Juan Pablo Restrepo

Successful treatment of severe nodular scleritis with adalimumab

Ocular features may occur in longstanding rheumatoid arthritis. Among them, scleritis represents the most frequent manifestation of ophthalmologic rheumatoid disease. There are three types of anterior scleritis: diffuse, nodular, and necrotizing with and without inflammation (scleromalacia perforans). Nodular scleritis is the second cause of anterior scleritis representing 20% of all types of scleritis. The conventional treatment of nodular scleritis consists in topical steroids and DMARDS. In severe cases, the therapy with immunosuppressive agents to avoid complications is necessary. We describe a 46-year-old woman presented right nodular scleritis with rheumatoid arthritis. She was treated initially with topical steroids and DMARDs but was unable to received systemic steroids due to left open angle glaucoma in the opposite eye. After an ocular exacerbation, we initiated adalimumab with complete resolution of nodular scleritis. This is the first report of adalimumab in the treatment of nodular scleritis. Adalimumab could be a good alternative in patients with severe nodular scleritis who fail to have conventional treatment with DMARDs and unable to receive systemic steroids.

Relato de casoPerfuração do colo por colite amebiana invasiva durante terapia anti‐TNF para espondiloartrite§Colonic perforation due to invasive amebic colitis during anti‐TNF therapy for spondyloarthritis☆

TNF blockade has been successful in the treatment of some rheumatic diseases such as spondyloarthritis. Many infectious complications have been reported with anti-TNF therapy, mainly bacterial, mycobacterial, viral and fungal infections. Entamoeba histolytica is an extracellular protozoan parasite that mainly causes colitis and hepatic abscess; bowel perforation is an uncommon complication with high mortality. TNF is considered the principal mediator of cell immunity against amebiasis. Initially, it is chemotactic to E. histolytica, enhancing its adherence to enterocyte via galactose inhibitable lectin, and then activating macrophages to kill ameba though the release of NO, so that TNF blocking could be harmful, increasing amebic virulence. We describe the case of a 46-year-old woman with spondyloarthritis who presented a colonic perforation due to invasive amebic colitis during anti-TNF use.

Perfuração do colo por colite amebiana invasiva durante terapia anti-TNF para espondiloartrite♧

TNF blockade has been successful in the treatment of some rheumatic diseases such as spondyloarthritis. Many infectious complications have been reported with anti-TNF therapy, mainly bacterial, mycobacterial, viral and fungal infections. Entamoeba histolytica is an extracellular protozoan parasite that mainly causes colitis and hepatic abscess; bowel perforation is an uncommon complication with high mortality. TNF is considered the principal mediator of cell immunity against amebiasis. Initially, it is chemotactic to E. histolytica, enhancing its adherence to enterocyte via galactose inhibitable lectin, and then activating macrophages to kill ameba though the release of NO, so that TNF blocking could be harmful, increasing amebic virulence. We describe the case of a 46-year-old woman with spondyloarthritis who presented a colonic perforation due to invasive amebic colitis during anti-TNF use.

Osteomas múltiples faciales asociados a síndrome de Gardner

SUMMARY The facial osteomas are one of the extracolonic manifestations of Gardner syndrome that may precede the appearance of intestinal polyps. The most common location is in the mandibular region but may affect other bones of the face. Despite being benign lesions can grow in an exaggerated manner and require surgical treatment. We describe a woman of 16 who presented a multiple osteomas of the face.

Complete heart block in ankylosing spondylitis.

Ankylosing spondylitis (AS) is a chronic rheumatic disease of young men that affects mainly the axial skeleton and is associated with HLA-B27 in 90% of the cases. Incidence of cardiovascular involvement in AS ranges between 10%-30%; conduction disturbances have been described in 1%-9% of the patients with AS. The majority of the series show a relationship with longstanding disease. To our knowledge, this is the first report of complete heart block in early AS.

Vasculopatía livedoide debida a síndrome antifosfolípido

Resumen La vasculopatia livedoide es una entidad rara y cronica que afecta predominantemente los miembros inferiores. La etiologia de la enfermedad es desconocida, pero en la histopatologia se observa trombosis en la dermis sin compromiso inflamatorio de la pared del vaso. Se manifiesta por lesiones petequiales y por ulceraciones que sanan con cicatrices hiperpigmentadas alternando con areas blanquecinas. Se han empleado multiples tratamientos hasta el momento, sin total exito.

Sinovitis villonodular pigmentaria. Revisión de la literatura a propósito de un caso

Resumen La sinovitis villonodular pigmentaria es una neoplasia benigna con proliferacion sinovial y deposito de hemosiderina. Se presenta usualmente entre la tercera y cuarta decada de la vida. Tipicamente es monoarticular y puede afectar cualquier articulacion, pero mas frecuentemente compromete las grandes articulaciones de la extremidad inferior. El tratamiento se basa en la erradicacion del tumor mediante cirugia o radioterapia.

Peripheral corneal melting syndrome in psoriatic arthritis treated with adalimumab

Peripheral corneal melting syndrome is a rare immune condition characterized by marginal corneal thinning and sometimes perforation. It is associated with rheumatic and non-rheumatic diseases. Few cases of peripheral corneal melting have been reported in patients with psoriasis. The pathogenesis is not fully understood but metalloproteinases may play a pathogenic role. Anti-TNF therapy has shown to decrease skin and serum metalloproteinases levels in psoriasis. We report a 61-year-old man with peripheral corneal melting syndrome associated with psoriatic arthritis who received Adalimumab to control skin and ocular inflammation. To our knowledge, this is the first case report of peripheral corneal melting syndrome in psoriatic arthritis treated with Adalimumab showing resolution of skin lesions and complete healing of corneal perforation in three months.

Monoartritis aguda de rodilla como manifestación de fractura por estrés del platillo tibial

Resumen Las fracturas por estres (FPE) pueden ocurrir en pacientes con hueso normal o metabolicamente debil.Habitualmente se presentan en personas deportistas o en aquellas que recientemente han cambiado laduracion e intensidad del ejercicio. La sintomatologia clinica a menudo se confunde con otras condicio-nes musculo-esqueleticas, por lo tanto la imaginologia juega un papel crucial en el diagnostico de estapatologia. Se describe a continuacion el caso de una mujer de 21 anos, no deportista, que luego de unesfuerzo minimo presento una monoartritis de rodilla derecha de tipo hemorragica, quien mediante unaRNM se confirmo una FPE del platillo tibial.Palabras clave: fracturas por estres, tibia, RNM. Summary Stress fractures may occur in patients with normal bone or metabolically weak. They usually presentassociated with sports or those who have recently changed the duration and intensity of exercise. Theclinical symptoms are often mistaken with other musculoskeletal conditions, thus imaging plays a crucialrole in the diagnosis of this condition. We describe the case of a woman of 21 years old, non-athlete whoafter a minimal effort presented a right knee monoarthritis hemorrhagic type, the MRI findings confirmeda stress fracture of the tibial plateau.Key words: stress fractures, tibia, MRI.

Encondroma solitario de fémur

Resumen El encondroma solitario es un tumor cartilaginoso de naturaleza que se presenta entre la tercera y cuarta decada de la vida. Se mujer de 60 anos con encondroma solitario en femur izquierdo una resonancia nuclear magnetica.