ABSTRACT
CONTEXT: The term pulmonary-renal syndrome has been used frequently to describe the clinical manifestations of a great number of diseases in which pulmonary hemorrhage and glomerulonephritis coexist. The classic example of this type of vasculitis is Goodpasture´s syndrome, a term used to describe the association of pulmonary hemorrhage, glomerulonephritis and the presence of circulating antiglomerular basement membrane antibodies (anti-GBM). Among the several types of systemic vasculitides that can present clinical manifestations of the pulmonary-renal syndrome, we focus the discussion on two types more frequently associated with antineutrophil cytoplasm antibodies (ANCA), microscopic polyangiitis and Wegener´s granulomatosis, concerning a 10 year old girl with clinical signs and symptoms of pulmonary-renal syndrome, with positive ANCA and rapidly progressive evolution. CASE REPORT: We describe the case of a 10-year-old girl referred to our hospital for evaluation of profound anemia detected in a primary health center. Five days before entry she had experienced malaise, pallor and began to cough up blood-tinged sputum that was at first attributed to dental bleeding. She was admitted to the infirmary with hemoglobin = 4 mg/dL, hematocrit = 14 percent, platelets = 260,000, white blood cells = 8300, 74 percent segmented, 4 percent eosinophils, 19 percent lymphocytes and 3 percent monocytes. Radiographs of the chest revealed bilateral diffuse interstitial alveolar infiltrates. There was progressive worsening of cough and respiratory distress during the admission day, when she began to cough up large quantities of blood and hematuria was noted. There was rapid and progressive loss of renal function and massive lung hemorrhage. The antineutrophil cytoplasm antibody (ANCA) test with antigen specificity for myeloperoxidase (anti-MPO) was positive and the circulating anti-GBM showed an indeterminate result
Subject(s)
Humans , Female , Child , Antibodies, Antineutrophil Cytoplasmic/blood , Kidney Diseases/pathology , Lung Diseases/pathology , IgA Vasculitis/pathology , Fatal Outcome , Kidney Diseases/therapy , Lung Diseases/therapy , Churg-Strauss Syndrome/pathology , Anti-Glomerular Basement Membrane Disease/pathology , Granulomatosis with Polyangiitis/pathology , SyndromeABSTRACT
Refletindo sobre a contribuição da epidemiologia ao desenvolvimento de sistemas de informação com finalidade de apoio a atividades de gerência de serviços de saúde, os autores apresentam uma experiência levada a efeito nos serviços médicos de uma grande empresa de energia elétrica. Abstraindo-se, por motivos éticos, as informações geradas, dá-se ênfase aos aspectos metodológicos de concepção e operação do sistema, relatando-se sua estratégia de desenvolvimento e implantação, com descrição das rotinas de coleta de dados, processamento e análise. Conclui-se que o cabedal epidemiológico pode contribuir com a elevação de qualidade da informação produzida, mas que os sistemas de informação, como instrumentos gerenciais, necessitam ainda de maior reconhecimento e suporte, particularmente no que se refere a seus custos operacionais.