Blood levels of brain-derived neurotrophic factor (BDNF) in systemic lupus erythematous (SLE): a systematic review and meta-analysis

Abstract Objectives BDNF has been implicated in the pathophysiology of systemic lupus erythematosus (SLE), especially its neuropsychiatric symptoms. The purpose of this study was to investigate the profile of blood BDNF levels in patients with SLE. Methods We searched PubMed, EMBASE, and the Cochrane Library for papers that compared BDNF levels in SLE patients and healthy controls (HCs). The Newcastle-Ottawa scale was used to assess the quality of the included publications, and statistical analyses were carried out using R 4.0.4. Results The final analysis included eight studies totaling 323 healthy controls and 658 SLE patients. Meta-analysis did not show statistically significant differences in blood BDNF concentrations in SLE patients compared to HCs (SMD 0.08, 95% CI [− 1.15; 1.32], P value = 0.89). After removing outliers, there was no significant change in the results: SMD -0.3868 (95% CI [− 1.17; 0.39], P value = 0.33. Univariate meta-regression analysis revealed that sample size, number of males, NOS score, and mean age of the SLE participants accounted for the heterogeneity of the studies (R2 were 26.89%, 16.53%, 18.8%, and 49.96%, respectively). Conclusion In conclusion, our meta-analysis found no significant association between blood BDNF levels and SLE. The potential role and relevance of BDNF in SLE need to be further examined in higher quality studies.

Cardiovascular risk in the postnatal life of children born to women with systemic lupus erythematous / Riesgo cardiovascular en la vida posnatal de hijos de mujeres con lupus eritematoso sistémico

Abstract Systemic lupus erythematous (SLE) is an autoimmune disease with clinical manifestations in multiple organs, primarily striking women of reproductive age. Women with SLE can became pregnant such as any other healthy woman and carrier their pregnancy to term due to the improvement of health systems, but their specific inflammatory conditions could affect the microenvironment in which the fetus grows, and influence the development of placenta and the fetal heart. Until now, there is very little evidence of any increased risk of postnatal cardiovascular disease (CVD) in the apparently healthy children from women with SLE, but it is this great variability in the effects of lupus on pregnant products is related to.

Resumen El lupus eritematoso sistémico (LES) es una enfermedad autoinmune que presenta diversas manifestaciones clínicas en múltiples órganos, y afecta principalmente a mujeres en edad reproductiva. Las mujeres con LES se pueden embarazar y llevar a término su embarazo, sin embargo, las condiciones inflamatorias específicas de la madre pueden modificar el microambiente en el que el embrión y el feto se desarrollan y afectar la formación y desarrollo de la placenta y el corazón fetal. Hasta ahora hay muy poca evidencia de que haya un mayor riesgo de enfermedad cardiovascular (ECV) en hijos aparentemente sanos de madres con LES, a pesar de que se sabe que hay un mayor riesgo de alteraciones cognitivas y neuronales, así como de desarrollar enfermedades autoinmunes en esos niños. El objetivo de esta revisión fue realizar una búsqueda bibliografía cruzando palabras clave acerca la enfermedad cardiovascular en hijos sanos de mujeres con LES. La evidencia mostró que la autoinmunidad materna puede favorecer la predisposición para el desarrollo de ECV en sus hijos, por medio de la modificación de señales que alteran el microambiente durante la gestación, lo que puede afectar la respuesta inmunitaria y cambios epigenéticos durante la vida posnatal.

Cardiac Tamponade an Unusual Presentation of SLE — A Case Report

Systemic Lupus Erythematous (SLE) is an immune mediated disease, having variety of clinical manifestations but Cardiac Tamponade is rare as initial presentation. We are presenting an unusual case of cardiac tamponade as initial manifestation of SLE, which was also associated with Mitral Valve Vegetation, Posterior Reversible Encephalopathy Syndrome (PRESS); successfully responded to Pericardiocentesis, Steroids and Antimalarials

Clinical Efficacy of Qinghao Fuzheng Jiedu Decoction in Treatment of Systemic Lupus Erythematous / 中国实验方剂学杂志

