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1.
Article in English | WPRIM | ID: wpr-922403

ABSTRACT

OBJECTIVES@#To study the predictive factors for glucocorticoid therapy by analyzing the association between the clinical features and treatment regimens in children with eosinophilic gastroenteritis.@*METHODS@#A retrospective analysis was performed on the medical data of 182 children with eosinophilic gastroenteritis who were admitted to Guangzhou Women and Children's Medical Center from January 2012 to December 2020. According to whether glucocorticoids were used, these children were divided into a glucocorticoid treatment group and a control group. The two groups were compared in terms of age, history of allergy, clinical symptoms, laboratory examination results, endoscopic findings, and pathological results of gastrointestinal mucosa. A multivariate logistic regression analysis was performed for the results with statistical significance.@*RESULTS@#Of the 182 children, 36 (19.8%) received glucocorticoid therapy. The rates of hematochezia, anemia, and mucosal ulceration/luminal stenosis under endoscopy and the mucosal eosinophil infiltration count were significantly higher in the glucocorticoid treatment group than those in the control group (@*CONCLUSIONS@#Mucosal ulceration/luminal stenosis under endoscopy or a significant increase in the mucosal eosinophil infiltration count based on pathology suggests that glucocorticoid therapy can be considered in children with eosinophil gastroenteritis.


Subject(s)
Child , Enteritis/drug therapy , Eosinophilia/drug therapy , Female , Gastritis , Glucocorticoids/therapeutic use , Humans , Retrospective Studies
2.
Rev. Assoc. Med. Bras. (1992) ; 65(3): 326-329, Mar. 2019. graf
Article in English | LILACS | ID: biblio-1003043

ABSTRACT

SUMMARY Eosinophilic fasciitis, or Shulman's disease, is a rare disease of unknown etiology. It is characterized by peripheral eosinophilia, hypergammaglobulinemia, and high erythrocyte sedimentation rate. The diagnosis is confirmed by a deep biopsy of the skin. The first line of treatment is corticotherapy. We present a rare case of eosinophilic fasciitis in a 27-year-old woman with an atypical presentation with symmetrical peripheral edema and a Groove sign. The patient responded well to treatment with corticosteroids at high doses and, in this context, was associated with hydroxychloroquine and azathioprine. After two and a half years, peripheral eosinophilia had increased, and more of her skin had hardened. At that time, the therapy was modified to include corticoids, methotrexate, and penicillamine. It is of great importance to publicize these cases that allow us to gather experience and better treat our patients.


RESUMO A fasciite eosinofílica ou doença de Shulman é uma doença rara de etiologia desconhecida. É caracterizada por eosinofilia periférica, hipergamaglobulinemia e velocidade de sedimentação eritrocitária elevada. O diagnóstico é confirmado por biópsia profunda da pele. O tratamento de primeira linha é a corticoterapia. Apresentamos um caso raro de fasciite eosinofílica numa mulher de 27 anos com uma apresentação atípica com edema periférico simétrico e sinal de Groove. A paciente respondeu bem ao tratamento com corticoides, mas em doses elevadas, e, nesse contexto, associou-se hidroxicloroquina e azatioprina. Ao fim de dois anos e meio verificou-se aumento de eosinofilia e novamente pele mais endurecida. Nessa altura alterou-se a terapêutica para corticoides, metrotexato e penicilamina. É de grande importância a divulgação desses casos que nos permitem reunir experiência e assim melhor tratar os nossos doentes.


