Mycobacterium marinum (M. marinum) is a nontuberculosis mycobacterium that is normally associated with cutaneous lesions. Most cases occur after an individual has suffered minor trauma in association with contaminated fresh or salt water. In immunocompromised patients, M. marinum can cause osteomyelitis, synovitis and/or disseminated infection, which can be mistaken for rheumatoid arthritis (RA) or remitting seronegative symmetrical synovitis with pitting edema (RS3PE). Therefore, precise history taking and specimen culture are very important for early diagnosis and appropriate treatment. We report an unusual case of septic polyarthritis due to M. marinum that was diagnosed by culture and improved with antibiotic therapy.
Arthritis ; Arthritis, Rheumatoid ; Early Diagnosis ; Edema ; Immunocompromised Host ; Mycobacterium ; Mycobacterium Infections, Nontuberculous ; Mycobacterium marinum ; Osteomyelitis ; Synovitis

TNF-alpha antagonists have been successfully utilized in the treatment of autoimmune diseases, including psoriasis and psoriatic arthritis. Paradoxically, new onset or exacerbation of psoriatic lesions during treatment with TNF-alpha antagonists have been reported. It has been postulated that TNF-alpha blockade may cause disruption in the balance between TNF-alpha and type 1 interferon (IFN)-alpha, which are the key players in the pathogenesis of psoriasis. We report a case of psoriasis exacerbation during TNF-alpha antagonist therapy in a 53-years-old man with ankylosing spondylitis. The patient has been treated with etanercept for 3 years and 7 months when he developed accelerated deterioration of psoriasis. His condition was previously under control solely by local treatment. Physical examination revealed vigorous desquamative lesions with silvery scale in both lower legs. Deterioration of psoriasis was attributed to etanercept therapy and was subsequently discontinued. Clinical improvement of psoriasis has been observed 2 months following cessation of etanercept.
Arthritis, Psoriatic ; Autoimmune Diseases ; Humans ; Etanercept ; Immunoglobulin G ; Interferons ; Leg ; Physical Examination ; Psoriasis ; Receptors, Tumor Necrosis Factor ; Skin ; Spondylitis, Ankylosing ; Tumor Necrosis Factor-alpha

Disseminated cryptococcosis mainly occurs in immunocompromised patients. It enters the body through the respiratory tract and spreads to the lungs, skin, liver and lymphoid organs. Among cryptococcosis, cryptococcal meningitis is a relatively frequent manifestation and causes serious morbidity and mortality. It needs urgent diagnosis and initiation of effective antifungal therapy. It is difficult to differentiate cryptococcal meningitis from neuropsychiatric lupus due to similar clinical symptoms, laboratory and cerebrospinal fluid findings. We report a case of disseminated cyrptococcosis in a patient with systemic lupus erythematosus being managed with mycophenolate mofetil, prednisolone and hydroxychloroquine.
Cryptococcosis ; Humans ; Hydroxychloroquine ; Immunocompromised Host ; Liver ; Lung ; Lupus Erythematosus, Systemic ; Meningitis, Cryptococcal ; Mycophenolic Acid ; Prednisolone ; Respiratory System ; Skin

Dermatomyositis is a systemic connective tissue disease affecting the skeletal muscles and skin. Necrotizing cutaneous vasculitis and subsequent diffuse subcutaneous and muscular calcification in patients with dermatomyositis is uncommon and has not been reported. A 23-year-old female with dermatomyositis developed necrotizing cutaneous vasculitis in the knee, elbow, buttock, toe and fingers associated with large ulcer formation. Her left 5th finger was amputated due to massive soft tissue destruction, and her right 5th finger later auto-amputated. Thereafter, she developed small subcutaneous nodules on both wrists, elbows, upper arms, neck, buttocks and thighs. X-ray, computerized tomography and gracilis muscle biopsy confirmed diffuse subcutaneous, fascia and muscular calcifications.
Arm ; Biopsy ; Buttocks ; Connective Tissue Diseases ; Dermatomyositis ; Elbow ; Fascia ; Female ; Fingers ; Humans ; Knee ; Muscle, Skeletal ; Muscles ; Neck ; Skin ; Thigh ; Toes ; Ulcer ; Vasculitis ; Wrist ; Young Adult

