ABSTRACT
Pemphigus vulgaris is a systemic auto-immune medical condition that mainly manifests with changes in skinand vasculopathy. This is a case report of a 69-year-old male with confirmed histopathologic diagnosis of Pemphigus vulgaris presenting ulterior Cognitive Impairment, mostly in executive function. The patient was treated using steroids, immunomodulatory therapy, fluoxetine and galantamine. Neuropsychological testing and magnetic resonance (MRI) were performed. This is the first report of correlational cognitive impairment with Pemphigus vulgaris in the literature. Physicians should be aware of vascular causes for cognitive impairment in patients presenting auto-immune conditions.
Phemphigus vulgaris é uma condição médica sistêmica autoimune que principalmente se manifesta com alterações de pele e vasculopatia. Este é um caso de um homem de 69 anos com diagnóstico histopatológico de Phemphigus vulgaris apresentando posterior comprometimento cognitivo, predominante em funções executivas. O paciente foi tratado com esteroides, terapia imunomoduladora, fluoxetina e galantamina. Avaliação neuropsicológica e ressonância magnética foram realizados. Este é o primeiro relato correlacionando comprometimento cognitivo a pênfigo vulgar na literatura. Os clínicos devem estar cientes das causas vasculares para comprometimento cognitivo em pacientes se apresentando comcondições autoimunes.
Subject(s)
Humans , Autoimmune Diseases , Dementia, Vascular , Dementia , Cognitive Dysfunction , Neuropsychological TestsABSTRACT
A correlação entre doença auto-imune tireoidiana e artrite reumatóide tem sido demonstrada de longa data. A incidência de prolapso de valva mitral é maior em populações com doença tireoidiana. Acredita-se haver algum componente auto-imune relacionado ao prolapso de valva mitral. Nesse estudo foram avaliados 203 prontuários de pacientes com Artrite reumatóide com ecocardiograma com o objetivo de estabelecer a prevalência de prolapso de valva mitral e doença tireoidiana nessa população. Desses 19 (9,3%) eram homens e 184 (90,6%) eram mulheres. A idade média foi de 53,50±13.67 anos) e o tempo médio de doença de 102±105.8 meses. O prolapso de valva mitral foi visto em 18 (8,86%) pacientes. A avaliação da função tireoidiana foi realizada em 186 indivíduos e desses 3 (1,6%) tinham hipertireoidismo, 28 (15,05%) hipotireoidismo e 155 (83,33%) eram eutireoideos. Pacientes com prolapso de válvula mitral não diferenciaram dos sem prolapso quanto à presença do látex (p=0,5), titulo do látex (p=0,51), presença de FAN (p=0,76), presença de hipotireoidismo (p=0,47), sexo (p=1,0) e idade de aparecimento da doença (p=0,1). Pacientes com prolapso de válvula mitral tinham artrite reumatóide de maior duração (p=0,0021). Conclusão: Os pacientes de artrite reumatóide com prolapso de valva mitral não se diferenciam da população sem prolapso quanto a sexo, idade de início da artrite reumatóide, presença e titulo do fator reumatóide, presença de FAN e de hipotireoidismo.
There is a well established correlation between auto-immune thyroid diseases and rheuma-toid arthritis. The mitral valve prolapse incidence is higher among the patients with thyroid diseases and it´s believed that there is an auto-immune component in its origins. The objective of this study was to explore the prevalence of mitral valve prolapse and thyroid disease in 203 patients with rheumatoid arthritis. The results showed that 19 (9, 3%) were men and 184 (90,6%) were women. The average age was 53, 50±13.67 years and the average time of disease was 102±105.8 months. The mitral valve prolapse prevalence was 8, 86% (18 pa-tients). The thyroid function was studied in 186 patients. Among these, 3 (1, 6%) had hyperthyroidism, 28 (15, 05%) hypothyroidism and in 155 (83, 33%) the thyroid function were normal. There was no difference between individuals with mitral valve prolapse and without on rheumatoid factor presence (p=0,5), latex title (p=0,51), antinuclear antibody presence (p=0,76), hipothyroidism (p=0,47), gender (p=1,0) and age of rheumatoid arthritis onset (p=0,1). Patients with mitral valve prolapse had longer disease duration (p=0,0021). Conclusion: The rheumatoid arthritis patients with mitral valve prolapse from this study have no significant differences from the population without mitral valve prolapse in gender, age of disease onset, presence and levels of rheumatoid factor, presence of antinuclear anti-bodies and hypothyroidism.
ABSTRACT
Auto-immune hepatitis (AIH) is one of the chronic liver diseases, seen predominantly in women, resulting from dysregulated immune mechanisms not yet clearly defined. Based on a combination of clinical and laboratory parameters with both positive and negative weights, the International AIH Group devised a scoring system in 1993. The system was modified in 1999 and has proven useful for both diagnostic and research purposes. This review deliberates on the clinical, immunological and histological features of this entity.