Presentations of perforated colonic pathology in patients with polymyalgia rheumatica: two case reports

<p>Abstract</p> <p>Introduction</p> <p>Polymyalgia rheumatica is an increasingly common disease in older people, which gives rise to arthralgia and is mainly treated with corticosteroids. Patients in this age group also have a higher incidence of other co-morbidities including colonic pathology. Corticosteroid usage may mask signs of sepsis or complications secondary to intra-abdominal pathology, thereby delaying diagnosis and treatment, with eventual adverse outcome. These two cases highlight the importance of awareness and prompt recognition of this condition in order to avoid significant morbidity and mortality.</p> <p>Case presentation</p> <p>Case 1</p> <p>A 73-year-old Caucasian woman with a diagnosis of polymyalgia presented with symptoms of an exacerbation in her right hip joint. Despite standard therapy with corticosteroids she failed to improve and started to develop features of widespread sepsis. Specific questioning revealed that, at the very onset of her symptoms, she had experienced mild diarrheal symptoms. Investigations revealed perforated diverticular disease with a peri-femoral abscess.</p> <p>Case 2</p> <p>A 69-year-old Caucasian woman with polymyalgia presented with left thigh pain and weakness associated with weight loss. A diagnosis of exacerbation of polymyalgia rheumatica was made and she was treated with corticosteroid therapy. Shortly afterwards she was admitted with generalized peritonitis. Laparotomy revealed a retroperitoneal abscess secondary to a perforated sigmoid colonic tumor.</p> <p>Conclusions</p> <p>Patients with polymyalgia may have perforated colonic diverticular disease which mimics their rheumatic pathology. In such cases steroid therapy, which is the mainstay of polymyalgia therapy, can be detrimental. Primary and hospital practitioners are encouraged to be vigilant regarding non-specific gastrointestinal symptoms and consider alternative diagnoses in those patients whose symptoms do not resolve with standard therapy, as this can lead to an overall better outcome.</p

Diet Therapy for Inflammatory Bowel Diseases: A Call to the Dining Table

The article comments on the recent systematic review and meta-analysis of dietary interventions for Crohn’s disease and ulcerative colitis. We discuss the pitfalls of current data and emphasize the importance of further research into diets and inflammatory bowel diseases

Folic acid deficiency optic neuropathy: A case report

<p>Abstract</p> <p>Introduction</p> <p>Nutritional optic neuropathies are uncommon and can be associated with gradual visual loss and optic atrophy or sudden vision loss and optic disc swelling.</p> <p>Case presentation</p> <p>A 44-year-old woman presented with a 4-week history of progressive visual loss and was noted to have bilateral retrobulbar optic neuropathy. No other clinical abnormality was noted. Investigations revealed severe folate deficiency with normal vitamin B12 levels. Her alcohol and tobacco consumption was moderate and subsequent correction of folate levels with oral supplementation has led to improvement in her visual acuity.</p> <p>Conclusion</p> <p>This case highlights an unusual presentation of folic acid deficiency that may present to the general physician.</p