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Erythema nodosum leprosum (ENL) is a severe immunological complication of leprosy, characterised by painful nodules, fever, arthralgia, oedema, and systemic symptoms. Temporal classifications-acute, recurrent, and chronic-are inconsistently applied, complicating data comparisons. Standardised and agreed definitions are essential to ensure consistency in diagnosis, research, and clinical management. To examine how temporal classifications of ENL are used in modern literature and compare them to descriptions from the pre-corticosteroid era. We conducted a semi-systematic review of historical and contemporary literature. Historical texts published before 1940, prior to the introduction of sulfone antibiotics and corticosteroids, were purposively selected to capture descriptions of the natural history of ENL. For modern studies, we systematically searched PubMed, EMBASE, LILACS, SciELO, Scopus, African Index Medicus, Cochrane, and ClinicalTrials.gov from May 2024 to March 2025. The systematic review identified 572 articles after de-duplication, and 41 met inclusion criteria for providing definitions of ENL subtypes. Five historical treatises were selected. Their clinical observations of nodular skin lesions with systemic symptoms-ranging in duration from weeks to months or even years-align with contemporary understandings of ENL. 41 studies included, at least one of the three temporal classifications (acute, recurrent, or chronic). The six-month criterion distinguishing acute and chronic ENL is used in all current definitions. However, definitions for recurrent and chronic ENL frequently overlapped, both referring to prolonged or multiple episodes after initial treatment, underscoring a lack of conceptual clarity. The absence of standardised ENL terminology impedes data comparison, meta-analysis, and clinical guideline development. A Delphi consensus process and longitudinal observational studies are recommended to refine, standardise agreed ENL classifications.

More has been written about Mozart's illnesses and death than for any other composer. An exploration of PAMA's Bibliography of Performing Arts Medicine provides the data for this review. The bibliography contained 136 entries that pertained to Wolfgang Amadeus Mozart. Of these, 81 were available to the author, either in printed or electronic copy. In order to provide a clearer historical perspective on this topic, this review assembles information pertaining to illnesses and other medical problems that occurred during Mozart's life as well as those purportedly contributing to his death.

Sarcoidosis is a multisystemic disease, characterised by histopathologic presence of non-necrotising granulomas, primarily affecting the lungs (>90%). We present three cases predominantly characterised by uncommon extrapulmonary manifestations of sarcoidosis, where only one had pulmonary involvement. We describe three female patients, between the second and third decades of life, whose sarcoidosis was a diagnostic challenge due to their atypical extrapulmonary manifestations, from which we highlight: livedo reticularis and painful subcutaneous nodules with uncommon localisation, size and histology, being the first reported case of extensive subcutaneous nodules triggered by intramuscular penicillin; extensive symptomatic and refractory osseous involvement; and dispersed erythema nodosum affecting the entire body surface. All three patients required third-line treatment (antitumour necrosis factor agents) to achieve significant clinical and imagiological improvement. Through this case series, we highlight the importance of considering the rare and atypical presentations of sarcoidosis to avoid diagnostic delays and serious repercussions on the patient’s prognosis.

Crohn's disease (CD) is a chronic, progressive, destructive disease. Numerous intestinal and extraintestinal complications and manifestations can occur during its clinical course. This literature review summarizes our current knowledge of the long-term complications, extraintestinal complications, and mortality in CD in adults as reported in population-based studies that include long-term follow-up results.MethodsA literature search of English and non-English language publications listed in the electronic databases of Medline (source PubMed, 1935 to July, 2009).ResultsThe relative risk of incident fractures is increased in CD patients by ≈30%–40%. These patients have also have a 3-fold increased risk of deep venous thrombosis and pulmonary embolism. A variety of extraintestinal manifestations (primary sclerosing cholangitis, ankylosing spondylitis, iritis/uveitis, pyoderma gangrenosum, erythema nodosum) and diseases (asthma, bronchitis, pericarditis, psoriasis, rheumatoid arthritis, and multiple sclerosis) are associated with CD. The risks of colorectal and small bowel cancers relative to the general population are 1.4–1.9 and 21.1–27.1, respectively. A slightly increased risk of lymphoma, irrespective of medication use, has been reported in a recent meta-analysis of population-based studies. Overall mortality is slightly increased in CD, with a standardized mortality ratio of 1.4.ConclusionsCD is frequently associated with disease complications and extraintestinal conditions. Whether the impact of changing treatment paradigms with increased use of immunosuppressives and biologic agents can reduce disease complications and associated conditions is unknown. (Inflamm Bowel Dis 2011;)