Objective:To study the clinical effect of Qinghao Fuzheng Jiedu decoction on systemic lupus erythematous （SLE）. Method:A total of 109 SLE patients admitted to the Rheumatology and Immunology Department of Wuhan No. 1 Hospital from December 2019 to October 2020 were selected and divided into an observation group （55 cases） and a control group （54 cases） using the random number table. Two cases in the observation group dropped out， leaving a total sample of 53， and one case in the control group dropped out， with 53 cases finally included. Patients in the control group were treated with prednisone tablet and azathioprine. On this basis， those in the observation group further received Qinghao Fuzheng Jiedu decoction. The clinical efficacy， traditional Chinese medicine （TCM） syndrome score， TCM syndrome efficacy， immunoglobulin （Ig） G， IgA， IgM， and complements C3 and C4 of the two groups were compared. The conversion of positive antinuclear antibody （ANA） and anti-double-stranded deoxyribonucleic acid antibody （DS-DNA） titers to negative in two groups after treatment was analyzed. Result:The total clinical efficacy rate of the observation group was significantly higher than that of control group （92.45% vs 73.58%，<italic>χ²</italic>=6.692，<italic>P</italic><0.05）. Before treatment， there were no significant differences in IgG， IgA， IgM， complements C3 and C4， and serum ANA and ds-DNA titers between two groups. After treatment， the levels of IgG， IgA， and IgM and serum ANA and ds-DNA titers in both groups obviously declined， whereas the levels of complements C3 and C4 rose （<italic>P</italic><0.05）. Besides， the levels of IgG， IgA， and IgM and serum ANA and ds-DNA titers in the observation group were lower than those in the control group， while the levels of complements C3 and C4 were higher （<italic>P</italic><0.05）. The negative rates of ANA and ds-DNA in observation group were significantly higher than those in control group （<italic>χ²</italic>=8.040，<italic>P</italic><0.05）. TCM syndrome scores were decreased in both groups after treatment （<italic>P</italic><0.05）， and the score in observation group was lower than that in control group （<italic>P</italic><0.05）. In terms of TCM syndrome efficacy， the total effective rate of observation group was significantly increased as compared with that of the control group （94.34% vs 50.94%，<italic>χ²</italic>=25.112，<italic>P</italic><0.05）. Conclusion:Qinghao Fuzheng Jiedu decoction is effective in treating SLE and has a certain clinical application value.

Chinese Herbal Medicine for Systemic Lupus Erythematosus: A Systematic Review and Meta-analysis of Randomized, Placebo-Controlled Trials / 中国结合医学杂志

OBJECTIVE@#To provide evidence on the efficacy and safety of Chinese herbal medicine (CHM) as interventions for systemic lupus erythematosus (SLE).@*METHODS@#Seven electronic databases, including the Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), Chinese Biomedical Literature Service System (SinoMed), Wanfang, Embase, and PubMed, were comprehensively searched, from their inception to August 16, 2020, for all randomized controlled trials (RCTs) that focused on CHM used alone or in combination with conventional medicine for SLE. Outcomes were SLE activity index (SLEDAI), traditional Chinese medicine symptom/syndrome score (TCMSS), dosage of glucocorticoids, main serological testing, and incidence of adverse events. Data were extracted and pooled using Review Manager 5.3 software.@*RESULTS@#A total of 13 RCTs enrolling 856 participants met our inclusion criteria. Meta-analyses showed that, compared to placebo, CHM had statistically significant effect on reducing SLEDAI score (MD=-1.74, 95% CI: -2.29 to -1.18), diminishing TCMSS (SMD=-0.89, 95% CI: -1.16 to -0.62), decreasing dosage of glucocorticoids (MD=-2.41 mg/d, 95% CI: -3.34 to -1.48), lowering erythrocyte sedimentation rate (MD=-4.78 mm/h, 95% CI: -8.86 to -0.71), and increasing serum complement C4 level (MD=0.03 mg/dL, 95% CI: 0.00 to 0.06). No significant difference was found between CHM and placebo on adverse events.@*CONCLUSIONS@#CHM provided significant beneficial effect on controlling disease activity and reducing dose of glucocorticoids used among SLE patients. Future advanced designed RCTs for CHM treating moderate to severe SLE with multicenter and longer follow-up are urgently needed.

Cutaneous involvement of multiple myeloma

@#Cutaneous multiple myeloma (MM) is a rare disease. It can be primary or secondary in origin. The secondary type is further classified into specific and nonspecific types. The specific type is uncommon and is known as a secondary cutaneous plasmacytoma. We report a case of secondary cutaneous plasmacytoma in a 58-year-old man who had a history of plasma cell tumour of the lung and multiple myeloma. He achieved complete remission after the completion of chemotherapy and autologous stem cell transplant (ASCT). However, five months later, he developed multiple erythematous nodules on the whole body. Skin biopsy revealed diffuse neoplastic cells infiltrate in the reticular dermis with sparing of the upper papillary dermis and epidermis. The neoplastic cells were monotonous and homogenous with variable degrees of cytological atypia. Occasional cells showed distinctive plasma cell features. Plasma cell lineage was confirmed with CD138. The cells were immunoreactive to Kappa. Ki-67 was greater than 90%. They were non-immunoreactive to CD45, CD3, CD20, CD79 alpha and CK AE1/AE3. The findings were consistent with secondary cutaneous plasmacytoma. Our case illustrates that MM may present with nonspecific dermatological manifestations. As specific cutaneous involvement of MM is very uncommon; a high degree of clinical suspicion, detailed medical history and histopathological examination are required to arrive at an early diagnosis.

