Arthralgia myalgia differential diagnosis
While generally well tolerated, both local and systemic complications may appear. Case report We report the case of a 50 year-old female patient known with bladder tumor operated in January followed by 4 weeks of intravesical BCG immunotherapy, one administration per week.
Source: Romanian Journal of Rheumatology. The aim of the study is to evaluate the presence of EHM as well as that of comcomitant rheumatic autoimmune diseases among chronic hepatitis C virus HCV infected patients and to compare the related immunological patterns. We conducted a descriptive, cross-sectional analysis of all patients with HCV infection and a rheumatic disease, admitted between January -- June
After each course the patient accused low grade fever, nausea, pollakiuria and hematuria with limited duration. In Marchafter a cystoscopy and a bladder resection, she underwent another 5 weeks of BCG instillations.
- Беккер быстро проделал это со всеми буквами.
- Мистер Густафсон остановился .
- Brate dureroase în tratamentul articulațiilor umărului
- И прижала ладонь к горлу.
- В руке он сжимал ключ, взятый из лаборатории систем безопасности.
After the fourth course the patient presented to our clinic for fever with chills, pollakiuria, hematuria, conjunctivitis, myalgia and disabling migratory arthritis of the left ankle and right knee. Clinical exam at admission: high fever, arthralgia myalgia differential diagnosis ankle and right knee arthritis, impaired mobility in the left temporomandibular joint.
Following admission the patient developed left metacarpophalangeal and proximal interphalangeal arthritis of the index and medius. She had leukocytosis with neutrophilia, reactive thrombocytosis and high biologic inflammatory syndrome.
Urinalysis showed frequent leukocytes, no arthralgia myalgia differential diagnosis and negative cultures.
The culture for Mycobacterium spp. Suspecting a BCG arthritis and cystitis we started empiric antituberculous antiTB and glucocorticoid therapy. A week after admission Serratia marcescens was identified in one blood culture out of three collected, so we added ertapenem for 14 days.
Rheumatological examination raised suspicion of an autoimmune illness, but all specific blood tests were negative. Despite that, the rheumatologist added sulfasalazine, considering that even BCG arthritis can associate an autoimmune disorder. After 2 months of antiTB, glucocorticoid and sulfasalazine treatment the evolution was favorable, with remission of arthritis and fever.
Conclusion In our case, the cause of arthritis could be the BCG instillations, an autoimmune illness or the infection with Serratia marcescens. While the long-term progression of symptoms despite antiTB treatment is a strong argument in favor of an autoimmune cause negative specific tests being a counterargumentwe cannot exclude the immune disorder caused by BCG immunotherapy.
- Exerciții pentru durere în articulațiile degetelor
- Стратмор подался вперед и повернул к Сьюзан монитор компьютера.
- До поворота оставалось еще триста метров, а такси от него отделяло всего несколько машин.
Acknowledgements 1. Aguridă et al. Published: 15 October doi