We report a 50-year-old Caucasian woman who presented with recurrent erythema nodosum, leg swelling, malaise, weight loss and abdominal pain associated with an IgM lambda paraprotein. She was treated with six courses of an anti-CD20 monoclonal antibody and bendamustine chemotherapy over 6 months with a good clinical response.

BackgroundHidradenitis suppurativa (HS) is an inflammatory disorder characterized by chronic deep-seated nodules, sinus tracts, and scars in the intertriginous areas. A significant decrease in quality of life accompanies chronic pain of active lesions.Association with inflammatory bowel disease (IBD) and spondyloarthropathies suggest an inflammatory signature overlap with rheumatological disorders.ObjectivesBased on the idea that the association of HS and rheumatological disease is more important and frequent than previously thought, we aimed to evaluate the symptoms and findings of rheumatological diseases in our HS patients.MethodsConsecutive HS patients presented to the dermatology outpatient clinic between 2021-2022 are included in the study. Among the HS patients who applied to dermatology between 2021 and 2022, patients with arthralgia and low back pain were referred to the rheumatology department for evaluation. Family history was taken in detail for inflammatory conditions. Acute phase reactants were analysed.ResultsThe group comprised 55 HS patients, including sixteen Hurley stage I (27.2%), 24 Hurley stage II (41.8%), and 14 (23.6%) Hurley stage III patients. The mean age of onset for HS was 28.8 (min:14, max:56). 51% (N=28) were women. Family history for HS was present in 14 (25.4%) patients. Twenty-four (43.6%) of 55 HS patients who applied to the dermatology outpatient clinic had an autoinflammatory/autoimmune disease diagnosis or inflammatory symptom/finding other than HS (Table 1). Sixteen (29%) patients described arthralgia and were referred to the rheumatology outpatient clinic. Among the HS patients, 32.7% had a significant autoimmune or autoinflammatory condition other than HS in 1st or 2nd-degree relatives. Positive family history for inflammatory processes other than HS was present in 10 (41.6%) patients with an additional inflammatory condition and 8 (25.8%) patients without a different inflammatory disease. Family history of inflammatory disorders include (Familial Mediterranean fever, acne conglabata, inflammatory bowel disease, psoriasis, Takayasu arteritis, amyloidosis, ankylosing spondylitis, uveitis, erythema nodosum, Behçet’s disease and vitiligo. Serum amyloid A levels (SAA) were calculated in 16 patients, and 62.5% had elevated SAA levels.ConclusionAutoinflammatory rheumatological diseases or rheumatological symptoms were present in a significant proportion of HS patients. Prominent family history of inflammatory diseases suggests common genetic pathways in this spectrum of diseases. In addition, detailed history taking, including rheumatological symptoms in HS patients, is valuable and crucial in determining the extent of inflammation.References[1]Goldburg SR, Strober BE, Payette MJ, Part I. Hidradenitis Suppurativa: Epidemiology, clinical presentation, and pathogenesis, Journal of the American Academy of Dermatology (2019). doi: https://doi.org/10.1016/j.jaad.2019.08.090[2]Kridin K, Shani M, Schonmann Y, et al. Psoriasis and Hidradenitis Suppurativa: A Large-scale 532 Population-based Study. J Am Acad Dermatol. November 2018. doi: 10.1016/j.jaad.2018.11.036[3]Principi M, Cassano N, Contaldo A, et al. Hydradenitis suppurativa and inflammatory bowel 537 disease: An unusual, but existing association. World J Gastroenterol. 2016;22(20):4802-4811. 538 doi:10.3748/wjg. v22.i20.4802[4]Ramos-Rodriguez AJ, Timerman D, Khan A, Bonomo L, Hunjan MK, Lemor A. The in-hospital 540 burden of hidradenitis suppurativa in patients with inflammatory bowel disease: a decade 541 nationwide analysis from 2004 to 2014. Int J Dermatol. 2018;57(5):547-552. 542 doi:10.1111/ijd.13932[5]Richette P, Molto A, Viguier M, et al. Hidradenitis suppurativa associated with spondyloarthritis -- 544 results from a multicenter national prospective study. J Rheumatol. 2014;41(3):490-494. 545 doi:10.3899/jrheum.130977Acknowledgements:NIL.Disclosure of InterestsNone Declared.

