Pląsawica u 13-letniej dziewczynki jako pierwszy objaw tocznia rumieniowatego układowego, a może innej zapalnej choroby tkanki łącznej? Opis przypadku

Pląsawicę określa się jako mimowolne hiperkinetyczne zaburzenia, polegające na nagłych, nieregularnych, bezcelowych ruchach dotyczących obwodowych części ciała. Wśród wyodrębnionych w klasyfikacji American College of Rheumatology (ACR) zaburzeń ruchowych w przebiegu tocznia rumieniowatego układowego (SLE) pląsawica odgrywa wiodącą rolę. Przyczyną pląsawicy są zmiany zwyrodnieniowe bądź naciekowo-zapalne w strukturach zwojów podstawnych, których zajęcie obserwuje się również w zespołach antyfosfolipidowych (APS). W pracy przedstawiono nietypowy przypadek 13-letniej dziewczynki, u której przez kilka tygodni obserwowano nasilające się ruchy mimowolne dotyczące prawej kończyny górnej. Po przeprowadzeniu szerokiej diagnostyki różnicowej wykluczono przyczyny neurologiczne objawów, zaś z uwagi na zaburzenia koagulologiczne oraz obciążający wywiad rodzinny w kierunku chorób autoimmunologicznych u pacjentki wysunięto podejrzenie SLE. W badaniach dodatkowych, poza utrzymującymi się zaburzeniami w zakresie układu krzepnięcia, stwierdzano graniczne miano przeciwciał ANA, bez obecności przeciwciał anytgenowo-swoistych. Pacjentka spełniała kryteria laboratoryjne APS. Wobec nasilania się objawów pląsawiczych pod postacią powłóczenia kończyny dolnej i bełkotliwej mowy, u pacjentki zdecydowano o rozszerzeniu diagnostyki obrazowej o badanie SPECT uwidaczniając rozsiane ogniska niedokrwienne. Pomimo że pacjentka nie spełniała kryteriów rozpoznania SLE, w leczeniu zastosowano pulsy z metylprednizolonu, uzyskując spektakularną poprawę kliniczną

The trace fossil Lepidenteron lewesiensis: a taphonomic window on diversity of Late Cretaceous fishes

The trace fossil Lepidenteron lewesiensis (Mantell 1822) provides an exceptional taphonomic window to diversity of fishes as shown for the Upper Cretaceous of Poland, in the Middle Turonian–Lower Maastrichtian deposits of the Opole Trough, Miechów Trough, Mazury-Podlasie Homocline, and SE part of the Border Synclinorium. Lepidenteron lewesiensis is an unbranched burrow lined with small fish scales and bones, without a constructed wall. It contains scales, vertebrae, and bones of the head belonging to ten taxa of teleostean fishes: two undetermined teleosteans, six undetermined Clupeocephala, one Dercetidae, and one undetermined euteleostean. The preservation of fish remains suggests that fishes were pulled down into the burrow by an animal, probably by eunicid polychaetes.Das Spurenfossil Lepidenteron lewesiensis (Mantell 1822) ermöglicht einen biostratinomischen Einblick in die Diversität von Fischen, wie Fossilmaterial aus der Oberkreide von Polen zeigt. Es stammt aus dem Mittelturonium bis Untermaastrichtium des südöstlichen Abschnittes der Grenz-Synklinale, dem Opolen-Trog, dem Miechów-Trog und der Masuren-Podlachien-Homoklinale. L. lewesiensis ist ein unverzweigter Grabgang ohne ausgekleidete Wände, dessen Ränder von kleinen Fischschuppen und—knochen gebildet werden. Diese setzen sich aus Schuppen, Wirbel und Schädelknochen von zehn Teleostei-Taxa zusammen und zwar aus zwei unbestimmte Teleosteer, sechs unbestimmten Clupeocephala, einem Dercetidae und einem unbestimmten Euteleostei. Die Erhaltung der Fischüberreste deutet darauf hin, dass die Fische von einem Tier, wahrscheinlich einem Polychaeten der Familie Eunicidae, in den Bau gezogen wurden.We are very grateful to Dr. Lionel Cavin (Geneva) and the anonymous reviewer for constructive comments on an earlier version of the manuscript. Additional support was provided by the Jagiellonian University (DS funds), National Science Center (Grant Number: PRO-2011/01/N/ST10/07717), and the Laboratory of Geology (University of Lodz) BSt Grant No. 560/844. We are grateful to Dr. Johann Egger (Wien) and Kilian Eichenseer M.Sc. (Erlangen) for help with translating the abstract into German. We are grateful to Dr. Ursula Göhlich (Wien) for access to the Dercetis specimen

Ewolucja basenu kredowego na obszarze lubelskim wzdłuż strefy Teisseyre'a-Tornquista(SE Polska)

The Cretaceous basin of the Lublin area belongs to the SE part of the Mid-Polish Trough and its NE border extending on the East European Craton. Our study is based on isopach maps of seven time intervals, from Neocomian to Early Maastrichtian. Several main lithofacies have been distinguished whose areal extents were plotted on thickness pattern maps. The isopach and lithofacies maps helped to delimit the basin depocenter, providing information on vertical motions of the basin basement and synsedimentary reactivation of older fault zones. The areal extents of the siliceous and chalk lithofacies have been shown to be controlled by the positions of discontinuity zones in the crystalline basement. Two stages of accelerated subsidence have been established: in Turonian and Early Maastrichtian times. Regional comparisons of accumulation rates and their accelerations during these time spans gave possibility to distinguish the roles of eustatic and tectonic factors in the process of augmenting the basin capacity. Some remarks concerning Early Maastrichtian timing of the inversion onset are also presented