Subject(s)
Humans , Female , Adult , Eosinophilia/pathology , Fasciitis/pathology , Skin/pathology , Biopsy , Magnetic Resonance Imaging , Treatment Outcome , Rare Diseases , Edema/pathology , Eosinophilia/drug therapy , Eosinophilia/diagnostic imaging , Fasciitis/drug therapy , Fasciitis/diagnostic imaging
3.
An. bras. dermatol ; 91(5,supl.1): 57-59, Sept.-Oct. 2016. graf
Article in English | LILACS | ID: biblio-837929

ABSTRACT

Abstract Eosinophilic fasciitis is a rare sclerodermiform syndrome of unknown etiology. It is characterized by the thickening of the muscular fascia and subcutaneous tissue, with a variable infiltration of eosinophils. Peripheral eosinophilia, poly or monoclonal hypergammaglobulinemia and increased erythrocyte sedimentation rate can be seen. Clinical features begin acutely, with local edema and a painful and symmetrical stiffening of the limbs, progressing rapidly to fibrosis, which can limit joint movements. Some cases have a history of strenuous physical exercise or trauma. The diagnosis is confirmed by a deep skin biopsy. Glucocorticoids in high doses is the treatment of choice. We report a typical eosinophilic fasciitis case with peripheral eosinophilia and dramatic response to pulse therapy with methylprednisolone.


Subject(s)
Humans , Male , Adult , Skin/pathology , Eosinophilia/pathology , Fasciitis/pathology , Syndrome , Biopsy , Methylprednisolone/therapeutic use , Magnetic Resonance Imaging , Pulse Therapy, Drug , Eosinophilia/drug therapy , Extremities/pathology , Fasciitis/drug therapy , Glucocorticoids/therapeutic use
4.
An. bras. dermatol ; 91(5): 646-648, Sept.-Oct. 2016. graf
Article in English | LILACS | ID: biblio-827753

ABSTRACT

Abstract: Eosinophilic pustular folliculitis (EPF) or Ofuji disease is a rare dermatosis, prone to recurrence and chronicity. The peak incidence occurs in the third decade of life and its exact etiology remains unknown. Evidence suggests that the expression of adhesion molecules and the production of cytokines activate the follicular unit, but the stimulus that triggers these changes remains unclear. The three clinical variants reported in the literature include classic EPF, immunosuppression-associated EPF, and infancy-associated EPF. We report a case of eosinophilic pustular folliculitis with peculiar epidemiological characteristics, which represents a challenging therapeutic scenario.


Subject(s)
Humans , Female , Adult , Pregnancy Complications , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Indomethacin/therapeutic use , Skin Diseases, Vesiculobullous/drug therapy , Eosinophilia/drug therapy , Folliculitis/drug therapy , Recurrence , Pregnancy , Skin Diseases, Vesiculobullous/complications , Skin Diseases, Vesiculobullous/pathology , Eosinophilia/complications , Eosinophilia/pathology , Folliculitis/complications , Folliculitis/pathology , Granulocytes/pathology
5.
Article in Portuguese | LILACS | ID: lil-758439

ABSTRACT

O Toxocara canis (Tc) é um parasito pertencente ao filo Nematódeo que possui como hospedeiro definitivo os cães, O homem é hospedeiro paratênico e contamina-se acidentalmente ao ingerir ovos contendo larvas infectantes (L3) do parasito, as quais são liberadas e atravessam a mucosa intestinal, atingem a circulação, Durante este processo migratório, antígenos de excreção e secreção (TES) são liberados provocando intensa reação inflamatória, do tipo Th2, caracterizando a síndrome, denominada Larva Migrans Visceral (SLMV), As principais características desta doença crônica são as eosinofilias sanguínea e tecidual persistentes, Desse modo, torna-se importante a busca por terapias que contribuam com a redução dos quadros inflamatórios com intensa eosinofilia, Assim, o uso deste bioterápico, produzido a partir do extrato antigênico de ovos e larvas de (Tc), e seu efeito no recrutamento de leucócitos totais, células mononucleares e eosinófilos no sangue, para o espaço broncoalveolar e para a cavidade peritoneal de camundongos infectados pelo (Tc) foi investigado, Foram utilizados camundongos fêmeas (Swiss), divididos nos grupos: Controle (C), Infectado (Tc), Imunizado (Im+Tc) e Tratado (Tc+Bio), Os animais Tc, Im+Tc e Tc+Bio receberam 500 ovos/animal por gavagem, Posteriormente, os animais foram eutanasiados no 18º dia da infecção e o número das células nos compartimentos foi determinado, Os resultados obtidos demonstraram que, Im+Tc, assim como nos Tc+Bio tiveram redução significativa dessas células nos compartimentos analisados quando comparados grupo Tc, Assim, sugeriu-se que a bioterapia modulou negativamente o recrutamento de células inflamatórias, principalmente eosinófilos no sangue, pulmão e intestino demonstrando um potencial anti-inflamatório desse bioterápico na SLMV experimental...


