Sweet's syndrome in Behçet's disease

Few cases of Sweet's syndrome have been reported in patients with Behçet's disease.Case reportA 47-year-old woman with five year history of oral and genital ulcers that had not been investigated previously was admitted for an eruption of tender, erythematous, vesicle-like papules over the face, neck, palms, and legs. She reported polyarthralgia and weight loss of 6 kg over the previous month. At admission, she had a fever of 38.5 °C and conjunctivitis. Joint tenderness to mobilization without evidence of synovitis was noted. Laboratory tests showed inflammation and leukocytosis (12.5 × 10⁹/L) with 74% neutrophils. The skin biopsy was typical for Sweet's syndrome, and the pathergy test was positive. Glucocorticoid therapy 40 mg/day and colchicine were effective in alleviating the manifestations.DiscussionOverlap exists between the clinical manifestations of Sweet's syndrome and Behçet's disease. Data from the literature suggest that Behçet's disease may be among the conditions that underlie Sweet's syndrome.     

Leflunomide-induced toxic epidermal necrolysis in a patient with rheumatoid arthritis

IntroductionLeflunomide is an immunomodulating agent with proven efficacy in rheumatoid arthritis. Although its overall safety profile is good, a few cases of toxic epidermal necrolysis have been reported.Case reportThis 36-year-old woman had rheumatoid arthritis that proved refractory to sulfasalazine and methotrexate, which were used successively in combination with symptomatic drugs. Leflunomide was started. A maculopapular rash and a fever developed 2 weeks later. The skin lesions spread rapidly to most of the body, and ulcers of the ocular and oral mucosa appeared. Leflunomide was stopped. Cholestyramine washout and prednisolone (60 mg/day) were given. The skin lesions healed over the next month. Punctate keratitis with keratinization of the cornea led to complete loss of vision.DiscussionThe main adverse effects of leflunomide consist of diarrhea, nausea, liver enzyme elevation, hypertension, alopecia, and allergic skin reactions. A few cases of severe skin reactions such as toxic epidermal necrolysis have been reported. They require immediate discontinuation of the drug and a washout procedure to hasten drug elimination from the body.ConclusionClose monitoring for severe skin reactions is in order when using leflunomide.     

Complications of the mini-open anterolateral approach to the thoracolumbar spine

The mini-open anterolateral approach to the thoracolumbar spine is gaining popularity as a minimally-invasive alternative to traditional open thoracolumbar approaches. Published studies reporting and discussing the complications associated with this minimally invasive approach, however, are limited. We performed a retrospective review of patients undergoing the mini-open lateral approach to the thoracolumbar spine for corpectomy/fusion. Intraoperative and postoperative complications are reported and analyzed. Eighty consecutive patients underwent the mini-open lateral approach with corpectomy and fusion for trauma (71%), tumor (26%) and infection (3%). Total complication rate was 12.5% (dural tear 2.5%, intercostal neuralgia 2.5%, deep vein thrombosis 2.5%, pleural effusion 1.3%, wound infection 1.3%, hardware failure 1.3%, hemothorax 1.3%). Two patients needed a re-operation to address the complication (hardware failure, hemothorax). There were no postoperative neurological complications. The mini-open anterolateral approach to the thoracolumbar spine is an appealing alternative to the traditional open approaches. This technique, however, is technically demanding and requires proficiency in the use of minimally invasive spinal surgery instruments and retractors.