Dietary advice in systemic sclerosis: the dangers of a high fibre diet

Article Abstract:

A high-fiber diet may be inadvisable for patients with systemic sclerosis. Systemic sclerosis is an autoimmune disease often associated with gastrointestinal atrophy and reduced colon activity. Four patients were advised to begin a high-fiber diet for constipation, and all developed abdominal pain and distention. Two required hospital care and one patient required colostomy surgery. The sudden introduction of dietary fiber in patients with systemic sclerosis can lead to colon impaction and perforation. A low-fiber diet, or the gradual introduction of fiber, is advised. Lactulose laxatives may be useful if constipation is excessive.

Complications and side effects, Systemic scleroderma, Scleroderma (Disease), High-fiber diet, High fiber diet

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A man with intermittent fever and arthralgia

Article Abstract:

A 44-year-old man with recurrent fever and joint pain, which progressed without diagnosis for six years, was determined to have Whipple's disease after a bout of diarrhea and weight loss. Whipple's disease is caused by the actinomycete bacterium Tropheryma whippelii and usually affects people who work around farms. Patients often develop joint pain, arthritis, fever, cough, fatigue, and gastrointestinal symptoms, which may develop over many years. Untreated, the infection can spread to the central nervous system and is fatal. Co-trimoxazole antibiotic therapy for a year or more is indicated.

Care and treatment, Whipple's disease, Fever, Co-trimoxazole, Trimethoprim-sulfamethoxazole (Drug combination)

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Chronic fatigue, arthralgia, and malaise

Article Abstract:

Many types of infections can mimic the symptoms of arthritis over a long period of time. Work history may give doctors important clues to identifying a patient's disease. Doctors found a Yersinia pseudotuberculosis infection in a 25-year-old veterinary nurse after six years of monthly arthritis-like episodes, stomach and intestinal pain, bloody diarrhea, and persistent fatigue. This patient apparently acquired Yersinia infection by handling an infected animal at work. Treatment with tetracycline resolved all of the symptoms.

Diagnosis, Physiological aspects, Bacterial infections, Chronic fatigue syndrome

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