Histopathological Features and Clinical Variants of Biopsy Confirmed Psoriasis Cases in a Tertiary Care Setting in Kerala.

Psoriasis is a chronic, immune mediated, relapsing, papulosquamous disease having a high prevalence. Since it affects other organ systems such as musculoskeletal system, gastrointestinal system and the eye, it can lead to considerable disability. Although only rarely life threatening, it has high morbidity due to its chronicity and absence of cure. MethodsThis study was conducted over a period of 2 years in the Department of Pathology, Medical College, Thiruvananthapuram. A total of 217 skin biopsy specimens in which a clinical diagnosis / differential diagnosis of psoriasis was made, was studied during this period. Results108 cases out of 217 which were histopathologically diagnosed as psoriasis were studied in detail. Male predominance was noted in the study population. The mean duration of disease in this study was 6.69 yrs. Fifty percentage of the patients had associated comorbidities with hypertension outnumbering others. Among male patients, 26 (32.5 %) had the habit of smoking. The most common presentation was as erythematous scaly plaques, with pruritus being the second most common presentation. Histopathology proved to be conclusive of psoriasis in all cases. Hyperkeratosis was seen in all cases which was the most consistent histopathological feature. Confluent parakeratosis which is one of the characteristic features of psoriasis was seen in 62 (57.4 %) cases with the rest being focal. Other epidermal features studied were papillomatosis, hypogranulosis, suprapapillary thinning, and basal mitotic figures. Spongiosis was seen in 83 (76.9 %), exocytosis of neutrophils in 66 (61.1 %) and Munro’s micro abscess in 42 (38 %) cases. Dilated blood vessel was the most common dermal change observed, seen in 105 (97 %). Lymphocytes were the most frequent upper dermal inflammatory infiltrate observed. Oedema was seen in 5 (4.6 %) of cases. ConclusionsPsoriasiform lesions pose diagnostic dilemma to the treating clinician. To provide a clear-cut diagnosis, histopathological evaluation is essential. It is also important to differentiate between the different variants of psoriasis in the context of treatment. It has an important role in the follow up of psoriatic patients.

Relación entre tiroiditis autoinmune y lupus eritematoso sistémico / Relationship between autoinmune thyroiditis and systemic lupus erythematosus

Introducción: El lupus eritematoso sistémico es una enfermedad autoinmune que se caracteriza por la presencia de autoanticuerpos, los cuales, junto con el proceso inflamatorio, son los responsables de las manifestaciones clínicas de la enfermedad. Se puede asociar con otras afecciones como la tiroiditis autoinmune, la que, en ocasiones, precede al diagnóstico de lupus. Objetivo: Describir la relación entre tiroiditis autoinmune y lupus eritematoso sistémico. Métodos: Estudio descriptivo, correlacional y retrospectivo, realizado en la Consulta Externa del Hospital Andino de Chimborazo en el periodo comprendido entre enero de 2017 y julio de 2018. El universo estuvo constituido por la totalidad de los pacientes (137) que acudieron a consulta y que presentaron diagnóstico de lupus eritematoso sistémico. La muestra quedó conformada por los 97 pacientes que cumplieron los criterios de inclusión y exclusión definidos para la investigación. Se empleó la correlación de Pearson para establecer la relación existente entre tiroiditis autoinmune y lupus eritematoso sistémico. Resultados: El promedio de edad de los pacientes fue de 36,32 años, con predominio de edad entre 26 y 35 años. Predominó el sexo femenino (91,75 por ciento) y el tiempo de evolución fue menor de 3 años (46,40 por ciento). El 32,99 por ciento de los casos con lupus eritematoso sistémico presentaron también diagnóstico de tiroiditis autoinmune, que precedió al diagnóstico de lupus en un 90,63 por ciento de los casos. Conclusiones: Existe una relación entre tiroiditis autoinmune y lupus eritematoso sistémico. Ambas afecciones comparten mecanismos autoinmunes comunes, pero no queda totalmente esclarecido el mecanismo que las interrelaciona(AU)