Since 1897 when Poncet first described polyarthritis in the acute stage of extra-articular tuberculosis, Poncet's disease has been considered a reactive arthritis to Mycobacterium tuberculosis. It is characterized by polyarthritis without evidence of direct mycobacterial involvement in patients with active tuberculosis, and eventually resolves without residual joint damage. Even though Poncet's disease is uncommon, the distinction between Poncet's disease and other arthritis, including tuberculous arthritis is clinically important. We report the second case of Poncet's disease diagnosed in a patient with pulmonary tuberculosis in Korea and review the relevant literature.
Arthritis ; Arthritis, Reactive ; Humans ; Joints ; Korea ; Mycobacterium tuberculosis ; Tuberculosis ; Tuberculosis, Pulmonary

Posterior reversible encephalopathy syndrome (PRES) has been described in various clinical settings, including severe hypertension, eclampsia, lupus and immunosuppressive therapy. We report a 27 year-old female systemic lupus erythematosus patient who developed severe headache, seizure and hemiparesis during her lupus nephritis flare. Magnetic resonance image (MRI) showed multi-focal high signal intensity lesions in the parieto-occipital cortex bilaterally and in the subcortical white matter. Her condition improved with immunosuppressive treatments, antihypertensives and hemodialysis. The extent of her lesions decreased on follow-up MRI 2 months later. This case suggests that PRES can be treated with immunosuppressive drugs that do not increase blood pressure.
Antihypertensive Agents ; Blood Pressure ; Eclampsia ; Female ; Follow-Up Studies ; Headache ; Humans ; Hypertension ; Lupus Erythematosus, Systemic ; Lupus Nephritis ; Magnetic Resonance Spectroscopy ; Paresis ; Pregnancy ; Renal Dialysis ; Seizures

Turner's syndrome (TS) is characterized by short stature and gonadal dysgenesis. It is often associated with systemic manifestations, such as cardiovascular, gastrointestinal, and musculoskeletal disorders. Although very rare, it is possible for TS to accompany autoimmune disease, including thyroid disease, inflammatory bowel diseases, diabetes mellitus, psoriatic arthritis, and juvenile rheumatoid arthritis. A 39-year-old woman was referred for symmetric polyarthritis of her hands and feet. She had been diagnosed with Turner's syndrome with 46,XO,-X,+fragment before the age of 22 years and had developed autoimmune hypothyroidism treated with thyroid hormone replacement. At the time of first visit, she had polyarthralgia with morning stiffness for more than 3 months. The musculoskeletal examination revealed symmetrical polyarthritis affecting the metacarpophalangeal, proximal interphalangeal, and metatarsophalangeal joints, fulfilling the ACR 1987 revised criteria for rheumatoid arthritis (RA). Here, we present an unusual case of RA associated with TS. It is important to pay meticulous attention to patients with TS so that inflammatory arthritis is not neglected and the diagnosis is not delayed.
Adult ; Arthralgia ; Arthritis ; Arthritis, Juvenile Rheumatoid ; Arthritis, Psoriatic ; Arthritis, Rheumatoid ; Autoimmune Diseases ; Diabetes Mellitus ; Female ; Foot ; Gonadal Dysgenesis ; Hand ; Humans ; Hypothyroidism ; Inflammatory Bowel Diseases ; Metatarsophalangeal Joint ; Thyroid Diseases ; Thyroid Gland ; Turner Syndrome

Septic arthritis of the sternoclavicular joint is a rare condition. The predisposing risk factors include intravenous drug abuse, subclavian vein catheter placement, diabetes mellitus and trauma. Delayed or inadequate management can lead to irreversible joint damage with subsequent disability, even death. We report a 48-year-old female patient who presented with right sternoclavicular joint swelling and right shoulder pain. Magnetic resonance imaging of the sternum showed swelling of the right sternoclavicular joint with gadolinium enhancement. Synovial fluid and bone tissue culture revealed Escherichia coli (E.coli), and confirmed the diagnosis of sternoclavicular septic arthritis. She was successfully treated with surgical debridement and ciprofloxacin without recurrence. This is the first case report of E.coli sternoclavicular septic arthritis in Korea.
Arthritis, Infectious ; Bone and Bones ; Catheters ; Ciprofloxacin ; Debridement ; Diabetes Mellitus ; Escherichia ; Escherichia coli ; Female ; Gadolinium ; Humans ; Joints ; Korea ; Magnetic Resonance Imaging ; Middle Aged ; Recurrence ; Risk Factors ; Shoulder Pain ; Sternoclavicular Joint ; Sternum ; Subclavian Vein ; Substance Abuse, Intravenous ; Synovial Fluid

