Table 2.
Case 1 | Case 2 | Case 3 | |
---|---|---|---|
Symptoms | Fever, abdominal pain, nasal stuffiness, back pain | Joint/extremity swelling, nodular rash (initially), neuritis | Fever, new painful skin lesions |
Exam findings | Abdominal tenderness, no rash | Joint swelling, erythematous lesions on back | Hypotension, diffuse nodular, tender rash, enlarged tender inguinal lymphadenopathy |
Laboratory findings | ESR: > 120 mm/hour | CRP: 28.67 mg/L | Creatinine: 1.8 mg/dL |
CRP: 10.82 mg/dL | WBCs: 5,600 cells/mL | ALT: 90 IU/L | |
WBCs: 2,900 cells/mL | Creatinine: 1.3 mg/dL | AST: 119 IU/L | |
Normal creatinine | Normal liver enzymes | WBCs: 23,400 cells/mL | |
Normal liver enzymes | Na: 124 mmol/L | ||
Radiographic findings | Abdominal CT: reactive mesenteric lymphadenopathy and hypodense splenic lesions | N/A | N/A |
Treatment | Prednisone | Prednisone and thalidomide | Prednisone → thalidomide |
Clinical course | Recurrence after 2 years with abdominal pain | Stable on low-dose prednisone and thalidomide after first recurrence | No recurrence after starting thalidomide |
ALT = alanine aminotransferase; AST = aspartate aminotransferase; CRP = C-reactive protein; CT = computed tomography; ESR = erythrocyte sedimentation rate; N/A = not applicable; Na = sodium; T2R = type 2 reaction; WBCs = white blood cells.