engleski

Occurence of chondritis of the nose in a patient with SLE

We present a case of 55-year-old male patient whose initial symptoms started several years ago as low back pain. He was successfully treated with physical rehabilitation. Two years later after an upper respiratory tract infection his condition worsened and he reported swelling and pain of both ankles, knees, feet, fists and jaw followed by high grade fever. Detailed clinical and laboratory work-up has been compatible with seronegative non-erosive polyarthritis. His symptoms gradually diminished with steroids and later with salazopyrine and NSAR therapy. Several months later arthritis relapsed during the attempt to tapper steroids. Higher doses of steroids, SSZ and introduction of gold salts improved his condition. In the following years new episodes of arthralgias, urticarial rush, night sweats, weight loss and inguinal lymphadenopathy arose the suspicion of lymphoma but during repeated evaluations no signs of malignant hematological disease were found. Patient has been followed on regular basis in the outpatient clinic. His serological status was always non-significant with fluctuating acute phase reactants. During the period of one year he developed progression of new symptoms: pain in the muscles of upper and lower extremities after minimal physical exertion with muscle atrophy. His joints became looser and instable and he repeatedly sprained his shoulder. He developed valgus position of knees and ankles. He also reported weight loss, poor sight and hearing, conjunctivitis and deformation of the basis of his nose with lowering of the its top. The suspicion of occult neoplasm with paraneoplastic syndrome has not been proved during a detailed hospital work-up. Isolated chondritis of nose with no metabolic bone disorder has been confirmed. Serological findings (ANA, anti-dsDNA, anti-histone, anti-SSB) have been diagnostic for SLE. He was discharged with therapy comprising of steroids, MTX and antimalarials.

SLE; polychondritis

nije evidentirano