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The herein report illustrates how a synovial tissue heavily infiltrated by neutrophils in the first weeks of arthritis, can evolve in few months to a synovial infiltration by lymphocytes with a characteristic pattern of rheumatoid arthritis (RA). This observation suggests a critical initial role of neutrophils in RA onset, which is eventually surpassed by the activation of the adaptive immune system. In addition, this patient, despite the absence of rheumatoid factors and anti-cyclic citrullinated peptide antibodies, progressed to a highly destructive and disabling disease, that was only controlled adequately with rituximab, due to the lack of response to methotrexate and serious adverse effects with TNF blockers therapy. [ABSTRACT FROM AUTHOR]

Background Sweet's syndrome is the most common neutrophilic dermatosis, but its pathophysiology is still largely unknown and different subgroups can be defined. Objectives To assess the clinical/laboratory factors in a series of patients with Sweet's syndrome and search for significant differences between defined subgroups. Methods A retrospective study of inpatient files with this diagnosis was made, and patients were included if they fulfilled the classical diagnostic criteria. Data were analyzed with the SPSS package, with a significance level of 5%. Results Forty-two patients fulfilled the inclusion criteria, with a median age of 50 years. Females comprised 88% of patients, and disease onset occurred in autumn or spring in over 70% of cases. A previous oropharyngeal infection was described by 38% of patients, and a previous or concomitantly diagnosed neoplasm by 10%. In contrast with the literature, the lower extremities were also involved in the majority of patients, and arthralgia was the most frequent extracutaneous manifestation. On bivariate analysis, in patients who reported a previous oropharyngeal infection, the lesions were significantly more frequent in autumn, and a shorter inpatient stay as well as a lower temperature on admission and lower prevalence of arthralgia were observed in the same group. Conclusions The subgroup of patients with a previous oropharyngeal infection had a less severe form of this syndrome. [ABSTRACT FROM AUTHOR]

We report a 35-year-old caucasian female with a history of polymorphic light eruption (PLE) who, after the outbreak of pruritic papules following the first sun exposure of the year, developed target lesions in two different bouts, the first on sun-exposed skin and the second on sun-protected sites. A diagnosis of erythema multiforme (EM) developing as a result of PLE was made. As far as we were able to search in the literature, EM occurring in two bouts has not been described previously. We discuss the differential diagnosis. [ABSTRACT FROM AUTHOR]

The herein report illustrates how a synovial tissue heavily infiltrated by neutrophils in the first weeks of arthritis, can evolve in few months to a synovial infiltration by lymphocytes with a characteristic pattern of rheumatoid arthritis (RA). This observation suggests a critical initial role of neutrophils in RA onset, which is eventually surpassed by the activation of the adaptive immune system. In addition, this patient, despite the absence of rheumatoid factors and anti-cyclic citrullinated peptide antibodies, progressed to a highly destructive and disabling disease, that was only controlled adequately with rituximab, due to the lack of response to methotrexate and serious adverse effects with TNF blockers therapy.

Angiosarcoma is the most common primary malignant tumour of the heart. It is a rare and aggressive neoplasm that almost always has a short and fatal evolution. By the time it produces symptoms it has usually progressed to a mass causing haemodynamic compromise. Initial presentation with metastatic disease is unusual. We report the case of a 72-year-old man who presented with painful skin lesions on both hands. The skin biopsy was diagnosed as intravascular metastasis of epithelioid angiosarcoma. Body computed tomography scan disclosed a solid mass in the left atrium. The tumour was judged unresectable and the patient was treated with systemic chemotherapy, consisting of liposomal doxorubicin, which resulted in a complete clinical response. The patient remains free of disease after 48 months of follow-up. The excellent clinical evolution of our patient verifies that liposomal doxorubicin may be effective in the treatment of these tumours and significantly prolong patients' lifespan.