The Toxocara canis (Tc) is a parasite that belongs to the nematode phylum and has dogs as definitive host. The men can be accidentally contaminated by ingesting eggs containing infective larvae of the parasite. These larvae, when ingested, pass through the intestinal mucosa, reach the portal circulation and migrate through different tissues of the host. During this process, excretory-secretory antigens (TES) are released causing an intense inflammatory reaction, the Th2 type, characterizing the syndrome, called Visceral Larva migrans (VLMS). The main features of this chronic disease are blood and tissue eosinophilias. Thus, it is important to search for therapies that may contribute to the reduction of inflammatory conditions with intense eosinophilia. In this study, we investigated the use of a biotherapic produced from the antigenic extract from eggs and larvae (Tc) and its effect on the recruitment of total leukocyte, mononuclear cells and eosinophils in blood, bronchoalveolar space and peritoneal cavity of mice infected with (Tc). Female mice (Swiss) were used divided in three groups: control (C), Infected (Tc) Immunized (Im + Tc) and Treaty (Tc + Bio). The animals Tc, Im + Tc and Tc + Bio received 500 eggs / animal by gavage. Subsequently, the animals were euthanized on day 18 after infection and the number of cells in the compartments was determined. Our results showed that, Im + Tc, as in Tc + Bio had reduced these cells in compartments analyzed compared to Tc group. Thus, it was suggested that the biotherapy negatively modulated the recruitment of inflammatory cells, particularly eosinophils in blood, lung and intestine demonstrating an anti-inflammatory potential of the biotherapic in the experimental VLMS...


Subject(s)
Animals , Female , Rats , Antigens, Helminth , Biotherapics , Eosinophilia/drug therapy , Toxocara canis
7.
J. bras. pneumol ; 40(5): 552-563, Sep-Oct/2014. tab, graf
Article in English | LILACS | ID: lil-728766

ABSTRACT

OBJECTIVE: To evaluate the effect size of oral corticosteroid treatment on eosinophilic bronchitis in asthma, through systematic review and meta-analysis. METHODS: We systematically reviewed articles in the Medline, Cochrane Controlled Trials Register, EMBASE, and LILACS databases. We selected studies meeting the following criteria: comparing at least two groups or time points (prednisone vs. control, prednisone vs. another drug, or pre- vs. post-treatment with prednisone); and evaluating parameters before and after prednisone use, including values for sputum eosinophils, sputum eosinophil cationic protein (ECP), and sputum IL-5-with or without values for post-bronchodilator FEV1-with corresponding 95% CIs or with sufficient data for calculation. The independent variables were the use, dose, and duration of prednisone treatment. The outcomes evaluated were sputum eosinophils, IL-5, and ECP, as well as post-bronchodilator FEV1. RESULTS: The pooled analysis of the pre- vs. post-treatment data revealed a significant mean reduction in sputum eosinophils (↓8.18%; 95% CI: 7.69-8.67; p < 0.001), sputum IL-5 (↓83.64 pg/mL; 95% CI: 52.45-114.83; p < 0.001), and sputum ECP (↓267.60 µg/L; 95% CI: 244.57-290.63; p < 0.0001), as well as a significant mean increase in post-bronchodilator FEV1 (↑8.09%; 95% CI: 5.35-10.83; p < 0.001). CONCLUSIONS: In patients with moderate-to-severe eosinophilic bronchitis, treatment with prednisone caused a significant reduction in sputum eosinophil counts, as well as in the sputum levels of IL-5 and ECP. This reduction in the inflammatory response was accompanied by a significant increase in post-bronchodilator FEV1. .