Introduction: Systemic lupus erythematous is an autoimmune disease characterized by the presence of autoantibodies, in adition to the inflammatory process are responsible for the disease's clinical manifestations. It can be associated with other conditions such as autoimmune thyroiditis, this affection, sometimes, precedes the diagnosis of lupus. Objective: To describe the relationship between autoimmune thyroiditis and systemic lupus erythematous. Method: It is a descriptive, correlational and retrospective study, carried out in the outpatient clinic of the Andean hospital of Chimborazo in the period between January 2017 and July 2018. The universe was constituted by the totality of patients (137) who attended the consultation and who presented a diagnosis of systemic lupus erythematous. The sample was constituted by 97 patients who met the inclusion and exclusion criteria defined for the investigation. Pearson correlation was used to establish the relationship between autoimmune thyroiditis and systemic lupus erythematous. Results: The average age of 36.32 years with predominance of patients between 26 and 35 years of age. The female sex is predominated (91.75 percent) and the evolution time is less than three years (46.40 percent. 32.99 percent. of the cases with SLE also present a diagnosis of autoimmune thyroiditis that preceded the diagnosis of lupus in 90.63 percent. Conclusions: The relationship between autoimmune thyroiditis and systemic lupus erythematous is described; both conditions share common autoimmune mechanisms, but the mechanism which interrelate both conditions is not completely clarified(AU)

The role of high mobility proteins (HMGB1) in systemic lupus erythematosus / Papel de las proteínas de alta movilidad (HMGB1) en el lupus eritematoso sistémico

ABSTRACT Introduction: The high mobility group box 1 proteins (HMGB1) are non-histone nuclear proteins reported to be present at high levels in some autoimmune diseases, such as systemic lupus erythematosus (SLE). Likewise, in contrast to healthy individuals, patients with SLE have a higher prevalence of anti-HMGB1 antibodies, and these levels have also been associated with heightened disease activity. This article will discuss the involvement of these proteins in immunology, and review the evidence supporting their clinical importance in SLE. Materials and methods: A narrative review was conducted based on a search of the literature up to October 2018, of articles describing the function, structure, prevalence and importance of HMGB1 in different manifestations of SLE. Articles focusing on the presence of HMGB1 and/or its antibodies in patients with SLE or other autoimmune diseases were also reviewed. Results: A total of 69 articles were found. These articles were the foundation to define the structure and functions of HMBG1, including its role as a cytokine released by immune cells in inflammatory processes and necrosis. Additionally, a description of its functions in phagocytosis and NETosis - that have an impact on autoimmune diseases, primarily in SLE - was included. Conclusion: HMGB1 proteins and anti-HMGB1 antibodies are elevated in the serum of patients with SLE, in contrast with healthy individuals or non-severe presentations of the disease; this suggests that they may play a role as a biomarker of disease activity.

RESUMEN Introducción: Las high mobility group box 1 protein (HMGB1, «proteínas de alta movilidad del grupo 1¼) son proteínas nucleares no histonas cuyos niveles se han documentado elevados en ciertas enfermedades autoinmunes, como el lupus eritematoso sistémico (LES). Igualmente, los pacientes con LES presentan una mayor prevalencia de anticuerpos anti-HMGB1 comparados con individuos sanos, al mismo tiempo que se han relacionado sus niveles con una mayor actividad de la enfermedad. En este artículo se revisará la participación de estas proteínas en la inmunología y se abordará la evidencia que sustenta su importancia clínica en el LES. Materiales y métodos: Se realizó una revisión narrativa basada en la búsqueda de la literatura hasta octubre de 2018, de artículos que describieran la función, estructura, prevalencia e importancia de las HMGB1 en diferentes manifestaciones del LES, así como artículos que hayan estudiado la presencia de las HMGB1 o sus anticuerpos en pacientes con LES u otras enfermedades autoinmunes. Resultados: Se encontraron un total de 69 artículos. Con base en ellos definimos la estructura y funciones de las HMBG1, incluyendo su papel como citocina liberada por células inmunes en procesos inflamatorios y en necrosis. Adicionalmente, describimos sus funciones en la fagocitosis y NETosis, que genera implicaciones en enfermedades autoinmunes, principalmente en el LES. Conclusión: Las proteínas HMGB1 y los anticuerpos anti-HMGB1 se encuentran elevados en suero de pacientes con LES comparados con individuos sanos o con formas no severas de la enfermedad, evidenciando que estas pueden comportarse como un biomarcador de actividad de la enfermedad.

Report of a case of probable overlap between systemic erythematous lupus and polyarteritis nodosa / Reporte de un caso de probable overlap de lupus eritematoso sistémico con panarteritis nudosa

ABSTRACT Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease with a wide range of clinical manifestations that may affect any organ. Polyarteritis nodosa (PAN) is defined as necrotizing inflammatory changes in the medium and small vessels, a rare form of systemic necrotizing vasculitis in childhood. This article discusses the case of a patient with a history of deep venous thrombosis of the left leg, who presented with erythematosus purple lesions in her right hand, associated with pain, intermittent claudication, progressive limping and generalized edema. While in hospital, she was diagnosed with SLE with renal involvement and medium vessel vasculitis mainly of the upper limbs. She also met the criteria for PAN, a rare association that is seldom described in the medical literature.

