¹Haider Al Attia

¹Al Hosn Medical Centre

Background(s): This presentation spans through live cases managed in Immuno/Rheumatological ward and all have special areas of radiological findings that add up to their academic interest

Method(s): 6 cases of unusual (Immuno-Rheumatological features ) are being presented.

Result(s): 1- A female with considerable skeletal deformities due to (spondyloepiphyseal dysplasia congenita) found to be asthmatic as well. She is noticed to have bronchial asthma which seemed to be additionally aggravated by the physical effect of extensive calcifications of the bronchial tree (Tracheobronchopathia osteochondroblastica).  2- A 20- year old Arab female with  livedo reticularis , multiple skin ulcers  attributed to  APL syndrome .She experienced repeated CVAs due to Right middle cerebral artery stenosis thus fulfilled the diagnosis of Sneddon’s syndrome.3- A female with relapsing multiple skin nodulosis and Raynaud’s phenomenon found to have SLE .She was found to have Christian Weber syndrome to be followed by episode of non-infective endocarditis indicated a Libman Sack ‘s syndrome on Echocardiography. 4- A 29 –year old female with PAPS developed significant pigmentation and found to be hypotensive as well. Hormonal evaluation indicated Addison disease which was related to a bilateral adrenal vein thrombosis. 5-A female with H/O lupus nephritis was found to Evan’s syndrome ( haemolytic anemia ,thrombocytopenia in SLE) .Furthermore, what is thought to be clinically a hepatosplenomegaly turned to be a (Beaver Tail liver anomaly) that could easily be mistaken as splenomegaly. 6- A 52- year old female presented with painless multiple  bilateral hand  nodules that was thought  initially to be  erythema elevatum diutinum and arthralgia . She RF negative but positive to anti CCP Abs. However, the hands and CXR  X-rays were within normal values. The MRI surprisingly indicated joint erosions . ACE was within normal values too. Nodular biopsy showed features of sarcoidosis. The case is unusual in the sense of being presented with positive anti CCP Abs cutaneo-arthritic sarcoidosis without pulmonic disease or it may reflect an overlap  syndrome of sarcoidosis/RA.

Conclusion(s): The cases presented in this series have a wide variety of clinicopathological features along with extensive laboratory work up however , the role of various radiological modalities was highly diagnostic and or in some was of  feature adding value