Edward B. Miller

Sudden Sensorineural Hearing Loss as a First Manifestation of Systemic Lupus Erythematosus: Association with Anticardiolipin Antibodies

Abstract: Sudden sensorineural hearing loss is a rarely reported manifestation of systemic lupus erythematosus (SLE). This condition has been most frequently seen in individuals with concomitant anticardiolipin antibody (ACL) syndrome, although a direct causal relationship remains unconfirmed. We report an unusual case of a young male with sudden unilateral hearing loss as the first manifestation of SLE. This individual was also found to be ACL positive and subsequently presented with other thrombotic manifestations compatible with this syndrome. The literature regarding this condition is reviewed and the significance of this case in fortifying the association of anticardiolipin antibodies and sensorineural hearing loss is discussed.

A Simple Technique for Minor Salivary Gland Biopsy Appropriate for use by Rheumatologists in an Outpatient Setting

Abstract Minor salivary gland biopsy is a potentially simple procedure with high diagnostic value used primarily in the diagnosis of Sjögren’s syndrome. We summarise our experience performing a simplified biopsy procedure, which is modified to allow its use by rheumatologists and other non-surgical physicians in an outpatient setting.

Cactus Thorn Arthritis: Case Report and Review of the Literature

Abstract: Synovitis secondary to penetrating plant thorn injuries is an infrequently reported event. Despite its wide geographic distribution, thorns from the prickly pear cactus (Optunia ficusindica) are a rare source of this type of inflammatory arthritis. We hereby present an unusual case of an individual who developed an acute monoarthritis of the knee shortly after sustaining a penetrating cactus thorn injury. The clinical and pathophysiologic features of cactus thorn arthritis are reviewed and the unusual features present in this individual are highlighted. Treatment options, with an emphasis on rapid diagnosis and therapeutic interventions, are discussed. Increased physician awareness and recognition of this unusual but not rare entity are essential as a means of improving clinical outcome.

Takayasu’s arteritis and hepatitis C: a new association?

Takayasu’s arteritis is a rare chronic inflammatory disease that primarily affects the large vessels arising from the aortic arch. Although it is most commonly reported in individuals of Asian extraction, other ethnic groups are frequently represented. A specific etiology of Takayasu’s arteritis has yet to be identified, but some reports indicate a possible causal relationship with hepatitis B antigen stimulation [1, 2]. We recently saw a 27-year-old new immigrant from India with known Takayasu’s arteritis who was also diagnosed as having concomitant active hepatitis C infection. Takayasu’s arteritis was originally diagnosed 3 years previously in India, when she presented with hypertension. Angiography confirmed stenoses of the right subclavian, right carotid, and left subclavian arteries that were treated with angioplasty and stents. Although she was tested for hepatitis B (negative), no evaluation for hepatitis C was performed. Following immigration to Israel, she complained of right-sided abdominal pain and was found to have elevated liver transaminases (ALT 191 IU/l and AST 111 IU/l). Evaluation, including hepatitis A and B serologies and abdominal ultrasound, was negative or normal. Hepatitis C antibody and PCR for viral RNA were positive, and liver biopsy confirmed portal tract inflammation and fibrosis consistent with chronic viral hepatitis. Treatment with interferon and ribavirin resulted in normalization of liver transaminases. Despite this improvement, she presented to our institution with a flare of her Takayasu’s arteritis characterized by fever, hypertension and an ESR of 100 mm/h that responded to treatment with high-dose prednisone and azathioprine. This case may well represent the co-occurrence of a common disorder (hepatitis C) with a rare one (Takayasu’s arteritis). Indeed, in large published series no cases of concomitant hepatitis C and Takayasu’s arteritis were reported [3]. However, the known association between chronic viral hepatitis (B and C) and other forms of vasculitides suggests that a possible causal relationship may well be involved. Alternatively, the Takayasu’s ‘flare’ may be the result of the antiviral therapy she received. Until these possible associations are clarified further, we suggest that all patients with Takayasu’s arteritis be investigated for concomitant hepatitis C infection.

Relapsing polychondritis and familial Mediterranean fever—an association

Relapsing polychondritis (RP) and familial Mediterranean fever (FMF) are systemic inflammatory disorders with seemingly distinct genetic and pathophysiologic mechanisms. An association between these disorders has been described based on a single case report with few clinical details available. We recently encountered a patient with biopsy-proven RP and genetically confirmed FMF. Following identification of this individual, we conducted a retrospective review of all cases of RP in our institution from 2000–2009 and identified one additional patient with RP who is also a genetic heterozygote for FMF. These cases highlight the previously reported but sparsely documented relationship between these seemingly separate disorders.