Actinomicosis orofaríngea complicada secundaria al tratamiento farmacológico / Complicated oropharyngeal actinomycosis secondary to pharmacotherapy

Anti-tumor necrosis factor (TNF)-α treatment is an effective therapeutic option in intestinal inflammatory chronic disease in cases of the ineffectiveness of other drugs, but it promotes the development of opportunistic infections in their severe forms, due to the profound suppression of T-cell mediated immunity it produces. Among the most frequent are bacterial granulomatous infections, such as mycobacteria (especially tuberculosis), and fungal infections. Actinomycosis is a rare suppurative granulomatous chronic opportunistic infection, which in states of immunosuppression, such as the one caused after treatment with TNF blockers, is complicated by more severe clinical pictures.We present the clinical case, not previously described, of cervicofacial actinomycosis complicated with pneumonia, secondary to treatment with adalimumab in a patient with Crohn's disease.

El tratamiento con anticuerpos anti-factor de necrosis tumoral (TNF) es una opción terapéutica efectiva en la enfermedad inflamatoria crónica intestinal, en casos de ineficacia a otros fármacos, pero favorece la aparición de infecciones oportunistas en sus formas graves, debido a la gran inmunodepresión de células T que produce. Entre las más frecuentes se encuentran las infecciones granulomatosas bacterianas, como las causadas por micobacterias (en la que se destaca la tuberculosis), y las fúngicas. La actinomicosis es una infección oportunista crónica, granulomatosa, supurativa e infrecuente que, en estados de inmunosupresión, como el provocado tras el tratamiento con anticuerpos monoclonales anti-TNF, puede complicarse con cuadros clínicos más graves. Se presenta el caso clínico, no descrito anteriormente, de actinomicosis cervicofacial complicada con neumonía, secundaria al tratamiento con adalimumab, en una paciente con enfermedad de Crohn.

Poliposis gigante de colon como forma de presentación de colitis ulcerativa ideopática. Reporte de caso / Giant polyposis of colon as a presentation form of the idiopathic ulcerative colitis. Case report

RESUMEN La poliposis gigante localizada es una complicación rara de la colitis ulcerativa ideopática de corta evolución. Esta lesión representa un acumulo localizado de pólipos que forman una masa colónica intraluminal de aspecto neoplásico que puede simular un cáncer de colon. Suele presentarse en los adultos jóvenes y es más común en los países desarrollados con una incidencia cada vez mayor. Se presentó un caso de pólipos inflamatorios gigantes (PIG) de recto sigmoides que ingresa como un probable tumor de recto cuyas manifestaciones clínicas fueron semejantes a la de cualquier enfermedad inflamatoria. El paciente desarrolló esta masa inflamatoria sobre una enfermedad inflamatoria intestinal de poco tiempo de evolución clínica, con buena respuesta al tratamiento medicamentoso (AU).

ABSTRACT The located giant polyposis is rare complication of idiopathic ulcerative colitis of short evolution. This lesion is a localized accumulation of polyps forming an intra luminal colon mass of neoplastic aspect that might simulate a colon cancer. It is usually found in young adults, and it is more common in developed countries with a higher and higher incidence. We presented a case of giant inflammatory polyps (PIG as acronym in Spanish) of sigmoid rectum that entered the hospital as a probably rectum tumour, the clinical manifestations of which were similar to others of any inflammatory disease. The patient developed an inflammatory mass on a, intestinal inflammatory disease of short time clinical evolution, with a good answer to the medicinal treatment (AU).