OBJETIVO: Avaliar o tamanho do efeito do tratamento com prednisona oral na bronquite eosinofílica na asma por meio de revisão sistemática e meta-análise. MÉTODOS: Revisão sistemática de artigos nas bases de dados do Medline, Cochrane Controlled Trials Register, EMBASE e LILACS. Foram selecionados estudos que preencheram os seguintes critérios: comparar ao menos dois grupos ou dois momentos (prednisona vs. controle, prednisona vs. outra droga ou pré vs. pós-tratamento com prednisona) e avaliar parâmetros antes e depois do uso de prednisona, incluindo eosinófilos, proteína catiônica eosinofílica (PCE) e IL-5 no escarro - com ou sem valores de VEF1 pós-broncodilatador - com os IC95% correspondentes ou com dados suficientes para calculá-los. As variáveis independentes foram uso e dose de prednisona e duração do tratamento. Os desfechos avaliados foram eosinófilos, IL-5 e PCE no escarro, bem como VEF1 pós-broncodilatador. RESULTADOS: A análise conjunta dos dados de pré e pós-tratamento revelou uma redução significativa nas médias de eosinófilos no escarro (↓8,18%; IC95%: 7,69-8,67; p < 0,001), IL-5 no escarro (↓83,64 pg/mL; IC95%: 52,45-114,83; p < 0,001), PCE no escarro (↓267,60 μg/L; IC95%: 244,57-290,93; p < 0,001), assim como um aumento significativo na média de VEF1 pós-broncodilatador (↑8,09%; IC95%: 5,35-10,83; p < 0,001). CONCLUSÕES: Em pacientes com bronquite eosinofílica de moderada a grave, o tratamento com prednisona determinou uma redução significativa nos níveis de eosinófilos no escarro, assim como nos níveis de IL-5 e PCE no escarro. Essa redução na resposta inflamatória foi acompanhada de um aumento significativo do VEF1 pós-broncodilatador. .


Subject(s)
Humans , Anti-Inflammatory Agents/therapeutic use , Asthma/drug therapy , Bronchitis/drug therapy , Eosinophilia/drug therapy , Prednisone/therapeutic use , Anti-Inflammatory Agents/administration & dosage , Eosinophils , Leukocyte Count , Prednisone/administration & dosage , Sputum/chemistry
8.
Article in Portuguese | LILACS | ID: lil-724263

ABSTRACT

A gastrenterite eosinofílica é uma doença rara com apresentação heterogênea caracterizada pela presença de intenso infiltrado de eosinófilos em um ou em múltiplos segmentos do trato gastrin- testinal. Foi realizada revisão da literatura com ênfase em diag- nóstico, diagnóstico diferencial e tratamento, com o objetivo de divulgá-la entre a comunidade médica e viabilizar diagnóstico e tratamento precoces dessa entidade clínica, a fim de evitar complicações.(AU)


Eosinophilic gastroenteritis is a rare disease with heterogeneous presentation characterized by intense eosinophilic infiltration in one or multiple segments of the gastrointestinal tract. This review of the literature emphasized diagnosis, differential diagnosis and treatment in order to disseminate this clinical entity among the medical community and facilitate early diagnosis and treatment in order to avoid complications.(AU)


Subject(s)
Humans , Eosinophilia/pathology , Gastroenteritis/diagnosis , Adrenal Cortex Hormones/therapeutic use , Leukotriene Antagonists/therapeutic use , Diagnosis, Differential , Eosinophilia/drug therapy , Gastroenteritis/drug therapy , Histamine Antagonists/therapeutic use , Muscle, Smooth/pathology
9.
Mem. Inst. Oswaldo Cruz ; 109(4): 399-407, 03/07/2014. tab, graf
Article in English | LILACS | ID: lil-716315

