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This article discusses a case of Immunoglobulin-A vasculitis (IgAV) in an adult patient presenting with edema in the scalp, face, and sternocleidomastoid muscle. IgAV is a small-vessel vasculitis that primarily affects children and is characterized by IgA deposits in the vessel walls. While subcutaneous edema in the scalp and face is rare in adults, it has been occasionally reported in children. Muscle involvement in IgAV is also uncommon and typically occurs in the lower extremities. This case highlights the importance of considering exacerbating IgAV and intensifying treatment when adult patients present with edema in the head and neck. Further research is needed to understand the underlying mechanisms and optimize treatments for similar cases. [Extracted from the article]

The article describes a case of an older male patient with vacuoles, E1 enzyme, X-linked autoinflammatory somatic (VEXAS) syndrome. Topics mentioned include the manifestation of granulomatosis with polyangitis, the management of the syndrome using methotrexate and infliximab, the indication of cytogenetic analysis, and the results of the positron emission tomography scan.

Key Clinical Message: Negative myoclonus may present in the early stages of cefepime neurotoxicity. Cefepime neurotoxicity typically presents as reduced consciousness, myoclonus, and seizures; however, negative myoclonus is uncommon. This video shows an older woman with cefepime neurotoxicity that presented as a negative myoclonus of the upper limbs. [ABSTRACT FROM AUTHOR]

Competing Interests: Competing interests: None declared.

We report a case of a woman in her early 80s with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis presented as myalgia mimicking polymyalgia rheumatica (PMR). She had positive results for the Neer and Hawkins-Kennedy impingement tests, and a normal serum creatine kinase (CK) concentration. At first, we suspected PMR; however, the patient did not strictly meet the classification criteria. Electromyography revealed an abnormal myogenic pattern, and muscle MRI revealed intramuscular and fascial hyperintensity. Moreover, chest CT revealed interstitial lung disease, and test results for ANCAs were positive. We diagnosed the patient with ANCA-associated vasculitis based on the criteria and treated her with corticosteroids and rituximab. Thus, ANCA-associated vasculitis can cause muscle involvement without elevation of the CK concentration and mimic PMR., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Streptococcus dysgalactiae subsp. equisimilis (SDSE) commonly causes a variety of infections in older individuals. However, respiratory infections are uncommon. We present the case of an older man with empyema due to SDSE subsequently to bacteraemia. He presented with a 1-day history of fever and laboratory findings revealed an increased white blood cell count and C- reactive protein (CRP) level. Chest CT revealed no infiltration and no pleural effusion. SDSE was detected in the blood cultures. Primary bacteraemia was suspected and antibiotic administration was initiated; however, 2 days later, his right breath sound diminished, and chest radiography revealed right pleural effusion. Thoracentesis yielded cloudy fluid with frank pus; thus, he was diagnosed with empyema due to SDSE, and a drainage tube was placed. Thereafter, his fever improved, and his CRP level decreased. Thus, SDSE can cause empyema probably by haemotological spread of SDSE to the pleura., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)