RESUMEN El lupus eritematoso sistémico (LES) es una enfermedad autoinmune heterogénea con una amplia variedad de manifestaciones clínicas que pueden afectar cualquier órgano. La panarteritis nudosa (PAN) se define como cambios inflamatorios necrotizantes en arterias medianas o pequenas, siendo una vasculitis necrotizante sistêmica rara en la infancia. Presentamos el caso de una paciente con antecedente de trombosis venosa profunda del miembro inferior izquierdo, que presenta lesiones violáceas eritematosas en la mano derecha, asociadas a dolor, claudicación intermitente, limitación funcional progresiva, así como edema generalizado. Durante la hospitalización se llega al diagnóstico de LES con compromiso renal y vasculitis de vasos medianos con predominio de miembros superiores que cumple criterios de PAN, asociación rara muy poco descrita en la bibliografía.

Derrame pericárdico como forma de debut del lupus eritematoso sistémico / Pericardial effusion as a debut form of systemic lupus erythematosus

Introducción: El lupus eritematoso sistémico tiene múltiples formas de presentarse; entre las manifestaciones cardíacas, es frecuente la afectación pericárdica, pero es poco frecuente que su forma de debut sea el derrame pericárdico. Objetivo: Destacar la importancia del diagnóstico precoz de una de las formas menos frecuentes de debut del lupus eritamatoso sistémico. Caso clínico: Se presenta el caso de una paciente de 50 años, que ingresó porque desde hacía 3 meses sufría dolor torácico, disnea, tos, síntomas articulares, dermatológicos y generales. Luego de la sospecha y el estudio clínico, hematológico, imagenológico y biopsia de piel, se diagnosticó precozmente derrame pericárdico por lupus eritematoso sistémico. Se impuso tratamiento oportuno con esteroides, y la evolución fue favorable. Conclusiones: A pesar del bajo índice de sospecha, se tuvo en cuenta al lupus eritematoso sistémico y se procedió a las determinaciones analíticas que confirmaron el diagnóstico(AU)

Introduction: Systemic lupus erythematosus has multiple ways of presentation; among cardiac manifestations, pericardial involvement is frequent, but it is rare that its debut form is the pericardial effusion. Objective: To emphasize the importance of early diagnosis of one of the less frequent forms of systemic lupus erythematosus. Clinical case: We present the case of a 50-year-old patient, who had been admitted for 3 months because of chest pain, dyspnea, cough, joint, dermatological and general symptoms. After the suspicion and the clinical, hematological, imaging and skin biopsy, pericardial effusion was diagnosed early due to systemic lupus erythematosus. Timely treatment with steroids was imposed, and the evolution was favorable. Conclusions: Despite the low index of suspicion, the systemic lupus erythematosus was taken into account and the analytical determinations that confirmed the diagnosis were made(AU)

Case Study On Beta Blockers Induced Psoriasis

Drug-induced Psoriasis is one among the common etiological factors of Psoriasis reported worldwide. Familiar drugs known to cause psoriasiform eruptions include Anti-malarials, Beta blockers, NSAIDs, Lithium. etc. Certain antihypertensives like ACE inhibitors, diuretics are also documented to have caused psoriatic episodes. A 57 y old South-Indian male patient with a history of Hypertension, Diabetes Mellitus, Atrial Fibrillation for 4 y; was on antihypertensive therapy for Hypertension and Atrial Fibrillation with proponolol for past 2 y and metoprolol initially. He was presented to the hospital two weeks after switching on to Metoprolol therapy for chief complaints of erythematous scaly lesions especially over both the extremities and paronydrial appearance of nails. Initially, he was on Propranolol therapy which was then shifted to Metoprolol due to an appearance of oral lesions in the mouth. Metoprolol was now discontinued and switched on to Atenolol. After 1-2 w of therapy with Atenolol, the lesions were found to disappear and no recurrence of psoriatic conditions were found. Proper reviewing of medical history for any allergic reactions and the optimization of drug therapy through Therapeutic Drug Monitoring could be initiated by Clinical Pharmacist in order to avoid such drug-induced flares.

Presentación faríngea de la sífilis secundaria: a propósito de un caso / Pharyngeal presentation of secondary syphilis: a case report

