No commercial re-use. See rights and permissions. Published by BMJ.This is a case of a 77-year-old woman with a 4.0 cm gas-containing iliopsoas bursa collection in the setting of mild-to-moderate degenerative joint disease. Given the limited extent of this patient's osteoarthritis and the absence of infectious signs or symptoms, both of which are typically related to gas collections at the hip, it was difficult to determine the aetiology of the patient's gas collection, whether it was related to her pain, and how best to manage her symptoms. Even in the setting of her MRI findings, which showed the gas collection lifting the iliopsoas tendon off the bone, the gas-containing bursa ultimately appeared to be a minor component of the patient's pain and definitive treatment of her underlying joint disease with a total hip arthroplasty allowed for successful pain management. Our case report demonstrates an unusual presentation of iliopsoas bursitis with a surprising response to medical, interventional and surgical management. © BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.A 50-year-old woman with a history of Crohn's disease treated with adalimumab presented with left hand pain and duskiness. Angiogram showed non-filling of the radial and digital arteries of the hand. Antiphospholipid antibody testing was positive, leading to a diagnosis of antitumour necrosis factor-induced antiphospholipid syndrome. Adalimumab was discontinued, and she was treated with the vitamin K antagonist warfarin and low-dose aspirin. Upon resolution of the antiphospholipid antibodies, she was transitioned to aspirin alone without recurrence of thrombosis. © BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.A 75-year-old man presented to the emergency department with 1-day history of right lower limb pain and 3-month history of vague abdominal pain. In the emergency department a thrombus was discovered in the right popliteal artery. CT scan of the abdomen and pelvis revealed high-density material in the pelvis, multiple hypodensities on the liver, ascites with omental nodularity, and high-density material along the stomach wall. He underwent thrombectomy and was started on anticoagulation therapy. The core needle biopsy revealed primary omental mesothelioma. There was no history of any known asbestos exposure. He also had to undergo therapeutic paracentesis twice due to abdominal distension. Mesothelioma treatment of carboplatin and pemetrexed was started, and the patient is currently receiving this chemotherapy treatment regimen. © BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.Penetrating injury of the orbit with a wooden stick is not an uncommon finding in ocular emergencies. A 36-year-old man presented with redness, pain in the left eye following fall from a motorcycle 3 days ago. Ocular examination showed features of combined anterior and posterior scleritis in the form of an anterior scleral nodule, retinal folds and T sign on ultrasonography. There was worsening of symptoms along with new onset diplopia following scleral deroofing which led to the suspicion of an intraorbital wooden foreign body (IOWFB). CT scan of orbit showed a well-defined hypodensity between the medial rectus and optic nerve resembling a pocket of air surrounded by a rim of hyperdensity. IOWFB was removed under direct visualisation via transconjunctival orbitotomy. This is the case of a missed retained IOWFB presenting with features of combined anterior and posterior scleritis. © BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.Non-displaced proximal humerus fractures are usually managed non-operatively despite of minor malalignment. Biceps tendon rupture due to attrition after malunion is rare around the proximal humerus. Rupture of the long head of biceps (LHB) tendon usually occurs inside the joint close to the origin at the labrum. Treatment is usually non-operative with good outcomes. We report a rare case of a 48-year-old female patient with persistent locking and internal impingement 8 months after a proximal humerus fracture with anterior angulation leading to extra-articular reversed LHB tendon rupture with intra-articular dislocation of the proximal stump. Interposition of the tendon (3.5 cm) between the glenoid and the humeral head was confirmed on MRI arthrogram. Arthroscopic proximal tenotomy and stump removal resulted in immediate relief with improved function (subjective shoulder value 95%; Constant Score 96). False interpretation of symptoms as posttraumatic stiffness should be avoided by a thorough examination and complementary MRI arthrogram investigation. © BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.A 25-year-old woman presented a challenging diagnosis of acute rheumatic fever (ARF). Initial symptoms included dry cough and three minor Jones criteria (unabating fever (38.4°C, 0d), elevated acute phase reactants (C-reactive protein, 13d) and joint pain (monoarthralgia) in her neck (0d)). ARF was diagnosed only after presentation of two major Jones criteria (polyarthritis/polyarthralgia (16d) and erythema marginatum (41d)) and positive antistreptolysin O titre (44d). Parotid swelling, peripheral oedema, elevated liver enzymes and diffuse lymphadenopathy complicated the diagnosis. Throat swab, chorea and carditis were negative or absent. Atypical ARF is challenging to recognise. There is no diagnostic test and its presentation is similar to that of other diseases. While the 2015 Jones criteria modification increased specificity of ARF diagnosis, atypical cases may still be missed, especially by physicians in developed countries. Suspicion of atypical ARF, especially after travel to high incidence regions, would allow for earlier treatment and prevention of rheumatic heart disease. © BMJ Publishing Group Limited 2020.  https://www.selleckchem.com/products/ABT-888.html  No commercial re-use. See rights and permissions. Published by BMJ.In Ecuador, a developing South American country, subjects affected with genetic syndromes of severe short stature are commonly referred to as dwarfs or midgets. Furthermore, and because in earlier studies some patients had evidenced mental retardation, such abnormality is assumed to exist in all affected subjects. Herein, we present two discrete instances in which this type of branding occurs. The first is that of individuals with Laron syndrome who are still called 'dwarfs' and considered as having a degree of mental retardation despite evidence showing otherwise. A similar problem, that of a girl affected with a genetic syndrome of short stature, which might include mental retardation, is also discussed. Considering that stigmatising is a form of discrimination, it concerns us all. Hence, the use of derogatory terms such as midget, dwarf or cretin, that might unintentionally occur even when delivering the best and most devoted medical care, must be eliminated. © BMJ Publishing Group Limited 2020. Re-use permitted under CC BY-NC.