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The article describes the case of a 69-year-old ethnic Chinese male who presented with periodic fevers associated with an urticarial eruption, cervical lymphadenitis, migratory arthralgia, pseudomembranous conjunctivitis, macrocytic anemia and raised acute-phase reactants. Topics covered include the findings of physical and laboratory examinations that led to the diagnosis of vacuoles, E1 enzyme, X-linked, antiinflammatory, somatic (VEXAS) syndrome, and patient outcome following treatment.

Background: Hypohidrosis is a risk factor for developing heat-related illnesses.Objective: To determine the prevalence of hypohidrosis in heat injury.Methods: Soldiers from the Singapore Armed Forces who developed heat injury between January 1, 2012 and December 31, 2013 were invited to participate in the study. Subjects were induced to sweat through exercising in a temperature- and humidity-regulated room, and then atomized starch-iodine powder was administered over their whole body to detect hypohidrosis. If this was found to be present, investigations to elucidate the cause of anhidrosis were performed.Results: Out of 65 males, 30 consented to participation. One was excluded because an exogenous cause resulted in heat injury. Nine (31%) demonstrated hypohidrosis. Of these, 1 (11%) had miliaria profunda, 2 (22%) had acquired idiopathic generalized anhidrosis and 6 (67%) manifested a new phenotype which we termed acquired symmetrical hypohidrosis (ASH).Conclusion: Thirty-one percent of healthy soldiers who developed heat injury had hypohidrosis. Concurrently, a new clinical phenotype of ASH was identified. [ABSTRACT FROM AUTHOR]