Eyelid ecchymosis and proptosis in lymphangioma.
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This article reports a patient with Ehlers-Danlos syndrome for whom the syndrome was diagnosed as a result of her TMJ complaints. The surgical management of the patient's joint laxity is discussed, and a review of the syndrome's biochemical basis, clinical features, and importance to the surgeon is presented.
Stomatitis areata migrans, unlike its analogue on the tongue, migratory glossitis, is not easily recognized and is so uncommon and varied in appearance that it may escape definitive diagnosis. It may be so puzzling to the clinician that the patient's credibility may be questioned. A detailed report of a case is presented in which an atypical migratory stomatitis went undiagnosed. Bizarre patient behavior followed in the form of self-inflicted injury (Munchausen syndrome) as the patient attempted to convince the care providers of the true existence of lesions in order to maintain their interest and to obtain relief from discomfort.
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A 68-year-old woman suffered from spontaneous hemarthrosis of the right elbow joint in april 1994. Cutaneous ekchymoses had been noted since summer 1993. Prothrombin time was prolonged (Quick percentage 40-50%) and was not corrected by prolonged administration of vitamin K. Coagulation studies showed isolated factor X (FX) deficiency without circulating FX inhibitor. This suggested the diagnosis of systemic amyloidosis which was retrospectively confirmed in small bowel biopsy specimens obtained one year before. Bilateral femoral head necrosis and femoral neck fracture due to amyloidosis, necessitated orthopedic surgery. The patient died four weeks postoperatively after several episodes of bleeding complications. Isolated FX deficiency may be hereditary but should--in the clinical context--also evoke the diagnosis of systemic amyloidosis. The possible bleeding tendency associated with amyloidosis is not attributable to acquired FX deficiency alone, but may also be caused by amyloid deposition in the microvasculature leading to acquired vascular hemorrhagic diathesis.
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Neuro-ophthalmic manifestations are common in giant cell arteritis (GCA) and sometimes may be the only presenting feature. Clinicians should be aware of typical and atypical features of GCA in order to intervene in time before permanent damage occurs.
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