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BACKGROUND One percent of paraneoplastic syndromes described in the literature present as cutaneous manifestations such as vasculitis, which may reveal potential initial diagnoses. Leukocytoclastic vasculitis is a subtype of small-vessel vasculitis. It affects the skin and internal organs, and diagnosis relies solely on histopathological examination. The literature on leukocytoclastic vasculitis linked with malignancies is scarce. CASE REPORT We present the case of a 60-year-old man with multiple cardiovascular comorbidities, presenting with dysuria and elevated prostate-specific antigen (PSA) levels. Further investigations led to diagnosis of metastatic prostate adenocarcinoma. Concurrently, he developed non-specific cutaneous lesions. He underwent hormonal therapy and radiotherapy. During initial treatment, the lesions rapidly progressed to necrotic ulcers; therefore, hormonal therapy was withheld. Extensive investigations ruled out potential infectious or rheumatological causes of the lesions, and histopathological analysis was consistent with cutaneous leukocytoclastic vasculitis. The patient underwent systemic corticoid treatment while continuing radiotherapy. Following completion of radiation therapy and a corticosteroid course, the patient showed good clinical response, with decreased PSA level, resolution of urological symptoms, and clinical improvement of the lesions. He was cleared for hormonal treatment continuation. CONCLUSIONS Given the temporal relationship between the onset of vasculitis, its exacerbation during first days of cancer treatment initiation and the rapid resolution following radiotherapy, a paraneoplastic etiology for leukocytoclastic vasculitis can be considered in this case. While the literature on leukocytoclastic vasculitis associated with malignancies is limited, clinicians must maintain vigilance to ensure timely and accurate diagnosis.

BACKGROUND Scleroderma is a chronic autoimmune disease characterized by angiopathy, autoimmunity, and fibrosis. One form of scleroderma, systemic sclerosis, is characterized by diffuse skin lesions and visceral involvement. Eosinophilic pleural effusion is a rare complication attributed to a large array of diseases. We present a case of a man with underlying systemic sclerosis who developed eosinophilic pleural effusion as a complication of associated Trichinella spiralis infection. CASE REPORT A 49-year-old man presented for bilateral inflammatory radio-ulnar-carpal joint pain, paresthesia of the hands and forearms and a 2-week history of right posterior aching thoracic pain and night sweats. The physical examination revealed sclerodermatous skin involvement of the hands, forearms, and forehead, sclerodactyly, Raynaud's phenomenon, and telangiectasias, together with muffled cardiac sounds and right basal abolishment of the vesicular breath sounds. Imagistic evaluation showed the presence of pleuro-pericardial fluid. A thoracocentesis highlighted the presence of an exudative eosinophilic pleural effusion. Laboratory findings showed leukocytosis, with elevated neutrophil and eosinophil counts. The patient was tested for a parasitic infection, but initially the results were negative. He started anti-inflammatory treatment, but no reduction of the pleural fluid was observed. Subsequent evaluation revealed specific anti-trichinella IgG antibodies. Albendazole and corticosteroid therapy were initiated, which resulted in remission of the symptoms. CONCLUSIONS This report highlights the possibility of developing rare or even not-until-now seen complications when 2 etiologically different diseases are associated. The physician should carefully assess the situation to find and resolve the underlying causes.

Background: Shared decision making (SDM) is very important from patients' perspective. This process has not yet been evaluated in Romania. The study aims to evaluate SDM from the patients' perspective and to evaluate patients' characteristics that associate with SDM., Material and Methods: A cross-sectional multicentric study comprising eight recruitment centres was performed. Inpatients and outpatients who referred to Hospital Units treating autoimmune diseases or atrial fibrillation were included. Another sample consisted of members of the Autoimmune Disease Patient Society, who completed an online anonymous questionnaire. All participants completed the Romanian translated version of the 9-item Shared Decision Making Questionnaire (SDM-Q-9), as these samples were used for the validation of this questionnaire, too. Patients had to refer to the visit in which the decision concerning the antithrombotic treatment was taken (atrial fibrillation patients), or the immunosuppressive treatment was last time changed (autoimmune disease patients). Ordinal regression having the total SDM score as dependent variable was used., Results: A total of 665 questionnaires were filled in within the hospital setting (n = 324; 48.7%) and online (n = 341; 51.3%). The median score for SDM was 34 of 45, but it differed between hospital completion -39/45 and online completion (anonymous) -20/45 (P < .001). Patients with higher education were influenced most by the setting, giving the best marks in hospital and low marks online, while those with lower education gave lower marks in both settings. In ordinal regression with SDM score as dependent variable, hospital completion of the questionnaire (OR = 9.5, 95% confidence interval, 5.69-16), collagen disease diagnosis (OR = 2.4, 95% confidence interval, 1.39-4.14), and immunosuppressive treatment (OR = 2.16, 95% confidence interval, 1.43-3.26) were independent predictors., Conclusion: In our study, full anonymity was associated with significantly lower scores for the SDM process. The patients with higher education were most influenced by this condition, while those with the lowest education were the most critical., (© 2019 John Wiley & Sons, Ltd.)

Background: Shared decision making (SDM) is becoming more and more important for the patient-physician interaction. There has not been a study in Romania evaluating patients' point of view in the SDM process yet. Therefore, the present study aims to evaluate the psychometric parameters of the translated Romanian version of SDM-Q-9., Material and Methods: A multicentric cross-sectional study was performed comprising eight recruitment centers. The sample consisted of in- and outpatients who referred to Hospital Units for treatment for atrial fibrillation or collagen diseases. Furthermore, patients who were members of Autoimmune Disease Patient Society were able to participate via an online survey. All participants completed the Romanian translated SDM-Q-9., Results: Altogether, 665 questionnaires were filled in within the hospital setting (n = 324; 48.7%) and online (n = 341; 51.3%). The Romanian version had good internal consistency (Cronbach α coefficient of 0.96.) Corrected item correlations were good ranging from 0.64 to 0.89 with low corrected item correlations for item 1 and item 7. PCA found a one-factorial solution (similar with previous reports) but the first item had the lowest loading., Conclusion: SDM-Q-9 is a useful tool for evaluation and improvement in health care that was validated in Romania and can be used in clinical setting in this country.

Background & Aims: Behçet's disease presents some similar clinical features with seronegative spondyloarthritides (SpA), raising the question whether a subgroup of patients with Behçet's disease belong in fact to the latter. As the already known inflammatory involvement at the level of the small bowel in SpA patients could not be extrapolated for patients with Behçet's disease associated SpA (BehSpA), the present study aims to investigate and compare it in these diseases., Methods: 54 consecutive patients with a form of SpA, and 7 patients with BehSpA were enrolled and submitted to videocapsule endoscopy (VCE) examination. After reviewing the VCE findings, calculation of the score of small bowel mucosal inflammatory change (Lewis) was performed for each patient. The comparison was made with a control group, sex and age-matched to the patients in the study groups., Results: The Lewis score differed in the groups considered for analysis (mean of 439, 179 and 81 in the SpA, BehSpA and the control group, respectively, with p = 0.04 for the comparison SpA vs. BehSpA and 0.05 for the comparison BehSpA vs. controls). C reactive protein (CRP) level was markedly reduced in the BehSpA group vs. the other SpA group (2.08 and 14.02 mg/L, respectively; p = 0.053)., Conclusion: The significant difference in intestinal inflammatory involvement in BehSpA versus the other SpAs, as well as the significantly lower serum levels of CRP, as revealed by the present study, clearly draw a line between the two disease entities.