ABSTRACT

Eosinophilic meningitis (EoM) is an acute disease that affects the central nervous system. It is primarily caused by infection with the nematode Angiostrongylus cantonensis. This infection was previously restricted to certain Asian countries and the Pacific Islands, but it was first reported in Brazil in 2007. Since then, intermediate and definitive hosts infected with A. cantonensis have been identified within the urban areas of many states in Brazil, including those in the northern, northeastern, southeastern and southern regions. The goals of this review are to draw the attention of the medical community and health centres to the emergence of EoM in Brazil, to compile information about several aspects of the human infection and mode of transmission and to provide a short protocol of procedures for the diagnosis of this disease.


Subject(s)
Animals , Humans , Central Nervous System Parasitic Infections , Eosinophilia , Meningitis , Strongylida Infections , Angiostrongylus cantonensis , Brazil/epidemiology , Communicable Diseases, Emerging , Central Nervous System Parasitic Infections/diagnosis , Central Nervous System Parasitic Infections/drug therapy , Central Nervous System Parasitic Infections/epidemiology , Eosinophilia/diagnosis , Eosinophilia/drug therapy , Eosinophilia/epidemiology , Eosinophilia/parasitology , Meningitis/diagnosis , Meningitis/drug therapy , Meningitis/epidemiology , Meningitis/parasitology , Snails/parasitology , Strongylida Infections/diagnosis , Strongylida Infections/drug therapy , Strongylida Infections/epidemiology
10.
Rev. cuba. med ; 51(1): 91-98, ene.-mar. 2012.
Article in Spanish | LILACS | ID: lil-628882

ABSTRACT

La gastroenteritis eosinofílica es una enfermedad rara que se caracteriza por la presencia de eosinofilia hística que afecta diferentes capas de la pared intestinal por lo que desde el punto de vista histológico se clasifica en mucosa, muscular o serosa, según la capa de la pared intestinal en la que predomine el infiltrado. Puede localizarse en cualquier porción del tubo digestivo, pero excepcionalmente en el colon. Se presentó un caso de colitis eosinofílica en un paciente de 26 años de edad con síndrome diarreico crónico. Se exponen datos clínicos y estudios patológicos. Se revisó el tema...


The eosinophilic gastroenteritis is a rare disease characterized by presence of histic eosinophilia involving different layers of the intestinal wall classified from the histological point of view in mucosa, muscular or serous, according to the layer of the intestinal wall with predominance of infiltrate. It may be located in any portion of the digestive tract, but exceptionally in the colon. This the case of eosinophilic colitis in a patient aged 26 with chronic diarrheic syndrome. Clinical data and pathologic studies results are showed. This matter was reviewed...


Subject(s)
Humans , Male , Young Adult , Colitis/diagnosis , Colitis/drug therapy , Eosinophilia/diagnosis , Eosinophilia/drug therapy , Prednisone/therapeutic use
11.
Article in English | WPRIM | ID: wpr-168860

ABSTRACT

Eosinophilic gastroenteritis (EGE) is an uncommon disease characterized by eosinophilic infiltration of the gastrointestinal tract, which is usually associated with abdominal pain, diarrhea, ascites, and peripheral eosinophilia. Steroids remain the mainstay of treatment for EGE, but symptoms often recur when the dose is reduced. Macrolides have immunomodulatory effects as well as antibacterial effects. The immunomodulatory effect results in inhibition of T-lymphocyte proliferation and triggering of T-lymphocyte and eosinophil apoptosis. Macrolides also have a steroid-sparing effect through their influence on steroid metabolism. We report a rare case of EGE, which relapsed on steroid reduction but improved following clarithromycin treatment.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Clarithromycin/therapeutic use , Enteritis/drug therapy , Eosinophilia/drug therapy , Gastritis/drug therapy , Humans , Immunologic Factors/therapeutic use , Male , Middle Aged , Prednisolone/administration & dosage
12.
Bol. latinoam. Caribe plantas med. aromát ; 10(3): 222-227, mayo 2011. ilus
Article in English | LILACS | ID: lil-687011

