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Background: Gastric angiodysplasia and the typical “watermelon stomach” aspect is one of the most characteristic vascular manifestations in systemic sclerosis (SS). These angiodysplasias can affect the intestine ocasionally as well as the stomach. Objectives: Description of a series of 5 patients with systemic sclerosis and presence of intestinal angiodysplasia (IA). Methods: Retrospective unicentric observational study in a tertiary hospital. Demographic data, comorbidities, manifestations of the disease, serological profile, concomitant treatments and bleeding manifestations, as well as endoscopic findings and received treatment were collected. Descriptive statistics was used to present the data. Results: We reviewed the medical records of the 88 patients with a diagnosis of SS followed up in the Rheumatology Service. Five cases (5.6%) of IA were identified (4 women and one male), with a mean age of 73 years (SD 13.71). In one case, the diagnosis of SS and IA was simultaneous. In the remaining 4 cases, the mean time from the diagnosis of ES to the diagnosis of the IA was 7.75 years (SD 2.6). Regarding the clinical presentation, 4 of the cases presented as anemia with iron deficiency. In these cases IA were found in the endoscopic studies. In one case, IA were a finding in the context of the study of diarrhea. In 4 of the cases, the IA were in the small intestine, so the diagnosis was made using an endoscopic capsule. In one case they were found in the colon, so the diagnosis was by colonoscopy. Only one of the cases of angiodysplasias in the small intestine required specific treatment with argon laser by enteroscopy. One case required a transfusion of packed red blood cells. In the remaining cases, treatment with oral or intravenous iron therapy was enough. In all 5 cases, it was a limited form of the SS with the presence of anticentromere antibodies. All cases presented Raynaud’s phenomenon, 3 of them with digital ulcers. Three of the cases associated primary biliary cholangitis, 3 cases pulmonary hypertension, 3 cases peristaltic involvement, 1 case interstitial lung disease and 1 case restrictive cardiomyopathy. As comorbidities, we identified 1 case of essential mixed cryoglobulinemia associated with hepatitis C virus, 2 cases of valvular heart disease, 2 cases of atrial fibrillation. Conclusion: The extragastric localization of the angiodysplasias should be taken into account in the patient with SS and iron deficiency, especially in those with a limited form of the illness and positive anticentromere antibodies Disclosure of interests: Carolina Merino argumanez: None declared, Olga Rusinovich: None declared, Maria Espinosa: None declared, Consuelo Ramos Giraldez Speakers bureau: Sanofi, Carmen Barbadillo Mateos: None declared, Jose Luis andreu Sanchez: None declared, Hilda Godoy: None declared

Background The primary antiphospholipid syndrome (APS) is characterized by arterial and/or venous thrombosis and pregnancy morbidity in the presence of anticardiolipin antibodies (aCL) and/or lupus anticoagulant (LA). In addition to prothrombotic effects of aPL on the brain, there are immunologic effects with proof of direct binding of aPL to various types of brain cells, presented as cognitive dysfunction (CD),migraine,seizure, multiple sclerosis-like syndrome (MS-like), transverse myelitis (TM), movement disorders, or psychiatric symptoms. Methods We examined 3 patients who were diagnosed primary APS.The patients were assessed with careful history taking, physical examination, blood laboratory evaluation, andMRI or head-CT.Our main objective was to describe neurologic manifestations of APS in our patients at Valme University Hospital and the response to treatment with hydroxychloroquine Results Among the 3 patients, there was male preponderance with 3 men and no-women.The mean age of presentation was 33.66±5.2 years (range, 23 50 years) and with a current mean age of 37±14,93 years.There was no mortality in our series. One of them debuted with sudden loss of consciousness along with jaw stiffness and posterior amnesia.The other one presented prickling sensation and involuntary movement of his right upper limb extending to right lower limbs without posterior generalization, and the third patient consulted with frontal, pulsating headache and binocular diplopia.100% were LA positive with prolongated Activated Partial Thromboplastin Time and dilute Russell viper venom time and negative for ANA with no collagenosis sign or symptoms. Neither presented complement alteration or cerebrospinal fluid variation.We observed positivity for aCL in one patient (33%). In 2 of 3 patients (66.66%), cortico-subcortical space occupant lesions (SOL) were observed, some of them with contrast enhancement, mimicking demyelinating lesion, while the other patient didn’t present any abnormality in the MRI images.All patients presented an appropriate response to treatment with prednisone,in downward treatment regimen, aspirin and hydroxychloroquine 200 mg twice a day. At the four-year follow-up, all of them remain asymptomatic.We observed a lessening of SOL in MRI images due to the treatment in two patients but the third one presented new lesions due to suspension od prednisone, which was reintroduced, lessening of SOL. Conclusions The neurological affection presented in APS can mimic multiple sclerosis symptoms and it is difficult to differentiate both entities That is why aPL determination should be part of screening tests and should not be delayed if the diagnosis of APS is suspected.Hydroxychloroquine could be a valid treatment in CNS manifestations in patients with APS Funding Source(s): None

