Psoriasis, bone and bowel: a comprehensive review and new insights

Psoriasis is a chronic immune-mediated disorder affecting about 2% of the population worldwide which is associated with significant morbidity. The disease usually presents as raised, well-demarcated erythematous plaques with adherent silvery scales. Psoriasis can appear at any age but it has two peaks occurring at 15–20 and 55–60 years of age. It affects males and females equally. Despite the multitude of investigations about psoriasis and even development of drugs with satisfactory results, its pathogenesis is not fully understood yet and its course is unpredictable. Various environmental triggers, e.g., obesity, stress and drugs may induce disease in genetically susceptible patients. Although psoriasis was considered primarily as a disease of the skin, more investigations have been revealed its systemic nature. Psoriatic arthritis (PsA) may complicate up to one-third of cases of psoriasis vulgaris (PV). Also, the association between psoriasis and a variety of other immune-mediated disorders such as inflammatory bowel disease (IBD) and celiac disease (CD) has been confirmed in various studies. Moreover, a growing body of evidences indicates that psoriasis shares some common histological and phenotypical properties with the spectrum of osteoimmunological diseases such as Paget’s disease of bone (PDB). Thus, exploring the common molecular and genetic mechanisms underlying psoriasis and related disorders is of paramount importance for better elucidating disease pathogenesis and designing more targeted treatments.

An arachnoid cyst rupture complicated with subdural hygroma in a middle-aged woman: a case report and review of the literature

Background

Arachnoid cysts (ACs) account for about 1% of all intracranial mass lesions. The Sylvian fissure is the most common site of ACs which are usually asymptomatic. Traumatic rupture of arachnoid cysts complicated with subdural hygroma is a relatively rare entity in adults especially in females. There is no consensus on their management and each case could add to previous experiences leading to more uniform therapeutic measurements. This case encompasses a combination of watchful strategy, limited surgery and ultimately successful cyst fenestration which highlights a good outcome without complications by adopting a stepwise procedure.

Case presentation

Here, the case of a 51-year-old Persian woman being presented with a 2-month history of a localized headache which had begun 4 days after a minor head trauma. Early brain computed tomography (CT) obtained in another center at 4th day of post-injury which misinterpreted as an old infarct. Repeated CT in our center revealed a large AC of Sylvian fissure complicated with subdural hygroma. Initially a conservative management pursued but due to worsening of the symptoms, a burr-hole craniotomy performed for hygroma evacuation that subsequently followed by cyst fenestration about 1-month later.

Conclusion

Previous awareness about radiographic characteristics of ACs as well as employing appropriate imaging modality are necessary for correct and timely diagnosis of symptomatic patients after minor head trauma because incidentally found ACs might be the underpinning causes of symptoms. Also, following a multistage therapeutic process along with the involvement of patients in decision-making are of paramount importance.

A Case Report of Bone Paget's Disease with Concurrent Psoriasis and Positive Celiac Serology

BACKGROUND

Paget's disease of bone (PDB) is the second most frequent metabolic bone disease affecting about 3 percent of the Caucasian population older than 55 years. Its etiopathogenesis is unknown .while viral agents like measles and respiratory syncytial virus has been proposed, the role of genetic susceptibilities loci such as SQSTM1/p62 gene mutations have been confirmed. A new inhibitory mechanism against osteoprotegerin (OPG) via autoantibodies has been revealed in a patient with occult celiac disease (CD) with a phenotype similar to juvenile Paget's disease, which suggests an immunological mechanism for Paget's disease-like disorders other than genetic causes. But there is no report in the literature searching for shared immunologic mechanisms underlying classic PDB, CD and psoriasis Case Presentation: I report the case of a 50-year-old Caucasian man who presented with progressive bilateral hearing loss. The patient had a history of total blindness which had developed shortly after a cranial osteotomy for optic nerve decompression without any specific diagnosis 15 years ago. He had also been suffering chronic psoriasis vulgaris. Because of his enlarged skull, a diagnosis of bone Paget's disease was suspected and plain radiographs revealed a polyostotic Paget's disease with characteristic radiologic signs. In searching for his refractory constipation causes, an elevated level of tissue transglutaminase IgA (tTG IgA) antibody was demonstrated. Alendronate sodium 40 mg daily was started and a gluten-free diet was recommended to him but he was not adherent to the treatments and lost to follow-up.

CONCLUSION

This case further supports the idea of considering PDB as an osteoimmunologic disorder, such as psoriasis and CD, because of similar biochemical features, including elevated levels of Cytokines such as interleukin-6 and tumor necrosis factor- α as well as bone resorption markers such as OPG and urinary deoxypyridinoline. So, the treatment of Paget's disease of the bone may benefit from progresses in osteoimmunology-targeted therapies. Also a probable causal relationship between PDB and CD by the production of neutralizing antibodies in CD against OPG or by inducing PDB in genetically susceptible patients through oxidative stress, has been postulated here.

Unilateral solitary erythema elevatum diutinum

Background

Erythema elevatum diutinum (EED) is a rare disease with unknown etiology, various presentations, broad spectrum of underlying conditions, and unified pathology. So, every case of it merits further investigation for better understanding of its causes and pathophysiology.

Case presentation

I report the case of a 32-year-old otherwise healthy man with an 8-year history of a refractory solitary lesion on his right hand and prompt response to dapsone 100 mg BID within 2 weeks without any recurrence after 2 years of follow-up.

Conclusion

This case report aims to inform clinicians about EED in order to consider it in the differential diagnosis of any chronic refractory papule, nodule, or plaque on the relevant skin sites due to its protean manifestations, potential underlying diseases, and, finally, excellent response to dapsone.

A Case of POEMS Syndrome with characteristic Skin Manifestations.. [DOI: 10.22541/au.166416482.24863936/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

I report the case of POEMS syndrome in a 68- year-old Caucasian woman who presented with exertional dyspnea. Progressive skin hyperpigmentation in parallel to sensorimotor neuropathy had been developed since 20 years ago.sclerodermoid changes was evident.

A case of SAPHO syndrome: a DISH of radiological features to be considered

Background

The acronym SAPHO stands for synovitis, acne, pustulosis, hyperostosis, and osteitis. It is a rare heterogenous disease with unknown etiology and a chronic relapsing and remitting course¹. Its skin and osteoarticular manifestations including palmoplantar pustulosis (PPP) and synovitis may be transient which further complicate the diagnosis. So, awareness about all features of the syndrome throughout the time seems mandatory for correct diagnosis and avoidance of unnecessary procedures.

Case presentation.

A case of SAPHO syndrome being reported in a middle-aged man who presented with bilateral PPP and exacerbation of back pain which developed shortly after covid-19 vaccine injection with a history of more than 20 years of inflammatory thoracic back pain and psoriasis vulgaris who initially had been worked up for metastatic bony lesions based on radiologic studies, irrespective of his skin lesions. The patient had good response to alendronate 70 mg weekly and celecoxib 200 mg BID without aggravation of existing skin lesions or new psoriatic lesions.

Conclusion

This case report aims to inform rheumatologists and radiologists about various radiologic and dermatologic manifestations of SAPHO syndrome with emphasizing on taking into consideration of past and present skin lesions in the interpretation of the radiologic signs in order to prevent irrelevant procedures or hazardous imaging and to urge rheumatology societies to set up a SAPHO registry for future randomized controlled trials. Suggestion of PPP responsiveness to NSAIDs as a new potential diagnostic tool for SAPHO diagnosis is another goal. It also aims to point out the possible coexistence of SAPHO and SpA or DISH syndrome.