ABSTRACT

Punica granatum Linn. (Punicaceae) commonly known as Pomegranate is a dark greenish large deciduous shrub or small tree, about 5-10 m height. Flower buds are traditionally used in the treatment of asthma and allergy. The aim of this study was to validate the traditional antiallergic property using milk-induced leucocytosis and milk-induced eosinophilia in rats. Flower buds of the plant were extracted successively using various solvents to obtain the respective extracts. These extracts were administered to mice at the dose of 50 and 100 mg/kg, orally. Only the ethanol extract showed significant reduction in leukocyte and eosinophil count, these results are a validation of the use of the extract of polar compounds of P. granatum flower buds as an antiallergic agent.


Punica granatum Linn. (Punicaceae) comúnmente conocida como granada es un pequeño árbol o arbusto grande de hoja caduca, de unos 50-10 m de altura y de color verde oscuro. Los botones florales se utilizan tradicionalmente en el tratamiento del asma y la alergia. El objetivo de este estudio fue validar la propiedad tradicional antialérgica utilizando ratas con leucocitosis y eosinofilia inducida por leche. Los botones florales de la planta se extrajeron sucesivamente con varios solventes para obtener los extractos respectivos. Estos extractos se administraron a los ratones a dosis de 50 y 100 mg / kg, por vía oral. Sólo el extracto obtenido con etanol mostró una reducción significativa en el recuento de leucocitos y eosinófilos, estos resultados son una validación del uso del extracto de compuestos polares de los botones florales de P. granatum como un agente antialérgico.


Subject(s)
Male , Animals , Mice , Anti-Allergic Agents/therapeutic use , Eosinophilia/drug therapy , Plant Extracts/therapeutic use , Pomegranate/therapeutic use , Leukocytosis/drug therapy , Lythraceae , Anti-Allergic Agents/pharmacology , Ethanol , Eosinophils , Plant Extracts/pharmacology , Leukocytes
13.
Article in English | IMSEAR | ID: sea-138653

ABSTRACT

Cholinomimetic agents have a number of potential indications in an ageing population. This case series emphasises the need to exercise caution while prescribing cholinergic drugs in elderly patients with asthma, particularly in patients with a history of virus-induced exacerbations and airway eosinophilia.


Subject(s)
Age Factors , Aged , Aged, 80 and over , Asthma/complications , Asthma/drug therapy , Cholinergic Agents/adverse effects , Eosinophilia/complications , Eosinophilia/drug therapy , Female , Humans , Male
14.
Rev. méd. Minas Gerais ; 19(4,supl.5): S25-S27, out.- dez. 2009.
Article in Portuguese | LILACS | ID: biblio-868473

ABSTRACT

A gastroenterite eosinofílica é uma afecção caracterizada pela infiltração maciça de eosinófilos no trato gastrointestinal. Foi descrita pela primeira vez por Kaijser em 1937 e pode acometer qualquer área do trato gastrointestinal. A causa e o mecanismo de infiltração de eosinófilos são ainda desconhecidos. A apresentação pode variar, dependendo da localização, assim como da profundidade e da extensão do acometimento, e geralmente tem curso crônico. É uma doença relativamente rara, que afeta predominantemente adultos jovens do sexo masculino. (AU)


Eosinophilic gastroenteritis is a condition with extensive infiltration of eosinophils in the gastrointestinal tract. It was first described by Kaijser en 1937 and can affect any part of gastrointestinal tract. The cause and the real way for infiltration are unknown. Presentation may vary depending on location as well as depth and extent of bowel wall involvement and usually runs a chronic relapsing course. It is a rare disease that affects mainly young adult men. (AU)