RESUMEN La sífilis es una infección de transmisión sexual causada por la bacteria Treponema pallidum. En los últimos años ha habido un aumento en la incidencia de esta enfermedad debido a la creciente infección por el virus de la inmunodeficiencia humana (VIH) e inmunodepresión. Conocida como "la gran imitadora" son muchos los signos y síntomas que puede simular, siendo la presentación orofaríngea infrecuente. Presentamos el caso de un varón de 31 años de edad que acude a nuestro servicio por clínica de otitis media serosa bilateral. En la exploración física se objetiva una masa en cavum y una ulceración en pared faríngea posterior que se biopsia en consultas externas siendo el resultado un intenso infiltrado inflamatorio crónico de probable origen infeccioso, por lo que se decidió tomar una nueva biopsia bajo anestesia general. El día de la intervención, el paciente refirió la aparición de un exantema eritematoso generalizado, pero de predominio palmo-plantar. Interrogado sobre sus antecedentes, el paciente reconoció conductas sexuales de riesgo y ser portador VIH, por lo que se orientó el diagnóstico hacia una probable sífilis secundaria que se confirmó posteriormente mediante serología. Las lesiones de orofaringe, la masa del cavum y el exantema remitieron con tratamiento antibiótico y corticoideo pautado. Cuando las manifestaciones de cabeza y cuello constituyen la presentación inicial de la sífilis, su diagnóstico se retrasa con frecuencia debido al desconocimiento por parte del médico de primaria, e incluso del otorrinolaringólogo, de las formas típicas de presentación en esta localización. Su diagnóstico precoz es fundamental para prevenir la extensión de la enfermedad.

ABSTRACT Syphilis is a sexually transmitted infection caused by the bacteria Treponema pallidum. Over the last years there has been an increase of the incidence of this disease due to the growing infection by the human inmunodeficiency virus (HIV) and the inmunosupression. Known as "the great imitator", there are many signs and symptoms that can simulate, being the oropharyngeal presentation infrequent. We present the case of a 31-year-old man who came to our service for bilateral otitis media. Physical examination revealed a mass in the cavum and ulceration in the posterior pharyngeal wall that was biopsied in the outpatient clinic. The result was an intense chronic inflammatory infiltrate of probable infectious origin, so it was decided to take a new biopsy under general anesthesia. On the day of the intervention, the patient reported the appearance of a generalized erythematous rash, but predominantly on the bottoms of the feet and on the palms of the hands. Questioned about his background, the patient recognized risky sexual behavior and being an HIV carrier, so the diagnosis was oriented towards a probable secondary syphilis that was subsequently confirmed by serology. The ulcerations of the oropharynx, the mass of the cavum and the rash subsided with antibiotic treatment and corticoid regimen. When the manifestations of the head and neck are the initial presentation of syphilis, its diagnosis is often delayed due to the lack of knowledge of the physicians of the typical presentation forms in this location. Early diagnosis is essential to prevent the spread of the disease and its complications.

Enfermedad de boca, mano, pie en un lactante / Hand, foot, and mouth disease in an infant

Se presenta el caso clínico de un lactante de 9 meses de edad, atendido en el cuerpo de guardia del Policlínico Docente José Martí de la provincia de Santiago de Cuba, por presentar lesiones exantemáticas y eritematosas en la piel, con ampollas alrededor de la boca, así como en manos, piernas y ambos pies, además de fiebre. Se le diagnosticó la enfermedad de boca, mano y pie, teniendo en cuenta la clínica y el incremento de esta afección trasmitida por el virus de Coxsackie en el municipio, por lo cual fue ingresado en el hogar, con vigilancia y seguimiento por su médico y enfermera de la familia, quienes indicaron las medidas para el control higiénico sanitario y de sostén que deben conocerse y aplicarse en el medio familiar para disminuir el riesgo de la infección.

The case report of a 9 months of age infant assisted in the emergency room of José Martí Teaching Polyclinic in Santiago de Cuba is presented, due to exanthematic and erythematous lesions in the skin, with bladders around the mouth, as well as in hands, legs and both feet, besides fever. The mouth, hand and foot disease was diagnosed, keeping in mind the clinic and the increment of this disorder transmitted by the Coxsackie virus in the municipality, reason why he was admitted at home, with medical supervision and followed by the family nurse and physician who indicated the measures for the health control that should be known and applied in the family to decrease the risk of infection.

Linfoma no Hodgkin de amígdalas en un paciente con lupus eritematoso sistémico / Non-Hodgkin's lymphoma of tonsils in a patient with systemic lupus erythematous

Introducción: las enfermedades reumáticas aumentan el riesgo de aparición de distintas comorbilidades y estado de salud inadecuado en los pacientes. Dentro de estas comorbilidades las más peligrosas, por la frecuencia que se producen y por el desenlace final de las mismas lo constituyen las enfermedades neoplásicas. Objetivos: socializar los elementos clínicos, de laboratorio e histopatológicos que permiten la sospecha clínica y el diagnóstico de linfoma no Hodgkin en pacientes con enfermedades reumáticas. Caso clínico: paciente femenina de 54 años de edad, con diagnóstico de lupus eritematoso sistémico y síndrome de Sjögren secundario que acude con manifestaciones clínicas dadas por sudores nocturnos profusos, toma del estado general, fiebre vespertina y adenopatías cervicales. Se le realiza el diagnóstico de linfoma no Hodgkin en amígdala derecha. Conclusiones: las enfermedades reumáticas aumentan el riesgo de aparición de enfermedades neoplásicas. El seguimiento periódico, la adherencia farmacológica y el monitoreo constante de manifestaciones generales y elementos de sospecha de procesos malignos, son las acciones fundamentales que se pueden realizar para prevenir o diagnósticas precozmente la aparición de afecciones neoplásicas en pacientes reumáticos(AU)

