Espondilodiscite: um diagnóstico diferencial raro de dor abdominal / Spondylodiscitis: a rare differential diagnosis of abdominal pain

Espondilodiscite é um processo inflamatório, geralmente infeccioso, que acomete os discos intervertebrais e as vértebras associadas. O diagnóstico pode ser bastante difícil, devido à raridade da doença, à sintomatologia insidiosa e à alta prevalência de dor lombar na populaçãogeral. Este relato descreve o caso de paciente admitido em serviço de Gastroenterologia com dor abdominal e lombar, acompanhada de emagrecimento progressivo. A propedêutica realizada foi fundamental para o diagnóstico e a exclusão de outras causas. O tratamento conservador foi suficiente para a completa recuperação do paciente.

Spondylodiscitis is an inflammatory process, often of infectious origin, that attacks the intervertebral disks and related vertebra. Diagnosis may be very difficult because it is a rare disease of insidious symptoms and also because of the high incidence of backache in the general. This report describes the case of a patient admitted to the Gastroenterology service with a complaint of abdominal and lumbar pain followed by progressive weight loss. Propaedeutics used had fundamental importance in the diagnosis and elimination of other causes. Conservative treatment was enough to achieve patient recovery.

The presence of Helicobacter pylori in the liver depends on the Th1, Th17 and Treg cytokine profile of the patient

The hypothesis that Helicobactermight be a risk factor for human liver diseases has arisen after the detection of Helicobacter DNA in hepatic tissue of patients with hepatobiliary diseases. Nevertheless, no explanation that justifies the presence of the bacterium in the human liver has been proposed. We evaluated the presence of Helicobacterin the liver of patients with hepatic diseases of different aetiologies. We prospectively evaluated 147 patients (106 with primary hepatic diseases and 41 with hepatic metastatic tumours) and 20 liver donors as controls. Helicobacter species were investigated in the liver by culture and specific 16S rDNA nested-polymerase chain reaction followed by sequencing. Serum and hepatic levels of representative cytokines of T regulatory cell, T helper (Th)1 and Th17 cell lineages were determined using enzyme linked immunosorbent assay. The data were evaluated using logistic models. Detection of Helicobacter pylori DNA in the liver was independently associated with hepatitis B virus/hepatitis C virus, pancreatic carcinoma and a cytokine pattern characterised by high interleukin (IL)-10, low/absent interferon-γ and decreased IL-17A concentrations (p < 10-3). The bacterial DNA was never detected in the liver of patients with alcoholic cirrhosis and autoimmune hepatitis that are associated with Th1/Th17 polarisation. H. pylori may be observed in the liver of patients with certain hepatic and pancreatic diseases, but this might depend on the patient cytokine profile.

Fibromialgia e infecção crônica pelo vírus da hepatite C: ausência de associação em duas amostras / Fibromyalgia and hepatitis C virus chronic infection: lack of association in two samples

OBJETIVO: avaliar a possível associação entre fibromialgia e infecção crônica pelo vírus da hepatite C (VHC). MÉTODOS: estudo transversal com 186 pacientes fibromiálgicas e 55 pacientes com diagnóstico de doenças difusas do tecido conjuntivo (DDTC) não-fibromiálgicas, e em 33 pacientes com infecção crônica pelo VHC e 34 controles sem doenças infecciosas relacionadas ao fígado, todas do sexo feminino e de idade igual ou superior a 18 anos. A fibromialgia foi diagnosticada segundo os critérios classificatórios do American College of Rheumatology (ACR) de 1990. Infecção crônica pelo VHC foi definida pela presença do RNA do vírus por meio da reação em cadeia da polimerase (PCR). As demais variáveis consideradas para as manifestações extra-hepáticas associadas à infecção crônica compreenderam: fadiga, parestesias, fenômeno de Raynaud, sintomas de boca e/ou olhos secos, depressão e presença de títulos detectáveis de anticorpos antitireoidianos. RESULTADOS: a infecção crônica pelo VHC foi detectada em três pacientes (1,6 por cento) do grupo fibromiálgico e em nenhuma das pacientes com o diagnóstico de DDTC (p = 0,39). A dor musculoesquelética crônica disseminada foi mais prevalente no grupo de pacientes infectadas pelo VHC (45,5 por cento) do que no grupo-controle (26,5 por cento), mas não foi detectada associação entre fibromialgia e infecção crônica pelo VHC (OR = 1,39; IC 95 por cento = 0,43-4,57). Dentre as manifestações extra-hepáticas, apenas os sintomas relativos a boca e/ou olhos secos apresentaram uma associação com a infecção crônica (OR = 6,40; IC 95 por cento = 1,94-21,87). CONCLUSÃO: o estudo não detectou uma associação entre fibromialgia e infecção crônica pelo VHC.

OBJECTIVE: to evaluate a possible association between fibromyalgia and hepatitis C virus (HCV) chronic infection. METHODS: cross-sectional study comprising 186 fibromyalgic women, 55 non-fibromyalgic controls with a diagnosis of diffuse connective tissue diseases (DCTD), 33 HCV chronically infected women and 34 selected from the gastroenterology outpatient clinic with no liver related infection disease, all aged 18 or older. Fibromyalgia was diagnosed according to the American College of Rheumatology (ACR) classification criteria. Chronic HCV infection was defined by detection of HCV-RNA using the polymerase chain reaction (PCR). Other extra-hepatic manifestations comprised: fatigue, paresthesia, Raynaud´s phenomenon, sicca symptoms, depression and detectable thyroid autoantibodies. RESULTS: HCV-RNA was detected in 3 of the 185 fibromyalgic women (1.6 percent) and in none of the 55 DCTD group (p = 0.39). Chronic widespread musculoskeletal pain was more prevalent in the infected group (45.5 percent) than in the non-infected (26.5 percent), but no association was found between fibromyalgia and HCV chronic infection (OR = 1.39; 95 percent CI = 0.43-4.57). With the regard to other variables, only sicca symptoms were found to be associated with chronic infection (OR = 6.40; 95 percent CI = 1.94-21.87). CONCLUSION: we found no association between fibromyalgia and chronic HCV infection.