Subject(s)
Humans , Male , Child, Preschool , Child Development , Developmental Disabilities/pathology , Eosinophilia/pathology , Gastroenteritis/pathology , Nutritional Status , Biopsy , Endoscopy, Digestive System , Eosinophilia/diagnostic imaging , Eosinophilia/drug therapy , Gastritis/diagnostic imaging , Gastritis/drug therapy
16.
Rev. méd. Chile ; 137(5): 666-671, mayo 2009. ilus
Article in Spanish | LILACS | ID: lil-521869

ABSTRACT

Eosinophilic esophagitis in adults (EE) is a disease of unknown cause, characterized by symptoms such as reflux and dysphagia that traditionally do not respond to antacid treatment. It affects mostly young men with a strong personal or familial history of a topy asthma and allergies. We repot three male patients aged 10, 14 and 15years, all with symptoms of dysphagia, two of them with chest pain caused by spasm of the esophagus, with heterogeneous endoscopic findings which included from leucoplakia to stenosis that needed endoscopic dilatation. All of them had abnormal findings in immunity studies (prick test or IgE levels). They received treatment based on diet measures, acid suppression and leukotriene inhibitors, with satisfactory clinical, endoscopic and histological response. EE should be suspected in children and adults with esophageal symptoms and personal or family history of allergy and asthma.


Subject(s)
Adolescent , Child , Humans , Male , Eosinophilia/pathology , Esophagitis/pathology , Acetates/therapeutic use , Esophagoscopy , Eosinophilia/drug therapy , Esophagitis/drug therapy , Omeprazole/therapeutic use , Quinolines/therapeutic use , /therapeutic use
17.
West Indian med. j ; 58(1): 69-71, Jan. 2009. ilus
Article in English | LILACS | ID: lil-672440

ABSTRACT

A 34-year old woman with dizziness, headache and both upper and lower extremities weakness was admitted to hospital. She had a history of photosensitivity but no asthma or allergy. On physical examination, malar rash and livedo reticularis were noted. White blood cell count was 18500/µL with 7585 eosinophils (41%). She also had positive antinuclear antibody (ANA), anti-double stranded DNA antibody (anti-ds-DNA antibody) and anticardiolipin antibody (aCL antibody). Echocardiography revealed left and right ventricular obliteration with fibromatous biventricular endothelial thickening. Brain MRI showed changes in favour of white matter ischaemia and lacunar infarction. Hypereosinophilic syndrome (HES) and systemic lupus erythematosus may be considered to have occurred concurrently in this patient.


Una mujer de 34 años de edad con mareos, dolor de cabeza y debilidad en las extremidades superiores e inferiores, fue ingresada a nuestro hospital. La mujer tenía una historia de fotosensibilidad pero no de asma ni alergia. En el examen físico, se observó erupción malar y livedo reticularis. El conteo de glóbulos blancos fue 18500/µL con 7585 eosinófilos (41%). También tenía anticuerpos antinucleares (ANA) positivos, anticuerpos anti-DNA de hebra doble (Anticuerpos anti-dsADN), y anticuerpos anticardiopilina (anticuerpos aCL). La ecocardiografía reveló obliteración ventricular izquierda y derecha con engrosamiento endotelial fibromatoso biventricular. La resonancia magnética (MRI) del cerebro mostró cambios a favor de la isquemia de la materia blanca y el infarto lacunar. Puede considerarse que el síndrome hipereosinofílico (SHE) y el lupus eritematoso sistémico tuvieron lugar de modo concurrente en este paciente.


Subject(s)
Adult , Female , Humans , Eosinophilia/complications , Lupus Erythematosus, Systemic/complications , Adrenal Cortex Hormones/therapeutic use , Anticoagulants/therapeutic use , Antirheumatic Agents/therapeutic use , Azathioprine/therapeutic use , Diagnosis, Differential , Drug Therapy, Combination , Echocardiography , Eosinophilia/diagnosis , Eosinophilia/drug therapy , Lupus Erythematosus, Systemic/diagnosis , Lupus Erythematosus, Systemic/drug therapy , Magnetic Resonance Imaging , Methylprednisolone/therapeutic use , Syndrome , Warfarin/therapeutic use
20.
J. bras. pneumol ; 34(11): 913-921, nov. 2008. ilus, tab
Article in Portuguese | LILACS | ID: lil-623379