Background Leprosy is a disease that was declared eliminated in 2010 from Nepal; however, new cases are diagnosed every year. The difficulty arises when the presentation of the patient is unusual. Case presentation In this case report we present a case of a 22-year-old Tamang man, from the Terai region of Nepal, with a clinical presentation of fever, malaise, and arthralgia for the past 2 weeks with hepatosplenomegaly and bilateral cervical, axillary, and inguinal lymphadenopathy. Features of chronic inflammation with elevated erythrocyte sedimentation rate of 90 mm/hour and liver enzymes were noted. With no specific investigative findings, a diagnosis of Still’s disease was made and he was given prednisolone. On tapering the medication, after 2 weeks, the lymphadenopathy and fever reappeared. On biopsy of a lymph node, diagnosis of possible tuberculosis was made. On that basis anti-tuberculosis treatment category I was started. During his hospital stay, our patient developed nodular skin rashes on his shoulder, back, and face. The biopsy of a skin lesion showed erythema nodosum leprosum and he was diagnosed as having lepromatous leprosy with erythema nodosum leprosum; he was treated with anti-leprosy medication. Conclusion An unusual presentations of leprosy may delay its prompt diagnosis and treatment; thus, increasing morbidity and mortality. Although leprosy has been declared eliminated, it should not be forgotten and physicians should have it in mind to make it a differential diagnosis whenever relevant.

With a degree in medicine from the University of Chicago, Rea decided to specialise in dermatology. 1958 found him embarking on a 2-year residency at the University Hospital in Ann Arbor. He then moved to New York, taking up his first academic appointment as an instructor at the New York University School of Medicine's Department of Dermatology. It was in 1970 that he crossed to the west coast to join USC, and there he remained, chairing its Section of Dermatology between 1981 and 1996, and becoming a full professor.

Tuberculosis (TB) causes substantial morbidity and mortality globally, with continued endemicity in developing populations. Most cases of primary TB present as pulmonary TB; however, between 10% and 20% include extrapulmonary manifestations. Almost 26% of extrapulmonary manifestations include musculoskeletal TB. The risk of reactivation of latent TB is approximately 10% per year and is most common in those with immunocompromising conditions. Diagnosis of extrapulmonary TB remains elusive because of atypical presentation. We present a case of a 71-year-old man with a history of renal transplantation and previously treated latent TB who presented with worsening left lower extremity pain and swelling over the previous six months. Initially, the patient was unsuccessfully treated for presumed bacterial cellulitis with several rounds of antibiotics. The patient was then seen by Dermatology, who diagnosed presumed primary erythema nodosum. He was managed with prednisone and topical steroids for several months with only partial improvement. At admission, physical exam was significant for a 4 × 3-cm erythematous, warm, and tender area on the lower left extremity. Labs showed elevated neutrophils and lymphopenia, and an MRI of the limb suggested hindfoot abscesses, talonavicular septic arthritis, and surrounding osteomyelitis. Intraoperative cultures grew acid-fast bacilli and were confirmed to be pan-sensitive complex. Musculoskeletal TB diagnosis requires a high index of suspicion, thorough physical exam, imaging, and tissue for culture and biopsy. Special attention should be placed on the combined risk factors of previous TB diagnosis, immunocompromised status, and symptoms refractory to alternative management strategies such as antibiotics and corticosteroids.