Avaliação colonoscópica em pacientes com espondilite anquilosante / Colonoscopic evaluation in patients with ankylosing spondylitis

Introdução: Pacientes com espondilite anquilosante podem apresentar-se com lesões inflamatórias intestinais, e, por isso, deve ser definido o uso da colonoscopia para tais pacientes. Objetivos: Avaliar as alterações colonoscópicas intestinais macroscópicas e achados histopatológicos microscópicos de pacientes com espondilite anquilosante; correlacionar os achados colonoscópicos e histopatológicos; e estudar a relação dos achados histopatológicos com as manifestações extra-articulares da doença, HLA-B27, BASFI and BASDAI. Métodos: Este é um estudo transversal de 22 pacientes com espondilite anquilosante. Os pacientes passaram por uma avaliação clínica, BASDAI e BASFI, coleta de sangue para determinação de HLA-B27, e colonoscopia com biópsia de quarto segmentos intestinais (íleo terminal, cólon direito, cólon sigmoide e reto). Resultados: Resultados colonoscópicos anormais foram obtidos em 13 (59,1%) pacientes, e a principal anormalidade foi a presença de pólipos intestinais. Os grupos de resultados colonoscópicos normais e anormais (n = 9 e n = 13, respectivamente) foram homogêneos no que diz respeito à idade, BASFI, BASDAI, e variáveis categóricas, e o valor P não revelou diferença significativa entre grupos. Dos resultados histopatológicos, 81% tiveram uma biópsia anormal do íleo terminal, 90.9% tiveram uma biópsia anormal do cólon sigmoide, e a biópsia retal estava anormal em 86.4%. Os achados histopatológicos revelaram biópsias anormais em 81%, 90.9%, 90.9% e 86.4% para o íleo terminal, cólon direito, cólon sigmoide e reto, respectivamente. Os resultados histopatológicos não revelaram associação estatisticamente significativa com as manifestações ex...

Introduction: Patients with ankylosing spondylitis can have intestinal inflammatory lesions, thus the use of colonoscopy for such patients should be defined. Objectives: To assess the gross intestinal colonoscopic changes and microscopic histopathologic findings of patients with ankylosing spondylitis; to correlate the colonoscopic and histopathologic findings; and to study the relationship of the histopathologic findings with extra-articular manifestations of the disease, HLA-B27, BASFI and BASDAI. Methods: This is a cross-sectional study of 22 patients with ankylosing spondylitis. The patients underwent clinical assessment, BASDAI and BASFI application, blood collection for HLA-B27 measurement, and colonoscopy with biopsy of four intestinal segments (terminal ileum, right and sigmoid colons, and rectum). Results: Abnormal colonoscopic results were obtained in 13 (59.1%) patients, the major abnormality being intestinal polyps. The groups of normal and abnormal colonoscopic results (n = 9 and n = 13, respectively) were homogeneous regarding age, BASFI, BASDAI, and categorical variables, and the P-value showed no significant difference between groups. The histopathological findings revealed abnormal biopsies in 81%, 90.9%, 90.9% and 86.4% for terminal ileum, right colon, sigmoid colon, and rectum, respectively. The histopathologic results showed no statistically significant association with the extra-articular manifestations, BASFI, BASDAI and HLA-B27 positivity. Conclusions: The histological analysis of the four intestinal segments evidenced inflammatory lesions in patients with normal and abnormal colonoscopic results, independently of bowel symptomatology and therapy used in the treatment of the basal disease. .

Dolor abdominal de origen orgánico en niños y adolescentes / Abdominal pain of organic origin in children and adolescents

El dolor abdominal constituye un motivo frecuente de consulta de niños y adolescentes. Éste puede ser de origen orgánico o funcional. En menores las causas son predominantemente orgánicas, y en los mayores de 5 años sólo el de 33 por ciento tiene este origen, y el 67 por ciento es funcional. Mediante una anamnesis acuciosa y un examen físico completo, el clínico podrá hacer una aproximación diagnóstica y orientar la solicitud de exámenes de manera dirigida. El objetivo de este artículo es entregar las herramientas semiológicas para lograr este objetivo.

Abdominal pain is a frequent complain of children and adolescents. This may have an organic or functional origin. In preschool children the causes are predominantly organic, and in those older than 5 years only percent have this origin, and 67 per cent are functional. Through a diligent history and physical examination, the clinician may make a proper approach to diagnosis and ask for complementary tests, if neccesary, in a target manner The aim of this article is to provide the semiologic tools to achieve this goal.