Introduction: rheumatic diseases increase the risk of the appearance of different comorbidities and inadequate health status in patients. Within these comorbidities the most dangerous, by the frequency that occur and by the final outcome of them are neoplastic diseases. Objectives: to socialize the clinical, laboratory and histopathological elements that allow clinical suspicion and the diagnosis of non-Hodgkin's lymphoma in patients with rheumatic diseases. Case report: A 54-year-old female patient with a diagnosis of systemic lupus erythematous and secondary Sjogren's syndrome who presented with clinical manifestations due to profuse nocturnal sweats, general condition, afternoon fever and cervical lymphadenopathy. He is diagnosed with non-Hodgkin's lymphoma in the right amygdala. Conclusions: rheumatic diseases increase the risk of the appearance of neoplastic diseases. The periodic follow-up, the pharmacological adherence and the constant monitoring of general manifestations and elements of suspicion of malignant processes, are the fundamental actions that can be performed to prevent or early diagnosis the appearance of neoplastic affections in rheumatic patients(AU)

Trastuzumab induced radiation recall dermatitis: an interesting case

Radiation recall dermatitis (RRD) is the appearance of skin reactions in previously irradiated skin which is triggered by the administration of certain drugs. Surgery, chemotherapy, and radiotherapy are the mainstay of treatment in breast cancer. RRD induced by trastuzumab has been rarely reported in India. This is a case report of a 56-year-old woman presented to the medical oncology outpatient department of our hospital with breast lump, and she was diagnosed to have human epidermal growth factor receptor 2 (HER-2/neu) positive invasive ductal carcinoma of left breast of stage T2N3cM0. She was treated with neoadjuvant chemotherapy, and she underwent modified radical mastectomy with axillary lymph node dissection. The treating oncologist was planned to start on adjuvant chemotherapy with injection trastuzumab for every four weeks, for 15 cycles. Patient received first dose of injection trastuzumab (450 mg) intravenously in the right (contralateral) arm and developed painful, swollen, erythematous blisters, and maculopapular rashes following the sharp linear borders of her previous radiation fields. She was reviewed by the medical oncologist and diagnosed as a rare case of RRD and treated with topical betamethasone cream. Causality assessment for RRD to trastuzumab was done using Naranjo and WHO-UMC scale and found to be in the category of probable and probable/ likely respectively.

Gyrate Erythema like Manifestation - An Unusual Presentation of Borderline Lepromatous Hansen's Disease

Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae. Once considered a taboo, it is still misdiagnosed and underdiagnosed. Leprosy can present in innumerable diverse ways which can be confused with many treatable and non-treatable, infectious and noninfectious disorders. Though leprosy is eliminated from India in 2005, still many new cases are being reported day by day. Here we found a very rare manifestation of borderline lepromatous leprosy presented with erythematous figurate bands over trunk, proximal extremities and erythematous patches over palms and soles.

Importancia de los valores de proteinuria para el diagnóstico de la nefropatía asociada al lupus eritematoso sistémico / Importance of proteinuria value for the diagnosis of nephropathy associated with systemic lupus erythematous

Introducción: La proteinuria persistente mayor que 0,15 g/24 horas-1 en un paciente lúpico indica nefropatía. La proteinuria estimada según la relación proteínas/creatinina (RPC) puede ser útil para diagnosticar la nefropatía asociada al lupus eritematoso sistémico. Objetivo: Determinar la presencia de proteinuria de 24 horas en pacientes con lupus eritematoso sistémico. Métodos: Se calculó la proteinuria de 24 horas según la razón proteínas/creatinina (RPC) de 60 pacientes (75,0 por ciento de piel blanca, 95,0 por ciento mujeres, 3,3 por ciento de 60 o años, 51,6 por ciento con más de 5 años de evolución de la enfermedad) atendidos en el Instituto de Reumatología del Hospital Clínico Quirúrgico Diez de Octubre de La Habana, Cuba, entre octubre de 2013 y septiembre de 2014, y agrupados según el filtrado glomerular estimado (eFG) y el tiempo de evolución de la enfermedad. Resultados: El eFG fue mayor o igual que 60 mL/min/m2 de superficie corporal en el 75 por ciento de los pacientes y fue independiente del tiempo de evolución de la enfermedad lúpica. El 53,3 por ciento de los pacientes mostró proteinuria mayor que 0,15 g/24 h. La proteinuria de 24 horas aumentó exponencialmente a medida que disminuyó el filtrado glomerular estimado. A mayor tiempo de evolución de la enfermedad fueron mayores los valores de proteinuria. El comportamiento de la proteinuria de 24 horas fue similar al observado con la albuminuria de 24 horas. Conclusiones: La proteinuria de 24 horas estimada de la RPC puede indicar la presencia de nefropatía lúpica incluso cuando el FG es mayor o igual que 60 mL/min/m2(AU)