Objective The aim of this study was to compare the functional results of 2 different procedure types, medical or surgical used in treating native joint septic arthritis. Methods In this cohort study, we reviewed the clinical registries of patients admitted to a single third-level hospital with the diagnosis of septic arthritis during the period of January 1, 2008, to January 31, 2016. Results A total of 63 cases of septic arthritis were identified in which the initial approach for 49 patients was medical (arthrocentesis), whereas the initial approach for 14 patients was surgical (arthroscopy or arthrotomy). Of the 49 patients who received initial medical treatment (IMT), 15 patients (30%) later required surgical treatment because of poor progress. The median age of the patients was 60 (SD, 18) years. The group who received IMT were older than those who received initial surgical treatment (median, 64 years [interquartile range {IQR}, 54–76 years], vs. 48 years [IQR, 30–60 years]). There was a larger percentage of male patients in the surgical group (78% vs. 42% [p = 0.018]). Thirty percent of the medical group had been receiving corticosteroid treatment (p = 0.018). Results of complete recovery of joint functionality showed no significant differences after 1 year (68% with MT vs. 67% with ST, p = 0.91). Both groups had similar symptom duration until diagnosis, duration of antibiotic therapy (median, 30 days [IQR, 28–49 days], vs. 29.5 days [IQR, 27–49] days), and mortality rate (3 in the medical group). Conclusions The results of the study show that initial surgical treatment in patients with native joint septic arthritis is not superior to IMT. However, half of the patients with shoulder and hip infections treated with IMT eventually required surgical intervention, suggesting that perhaps this should be the preferred initial approach in these cases.

Background: Sialodochitis fibrinosa is a rare disease which is characterized by recurring episodes of pain and swelling of the salivary glands due to the formation of mucofibrinous plugs. Analytic studies ascertain elevated levels of eosinophils and immunoglobulin E (IgE). Imaging studies such as magnetic resonance imaging (MRI) and sialography reveal dilation of the main salivary duct (duct ectasia). Treatment is initially supportive, consisting of compressive massages, and use of antihistamines and/or corticosteroids. Material and methods: In the following, 3 cases of sialodochitis fibrinosa are presented which were diagnosed in a third level hospital during the period of 2008 and 2016, as well as a literature review of all cases reported to our knowledge. Results: Of the 41 cases found, including the 3 of this article, 66% were women with an average age of 45 years old. However, 75% of reported cases were of Japanese heritage. Involvement of the parotid glands was more frequent than the submandibular glands. In more than half of all cases treatment with compressive massages, antihistamines and/or corticosteroids was effective. Conclusion: Clinicians should consider sialodochitis fibrinosa as a diagnostic possibility when presented with cases of recurring parotid and submandibular gland tumescence.