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Vasculitic neuropathies usually present acutely to subacutely, with an asymmetric pattern, involving multiple peripheral nerve territories. Drug-induced vasculitis is an often overlooked etiology of vasculitic neuropathy.We present the first reported case of nitrofurantoin-associated and an illustrative case of minocycline-associated vasculitic neuropathy, with a review of the literature.The first patient is a 60-year-old woman who developed axonal sensorimotor peripheral neuropathy after nitrofurantoin use, with a superficial radial nerve biopsy confirming vasculitis. The second patient is a 23-year-old woman, with a history of acne vulgaris treated with minocycline, who presented with a subacute right common peroneal mononeuropathy followed by a left deep peroneal mononeuropathy, with elevated antinuclear, perinuclear-antineutrophil cytoplasmic, and myleoperoxidase antibodies, and MPO titers, and a sural nerve biopsy showing large arteriole vasculitis. Finally, we provide a comprehensive review of previously published cases.Medications should be considered as a trigger for medication-induced vasculitic neuropathy. Accurate diagnosis would ensure timely treatment.

ObjectiveTo assess the potential association between TNF-inhibitors and MOGADBackgroundThe association of tumor necrosis factor-a (TNF)-inhibitors with MS has previously been suggested, whereas little is known about MOG-IgG-associated disease (MOGAD) in the context of these drugs. We recently encountered two patients who developed MOGAD while receiving TNF-inhibitors, prompting a search for similar cases in the literature and clinical practice.Design/MethodsThe two cases were seen at Mayo Clinic, Rochester (bilateral optic neuritis) and the University-Hospital of Sassari (brainstem syndrome). Three additional cases of MOGAD presenting during treatment with TNF-inhibitors were identified through Pubmed. We searched the medical records of 336 MOGAD patients seen at the Mayo Clinic, to assess if they had been treated with TNF-inhibitors.ResultsA total of 5 patients were identified. The median age at MOGAD presentation was 40 years (range, 36-49); 4/5 were male (80%). The median time from TNF-inhibitor initiation to MOGAD presentation was 6.5 years (range, 2-18). Of 4 patients who discontinued the TNF-inhibitor due to MOGAD onset, two subsequently had a MOGAD relapse. While in another patient, neurological symptoms subsided with corticosteroids despite TNF-inhibitor being maintained. The frequency of MOGAD presenting during TNF-inhibitors treatment at Mayo Clinic was 0.3% (1/336 cases).ConclusionsWe found that MOGAD is unlikely to present during treatment with TNF-inhibitors. The outcomes in these patients seemed not to be influenced by TNF-inhibitor treatment duration or discontinuation. These findings suggest the benefit of TNF-inhibitor withdrawal is not obvious, and the choice of discontinuing vs maintaining treatment with TNF-inhibitors should be weighted based on symptoms severity and activity status of the underlying systemic disorder. When withdrawal is considered, immunosuppression with agents potentially effective for both MOGAD and the immune-mediated disease originally managed by the TNF-inhibitor, could serve as dual purpose treatment.

ObjectivesTo develop an Outcome Measures in Rheumatology (OMERACT) ultrasonography score for monitoring disease activity in giant cell arteritis (GCA) and evaluate its metric properties.MethodsThe OMERACT Instrument Selection Algorithm was followed. Forty-nine members of the OMERACT ultrasonography large vessel vasculitis working group were invited to seven Delphi rounds. An online reliability exercise was conducted using images of bilateral common temporal arteries, parietal and frontal branches as well as axillary arteries from 16 patients with GCA and 7 controls. Sensitivity to change and convergent construct validity were tested using data from a prospective cohort of patients with new GCA in which ultrasound-based intima–media thickness (IMT) measurements were conducted at weeks 1, 3, 6, 12 and 24.ResultsAgreement was obtained (92.7%) for the OMERACT GCA Ultrasonography Score (OGUS), calculated as follows: sum of IMT measured in every segment divided by the rounded cut-off values of IMTs in each segment. The resulting value is then divided by the number of segments available. Thirty-five members conducted the reliability exercise, the interrater intraclass correlation coefficient (ICC) for the OGUS was 0.72–0.84 and the median intrareader ICC was 0.91. The prospective cohort consisted of 52 patients. Sensitivity to change between baseline and each follow-up visit up to week 24 yielded standardised mean differences from −1.19 to −2.16, corresponding to large and very large magnitudes of change, respectively. OGUS correlated moderately with erythrocyte sedimentation rate, C reactive protein and Birmingham Vasculitis Activity Score (corrcoeff0.37–0.48).ConclusionWe developed a provisional OGUS for potential use in clinical trials.

Purpose: The purpose of this study was to examine if empathy levels correlate with practical examination scores in DPT students. It was hypothesized that students with higher empathy levels would receive better scores on practical examinations. Methods: Participants were a convenience sample of 49 first and second year DPT students from Franklin Pierce University in Goodyear, AZ. After obtaining informed consent, participants completed the Interpersonal Reactivity Index (IRI) to assess personal empathy. These scores were compared with participants’ practical examination scores using a Spearman Rho statistical test with data analysis completed using SPSS software. Results: 49 participants (26 females, 23 males) with mean practical examination score (92.5% ± 0.02) and mean empathy score (72.80 ± 18.66). Spearman Rho correlation (rs = 0.864, p < 0.000). Conclusions: A significant positive correlation between empathy and practical examination scores in physical therapy students was found. Educators can use these findings to provide resources to students to assist with practical examination performance.

The literature contains two different classifications of solvable Lie algebras of dimensions up to and including 4. This paper is devoted to comparing the two classifications and translating each into the other. In particular, we exhibit an isomorphism between each solvable Lie algebra of one classification and the corresponding algebra of the second. The first classification is provided by de Graaf, and the second classification is from a recent book by Snobl and Winternitz.

A 22-year-old man with a history of intravenous heroin misuse, presented with 1 week of fatigue and fever. Blood cultures were positive for methicillin-sensitive Staphylococcus aureus . Physical examination showed multiple painful 1–2 mm macular rashes on the palm and soles bilaterally (figures 1 and 2). Splinter haemorrhages (figure 3) and conjunctival petechiae (figure 4) were also noted. A transoesophageal echocardiogram demonstrated a 16-mm vegetation on the mitral valve (figure 5). Vegitations >10 mm in diameter and infection involving the …