Introduction: Persistent proteinuria values over 0,15 g in 24 hours in a lupus patient is indicative of nephropathy. Proteinuria value estimated based on the protein-creatinine ratio (PCR) may be useful in diagnosing nephropathy associated with systemic lupus erythematosus. Objective: To determine the presence of 24-hour proteinuria in patients with systemic lupus erythematosus. Methods: 24-hour proteinuria was calculated based on the protein-creatinine ratio (PCR) of 60 patients (75,0 percent of white skin, 95,0 percent female, 3,3 percent 60 or older, 51,6 percent with more than 5 years of natural history of the disease) attended at Institute of Rheumatology of Diez de Octubre Clinical Surgical Hospital in Havana, Cuba, between October 2013 and September 2014, and grouped according to the estimated glomerular filtration rate (eGFR) and the time of natural history of the disease. Results: The eGFR was over than or equal to 60 mL/min/m2 of body surface in 75 percent of the patients and was independent of the natural history of lupus. 53,3 percent of the patients showed proteinuria value over 0,15 g in 24 hours. The 24-hour proteinuria value exponentially increased as the eGFR decreased. The longer the natural history of the disease, the higher the values of proteinuria. The behavior of the proteinuria value in 24 hours was similar to that observed with the albuminuria value in 24 hours. Conclusions: The estimated 24-hour proteinuria value based on PCR may be indicative of lupus nephropathy even when the GFR is conserved or is over than or equal to 60 mL/min/m2(AU)

Repercusión del lupus eritematoso sistémico en la cavidad bucal / Influence of systemic erythematous lupus in the oral cavity

Introducción: El lupus eritematoso sistémico es una enfermedad autoinmune, inflamatoria y sistémica, de causa desconocida, que puede afectar al aparato estomatognático. Objetivo: Describir las manifestaciones bucomaxilofaciales en pacientes con lupus eritematoso sistémico. Métodos: Se realizó un estudio observacional, descriptivo, de serie de casos, de 25 pacientes con diagnóstico de la enfermedad, ingresados en el Servicio de Reumatología del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba, durante el 2017. Resultados: Entre las lesiones intrabucales resultaron más frecuentes las periodontopatías, con 68,0 por ciento, y de las extrabucales, el eritema, con 40,0 por ciento. De igual forma, 10 pacientes presentaron alteración en la articulación temporomandibular, lo que representó 40,0 por ciento Conclusiones: Se pudo identificar una gran afectación en el complejo bucal a causa del lupus eritematoso sistémico. Al respecto, los estomatólogos desempeñan un importante papel en la detección de sus manifestaciones clínicas.

Introduction: The systemic erythematous lupus is an autoinmune, inflammatory and systemic disease, of unknown cause which can affect the stomatognatic aparatus. Objective: To describe the oral maxilofacial manifestations in patients with systemic erithematous lupus. Methods: An observational, series of cases descriptive study of 25 patients with diagnosis of the disease, admitted in the Rheumatology Service of Saturnino Lora Torres Teaching Provincial Clinical-Surgical Hospital in Santiago de Cuba was carried out during 2017. Results: Among the intraoral lesions there were the periodontopathies as the most frequent, with 68.0 percent, and of the extraoral lesions, the eritema, with 40.0 percent Likewise, 10 patients presented changes in the temporomandibular joint, what represented a 40.0 percent. Conclusions: A great damage could be identified in the oral complex because of the systemic erythematous lupus. In this respect, stomatologists plays an important role in the detection of its clinical manifestations.

Autoimmune Inner Ear Disease Mimicking Bilateral Ménière's Disease: A Case Report / 대한평형의학회지

Autoimmune inner ear disease (AIED) is a rare disease, accounting for < 1% of all cases of hearing impairment or dizziness. It is characterized by sensorineural hearing loss (SNHL) or vestibular dysfunction that results from an immunemediated process. Clinical features of AIED is SNHL that progresses over weeks to month with fluctuating hearing symptoms. Because there are no diagnostic laboratory and clinical feature, response to immunosuppressive therapy were important for diagnosis of AIED. Many diseases such as sudden SNHL and Meniere disease may also mimic AIED, a broad differential must be maintained in patients suspected of having AIED. We report a case of a 46-year-old female who presented with sudden hearing loss and vertigo. We could diagnose her as AIED with systemic lupus erythematous. The symptoms were improved treated with steroids.