Tuberculose hepática pseudotumoral / Pseudotumoral hepatic tuberculosis

Tuberculous involvement of the liver is usually a diffuse process, associated with miliary tuberculosis. However, localized tuberculosis of the liver producing a macronodular tuberculoma or an abscess is rare. The authors present a case of pseudotumoral hepatic tuberculosis in a 34-year old woman. This patient presented a 2 month history of fever, weight loss of 4kg and right upper quadrant abdominal pain. She denied jaundice, choluria, or acholia. Laboratory investigation, including renal and liver function tests, revealed normal levels. Chest X-ray was normal. Abdominal ultrasonography demonstrated a hypoechoic nodule in the right hepatic lobe. CT scan showed hypodense areas in the same place and no retroperitoneal lymphadenopathy. Due to the inespecificity of the signs, symptoms and image findings, a diagnostic laparoscopy was performed, it was however inconclusive. Then, the patient was submitted to a laparotomy with ressection of the lesion. Histological examination revealed a tuberculoid granulomatous lesion with caseous necrosis. Postoperatively, the patient was placed on antituberculous chemotherapy with rifampin, isoniazid and pyrazinamide. Eight months later, the patient is asymptomatic

Manifestações neurológicas da poliarterite nodosa: aspectos etiológicos, imunopatogênicos, clínicos e terapêuticos / Neurologic symptoms of Polyarteritis nodosa: etiology, immunopathology and therapeutic

A poliarterite nodosa (PAN) é uma vasculite necrotizante sistêmica que afeta artérias de pequeno e médio calibre e que tem grande variedade de formas clínicas, dependendo do território vascular comprometido, gravidade e distribuição das lesões dos vasos. O processo imunopatogênico determinante é o de lesão induzida por imunocomplexo. O diagnóstico correto advém da integração dos achados clínicos, laboratoriais e de imagem. A terapêutica baseia-se na imunoexpressão com o uso de corticoesteróides e agentes citotóxicos