When a patient suspected with juvenile idiopathic arthritis turns out to be diagnosed with an infectious disease – a review of Lyme arthritis in children

Abstract The Lyme arthritis is a common manifestation of infection with Borrelia burgdorferi spirochete. Despite its infectious background, the inflammation clinically and histopatologically resembles juvenile idiopathic arthritis. As it affects a considerable number of Lyme disease patients, it should be routinely considered in differential diagnosis. Development of arthritis is partially dependent on spirochetal factors, including the ribosomal spacer type and the sequence of outer surface protein C. Immunological background involves Th1-related response, but IL-17 provides an additional route of developing arthritis. Autoimmune mechanisms may lead to antibiotic-refractory arthritis. The current diagnostic standard is based on a 2-step testing: ELISA screening and immunoblot confirmation. Other suggested methods contain modified two-tier test with C6 ELISA instead of immunoblot. An initial 28-day course of oral antibiotics (doxycycline, cefuroxime axetil or amoxicillin) is a recommended treatment. Severe cases require further anti-inflammatory management. Precise investigation of new diagnostic and therapeutic approaches is advisable

Joint manifestations in children infected with Ascaris lumbricoides and Toxocara canis – single centre experience

Joint disorders in children are a frequent cause of parents’ concern and a reason of visiting family doctors and rheumatologists. In search for the correct diagnosis, a wide differential diagnosis should be conducted, including bacterial, parasitic, but also rheumatoid or proliferative process. However, the majority of complaints reported by children are reactive in nature. Diagnosis is based on the clinical symptoms and serology tests results. Ascaris lumbricoides or Toxocara canis infection may manifest itself not only with gastrointestinal, but also musculoskeletal symptoms, depending on the period of the disease. The aim of the paper was to assess the frequency of complaints associated with the locomotor system in children with the presence of serum antibodies against Ascaris lumbricoides and/or Toxocara canis and to analyse their relationship with selected laboratory tests (eosinophilia) and the final diagnosis. Material and methods: Medical records of 86 children hospitalised in 2013–2015 at the Department of Paediatric Cardiology and Rheumatology, Medical University of Łódź, were analysed. Children with musculoskeletal symptoms and positive serum antibody titres against Ascaris lumbricoides and/or Toxocara canis were included in the study. Results: Among the infected patients, the most frequently reported complaint from the locomotor system was knee (51%) and wrist (19%) pain. Ascaris lumbricoides infection was the dominant human parasitosis (66%), while in 15 patients (17%) Toxocara canis co-infestation was detected. Rheumatoid process was the most common suspicion (36%), but the final diagnosis of juvenile idiopathic arthritis was determined in only 12 patients (14%). Conclusions: Parasitic infections often coexist with articular symptoms reported by children and should always be excluded in the differential diagnosis. In some cases, a parasitic infection may be one of the factors that initiate the rheumatoid process

Serum Angiogenesis Markers and Their Correlation with Ultrasound-Detected Synovitis in Juvenile Idiopathic Arthritis

Synovial angiogenesis is considered to be an important early step in the pathogenesis of juvenile idiopathic arthritis (JIA). In this study we assessed levels of angiogenic markers in serum or synovial fluid and their possible relevance to disease activity or degree of ultrasound signs of synovial inflammation and angiogenesis in early JIA. The concentration of vascular endothelial growth factor (VEGF), its soluble receptors 1 and 2 (sVEGF-R1, sVEGF-R2), and angiopoietins 1 and 2 (ANG-1, ANG-2) were evaluated in 43 JIA patients and 23 healthy controls. Synovial angiogenesis was assessed by means of Power-Doppler Ultrasonography (PDUS), according to the fourth-grade vascularity scale. VEGF and its receptors’ (sVEGF-R1, sVEGF-R2) serum levels were significantly higher in JIA patients (p=0.002). We found large variation in serum ANG-1 and ANG-2 levels. The PDUS imaging identified increased synovial microvascular blood flow in 15 (35.7%) examined JIA children. Intensity of joint vascularization correlated with higher serum VEGF and its levels was lowest in grade 0 and highest in grade 3 (p<0.007 and p<0.001, resp.). In conclusion, the high correlation between synovial microvascular blood flow, serum angiogenic proteins, and symptoms of synovitis may indicate its important role in pathogenesis of JIA

Panniculitis in an 11-year-old girl – symptom of cat scratch disease or systemic lupus erythematosus onset?

Panniculitis is defined as an inflammation of the subcutaneous tissue of varying aetiology. It may appear in many systemic diseases, and often occurs in patients suffering from systemic inflammatory connective tissue diseases. It is observed mainly in the course of lupus erythematosus discoides (2–3% of patients), but it may be an early symptom of developing the systemic form of lupus erythematosus. In this paper we present a case of a patient with a severe course of panniculitis manifested as a painful, tough and warm skin lesion on the side of the thigh. It was accompanied by systemic symptoms, such as hectic fever, splenomegaly, and lymphadenopathy. In addition, tuberculosis, Lyme disease, salmonellosis and cat scratch disease antibodies were found positive. Despite aggressive antibiotic and anti-inflammatory therapy, there were no satisfactory results. Steroid therapy was attempted (pulses, followed by oral doses of methylprednisolone), which resulted in an effective clinical outcome