OBJECTIVE: Gout is crystal-induced arthritis with hyperuricemia. Uric acid lowering agent (UALA) is the maintenance drug of its treatment. Drug adherence is an important factor that influences treatment outcome. The purpose this study was to examine the drug adherence to UALA of 303 gouty patients and to analyze the factors associated with compliance. METHODS: We retrospectively assessed adherence to UALA in 303 patients who visited three hospitals affiliated with Hallym University. Patients were diagnosed as gout and used UALA with at least 6 month follow-up. Two adherence measures were calculated, the percentage of days covered (PDC) and the time until an extended break (at least 60 days) in treatment. A PDC <70% was considered poor adherence and factors associated with poor adherence were examined. RESULTS: Among the 303 patients, 283 (93.4%) were male. Mean age was 55.4+/-13.7 years. Comorbidities included hypertension in 117 (38.6%), diabetic mellitus in 108 (35.6%), angina in 107 (35.3%), myocardial infarction in 108 (35.6%), and heart failure in 113 (37.3%). The mean PDC was 65.8% with 63.4% of patients considered poorly compliant over the study period. Mean treatment duration before an extended break occurred was 203.5 days. Factors associated with good adherence included hypertension and prescription from rheumatologist. CONCLUSION: In our study, adherence to UALA in gouty patient was poor. Understanding the factors associated with adherence to UALA and proper education of gouty patients to improve drug adherence are needed.
Arthritis ; Comorbidity ; Compliance ; Follow-Up Studies ; Gout ; Heart Failure ; Humans ; Hypertension ; Hyperuricemia ; Male ; Myocardial Infarction ; Prescriptions ; Retrospective Studies ; Treatment Outcome ; Uric Acid

OBJECTIVE: This study investigated the effect of rosiglitazone, a synthetic peroxisome proliferator-activated receptor-gamma (PPAR-gamma) agonist, on pro-inflammatory gene expressions and cellular proliferation of fibroblast like synoviocyte (FLS) from patients with rheumatoid arthritis (RA), and to determine whether these actions are mediated by nuclear factor-kappaB (NF-B) down-regulation. METHODS: Synovial tissues from patients with RA were obtained during total knee replacement surgery, and FLS were isolated. RA FLS were subsequently treated with 10 micrometer, 50 micrometer and 150 micrometer rosiglitazone with or without TNF-alpha (10 ng/mL) stimulation. FLS proliferation in response to rosiglitazone treatment was measured by MTT assay, and mRNA expressions of IL-1beta, IL-6, CCL-2, CCL-7, COX-2 and MMP-9 were determined by real-time quantitative RT-PCR. The effects of rosiglitazone on NF-kappaB activation were evaluated using electrophoretic mobility shift assay (EMSA). RESULTS: Rosiglitazone treatment without TNF-alpha induced a dose-dependent reduction in mRNA expressions of IL-1beta, IL-6, CCL-2, CCL-7, COX-2 and MMP-9 from RA FLS. When TNF-alpha were treated with rosiglitazone, mRNA expressions of COX-2, MMP-9 were reduced dose-dependently. But mRNA expressions of IL-1beta, IL-6, CCL-2, CCL-7 were increased in 10 micrometer rosiglitazone with TNF-alpha and then decreased as the concentration of rosiglitazone increased. Rosiglitazone treatment also suppressed FLS proliferation in a dose-dependent manner, and EMSA showed decreased NF-kappaB expression with rosiglitazone treatment. CONCLUSION: Rosiglitazone suppressed cellular proliferation and mRNA expressions of pro-inflammatory mediators by down-regulating the NF-kappaB signaling pathway in RA FLS. The outcomes suggest that activation of PPAR-gamma can be a novel therapeutic approach in RA.
Arthritis, Rheumatoid ; Arthroplasty, Replacement, Knee ; Cell Proliferation ; Down-Regulation ; Electrophoretic Mobility Shift Assay ; Fibroblasts ; Gene Expression ; Humans ; Interleukin-6 ; NF-kappa B ; Peroxisomes ; RNA, Messenger ; Thiazolidinediones ; Tumor Necrosis Factor-alpha