Rheumatology

The author reviews how aortitis is detected, its many possible causes, and the workup and treatment of patients who are found to have it.

Dermoscopy of the skin lesions revealed homogeneous depigmented areas with perifollicular pigmentation.

The authors review clinical aspects of herpes zoster vaccination, including identifying at-risk patients, weighing the risks and benefits of the recombinant zoster vaccine, and using best practices for administering the vaccine.

The recommended conservative approach eschewing initial imaging in patients with acute or subacute low back pain is unlikely to miss a significant clinical problem in those with no “red flags,” though the evaluation should be tempered in patients with chronic low back pain.

After undergoing hip arthroplasty, the patient had hematoma formation in the pelvis, active bleeding from the surgical site, and a prolonged activated partial thromboplastin time. Careful evaluation led to the diagnosis of an acquired bleeding disorder.

This review highlights the differences between primary adrenal insufficiency, secondary adrenal insufficiency, including glucocorticoid-induced adrenal insufficiency, and glucocorticoid withdrawal syndrome.

Two articles this month highlight opposite ends of the treatment spectrum, one on introducing adjunctive corticosteroids when treating Pneumocystis pneumonia, and the other on syndromes associated with glucocorticoid withdrawal.

Guidelines and textbooks have recommended caution when using and withdrawing corticosteroids in patients with psoriasis, yet strong evidence that defines this association is hard to come by.

After tapering prednisone, the patient developed a circular plaque bordered with pustules superimposed on erythematous skin.

The patient had been on injectable insulin for the past 6 years, with frequent dose titrations because of poor control. A recent hemoglobin A1c was 7.2%.