Masquerades/Mimics

Question 1

MC rheum cause of FUO

Answer 1

giant cell arteritis (large vessel arteritis)

Question 2

most specific test for SLE

Answer 2

anti-smith Ab

(anti dsDNA also quite specific)

(ANA very sensitive, but not specific)

Question 3

anti-Ro/SSA

anti-La/SSB

Answer 3

Sjogren

Question 4

c-ANCA

Answer 4

GPA

Question 5

p-ANCA (antimeyloperoxidase)

Answer 5

eosinophilic granulomatosis w/ polyangiitis

Question 6

fever

arthralgia/myalgia

extremity claudication

weak pulses

discrepant BP

Answer 6

takayasu (large vessel)

Question 7

F, peripheral neuropathy, A/M, abd pn

cutaneous disease: nodules, ulcers, palpable purpura

multiorgan ischemia: look for GI, renal, and CNS (stroke-like) presentation

mimics IE w/ septic embolization

multiple aneurysms

Answer 7

polyarteritis nodosa (medium-vessel)

Question 8

palpable purpura in LEs (any pressure or gravity-dep area)

arthritis/arthralgia

recurrent abd pain (can be severe)

glomerulonephritis

testicular pain (mimics epididymitis)

Answer 8

consider IgA vasculitis (formerly Henoch-Schonlein purpura)

Question 9

recurrent F (lasts 1-3 days)

+

serositis (signs of peritonitis and pleuritis)

+

erysipelas-like erythema on legs

Answer 9

think of FMF

Question 10

recurrent F (lasts >7 days)

migratory rash

eye involvement common (periorbital edema, conjunctivitis)

Answer 10

think TRAPS

Question 11

elevated IgD (often IgA as well)

recurrent F (lasts 3-7 days)

usually presents 1st yr of life

triggered by vaccines

Answer 11

HyperIgG Syndrome (HIDS)

Question 12

brief episodes of fever, conjunctivitis, and urticarial rash after cold exposure

Answer 12

cryopyrin-associated periodic syndrome (CAPS)

Question 13

fever w/ aphthous ulcers, pharyngitis, and adenitis

3-6 days every 3-4wks like clockwork

Answer 13

PFAPA

Question 14

50yo

daily fevers

chronic urticarial rash, skeletal hyperostosis, LAD

Answer 14

Schnitzler’s syndrome

Question 15

F + cervical LAD in young (usually Asian) female

Answer 15

think Kikuchi’s disease

DX: bx w/ necrosis and significant histiocytic inflammation

TX: steroids

Question 16

Non-infectious causes of pathergy

Answer 16

sweet’s syndrome

pyoderma gangrenosum

Behcet syndrome

(ALL demonstrate neutrophilic dermatosis on skin bx)

Question 17

Indolent, fever rare

Papule at site of trivial trauma –> painful ulcer w/ violaceous/red border and necrotic base

dx? and what assoc syndromes?

Answer 17

pyoderma ganrenosum

• IBD MC
• also inflammatory arthritis
• solid organ/heme malignancy

Question 18

• recurrent cellulitis (cartilage inflammation - not true cellulitis)
• saddle-nose
• cauliflower ear
• sparing of ear lobe
• parasternal joint involvement

Answer 18

buzz words for relapsing polychondritis

Question 19

• evanescent, salmon-colored rash
• multi-system illness
• elevated ferritin
• pharyngitis
• Koebner (rash elicited by stroking skin/areas of pressure)

Answer 19

Adult Still’s buzz words

Question 20

• acute onset
• always febrile
• neutrophilic dermatosis
• Esp in setting of malignancy (AML), IBD, recent URI, vaccination, pregnancy

Answer 20

Sweet syndrome buzz words

Question 21

• self-limited fever + cervical LAD (esp unilateral/posterior)
• morbiliform exantham
• variably leukopenic with atypical lymphocytes

LN bx: necrotizing histiocytic infiltrate (not neutrophils)

Answer 21

consider kikuchi disease

young women w/o racial/ethnic proclivity

Question 22

• morning stiffness in proximal muscles (shoulder and hip)
• difficulty initiating movement after prolonged immobility

Answer 22

buzzwords for PMR

Question 23

Infections a/w HLH

Answer 23

• EBV (other herpesviridae)
• HIV
• histo
• Ehrlichia

Question 24

triad: hilar LAD, acute arthritis (ankles MC), erythema nodosum

Answer 24

Lofgren sydnrome (Sarcoid)

***uveitis, aseptic meningitis w/ basilar enhancement, non-caseating granulomas

Question 25

Presentations of Behcets

Answer 25

mucosal ulcers on mouth/genitals + GI (vs CMV) Aseptic meningitis (vs HSV) Visual changes Pathergy (needle/IV site)

Question 26

Minor Criteria for Still's

Answer 26

1. sore throat 2. LAD 3. HM/SM 4. abnormal LFTs 5. negative ANA/RF

Question 27

pustule at site of venipuncture

Answer 27

Behcets

Question 28

HLH clues

Answer 28

* EBV (or other infection with progressive sx) * massively elevated ferritin * cytopenia with negative ID w/u

Question 29

periodic episodes of fevers + serositis PLUS colchicine responsiveness mediterranean ethnicity

Answer 29

FMF buzz words

Question 30

Causes of EN

Answer 30

**_"NODOSUM"_** * **NO** cause \>50% * **D**rugs: sulfonamides, PCNs * **O**ral contraceptives * **S**arcoid (Lofgren's syndrome) * **U**lcerative colitis (or Crohn's or Behcets) * **M**icrobes (EBV, HBV/HCV, strep, bartonella, TB, endemic fungi)

Question 31

Major criteria for Still's

Answer 31

1. Fever \>39C for 1+ week 2. Arthritis/arthralgia \>2wk 3. typical rash (during fevers) - salmon-evanescent 4. WBC \>10k (\>80% PMNs)

Question 32

syndromes a/w saddle-nose deformity

Answer 32

* Relapsing polychondritis * Lepromatous leprosy * Congenital syphilis * Leishmaniasis * GPA * Cocaine use

Question 33

young woman (asian ancestry) carotidynia (pn w/ palpation) decreased pulses extremity claudication visual changes TIA

Answer 33

Takayasu arteritis dx via arteriography

Question 34

longstanding asthma new infiltrates and eosinophilia as steroids tapered rash (tender nodules on extensor surfaces, purpura, ecchymosis, necrosis) fever uncommon

Answer 34

buzz words for Churg-Strauss