-reactive protein (CRP) was positive in 12 patients. Immunology showed a positive Latex test (3 patients/6), Waaler-Rose reaction (8 patients/13), anti-cyclic citrullinated peptides (anti-CCP) antibodies (11 patients/11), anti-nuclear antibodies (2 patients/4). Anti-extractable nuclear antigens (anti-ENA) antibody testing in 4 patients showed positive anti-U1RNP (1 case), anti-SSA and anti-SSB (1 case). Plain X-Rays of the hands, wrists and feet showed destructive lesions in 16 patients. The diagnosis of rheumatoid arthritis (RA) was set in 21 patients, one of which was associated with Sjogren’s syndrome (SS) and one with primary Sjogren’s syndrome. Treatment was based on prednisone (21 cases), methotrexate (17 patients), and hydroxychloroquine (9 patients). The evolution was remarkable in 10 patients. Conclusion: Autoimmune diseases in the elderly are uncommon compared to the young adult population. In our study, we only found cases of rheumatoid arthritis and Sjogren’s syndrome. As the population ages, connective tissue diseases may be increasingly diagnosed.

Difficulties in the Management of Systemic Autoimmune Diseases in Saint-Louis Du Senegal through the Analysis of a Series of 70 Observations

Introduction: Systemic Autoimmune Diseases (SAID) long considered very rare in Africa are increasingly the subject of publications. The objective of this work is to identify the difficulties in the management of these pathologies in an internal medicine department in northern Senegal by analyzing the epidemiological, clinical-biological, therapeutic and evolutionary aspects of SAID. Methods: This was a descriptive cross-sectional study carried out in the internal medicine department of the Saint-Louis University Hospital Center. Included were all the files of patients followed in outpatient and/or hospitalization for autoimmune diseases according to the criteria of the American College of Rheumatology, during the period from January 2017 to December 2020. The data were analyzed using SPSS software version 21.0. As the study was descriptive, no statistical test was performed. Results: Out of 3800 patients, 70 presented SAID, i.e. a hospital prevalence of 1.8%. Polyarthritis was the first reason for consultation in 97% followed by skin manifestations in 8%. The patients had positive anti-nuclear autoantibodies in 88% of cases. Rheumatoid arthritis was the predominant condition (71%) followed by systemic lupus erythematosus (SLE) (15%) and undifferentiated autoimmune diseases in 10%. Eleven percent (11%) of patients had an associated autoimmune disease. Corticosteroids were used in the treatment of these conditions in 97% of cases and methotrexate was the most prescribed immunosuppressant (54%). Thirty-two percent (32%) of patients are lost to follow-up. Conclusion: SAID are diverse and under diagnosed;they are characterized by diagnostic delay above all linked to access to specialists and sometimes to the high cost of paraclinical examinations, in particular immunology. Treatment remains based primarily on corticosteroid therapy and conventional immunosuppressants in the face of the unavailability of biotherapies.