ABSTRACT

OBJETIVO: Avaliar a utilização e a influência da determinação do componente inflamatório das doenças das vias aéreas (inflamometria), através do exame do escarro induzido, nas decisões terapêuticas de um serviço terciário de pneumologia. MÉTODOS: Foram analisadas 151 amostras de escarro induzido de 132 pacientes consecutivamente referidos para indução de escarro com propósitos clínicos por cinco pneumologistas, no período entre julho de 2006 e fevereiro de 2007. As indicações para a realização do teste e a conduta terapêutica adotada em função do resultado foram analisadas através de um questionário estruturado preenchido pelo médico que solicitou o escarro induzido. O escarro foi obtido e processado de acordo com uma técnica previamente descrita. RESULTADOS: As principais indicações do teste foram: titulação da dose do corticosteróide inalatório na asma moderada a grave (54,3%), investigação de tosse crônica (30,5%), monitoração da inflamação em pacientes com bronquiectasias (7,3 %) e monitoração da inflamação na doença pulmonar obstrutiva crônica (6%). Dos 82 pacientes com asma, 47 (57%) apresentaram bronquite eosinofílica (eosinófilos > 3%). Bronquite eosinofílica sem asma foi diagnosticada em 9 (19%) dos 46 pacientes que realizaram o exame para investigar tosse crônica. Bronquite neutrofílica (neutrófilos > 65%) foi observada em 13 pacientes; 5 com asma, 2 com tosse crônica e 6 com doença pulmonar obstrutiva crônica/bronquiectasias. Com base nos resultados do exame do escarro induzido, 48 (64,7%) pacientes com asma tiveram sua dose de corticosteróide modificada. CONCLUSÕES: A aplicação sistemática da inflamometria através do exame do escarro induzido pode trazer importantes benefícios aos pacientes com doenças respiratórias, principalmente àqueles portadores de asma e/ou tosse crônica.


OBJECTIVE: To evaluate the usefulness of determining the inflammatory component of airway diseases (inflammometry) by induced sputum cell counts, as well as its influence on treatment decisions in a tertiary facility for the treatment of respiratory diseases. METHODS: We analyzed 151 sputum samples from 132 consecutive patients referred for clinical sputum induction by five pulmonologists between July of 2006 and February of 2007. A structured questionnaire related to the reasons for requesting the test and to the therapeutic decision making based on test results was completed by each attending physician upon receiving the test results. Induced sputum was obtained and processed according to a technique previously described. RESULTS: The principal motives for ordering the test were inhaled corticosteroid dose titration in patients with moderate-to-severe asthma (in 54.3%), investigation of chronic cough (in 30.5%), and monitoring airway inflammation in patients with bronchiectasis (in 7.3%) or chronic obstructive pulmonary disease (in 6%). Of the 82 patients with asthma, 47 (57%) presented eosinophilic bronchitis (>3% eosinophils). Nonasthmatic eosinophilic bronchitis was diagnosed in 9 (19%) of the 46 patients with chronic cough. Neutrophilic bronchitis (>65% neutrophils) was found in 13 patients, of which 5 had asthma, 2 had chronic cough, and 6 had chronic obstructive pulmonary disease/bronchiectasis. Based on the induced sputum results, the corticosteroid dose was modified in 48 asthma patients (64.7%). CONCLUSIONS: The systematic application of inflammometry using induced sputum cell counts can be beneficial for patients with airway diseases, particularly those with asthma or chronic cough.


Subject(s)
Female , Humans , Male , Middle Aged , Asthma/diagnosis , Bronchitis/diagnosis , Diagnostic Techniques, Respiratory System , Eosinophilia/diagnosis , Sputum/cytology , Adrenal Cortex Hormones/therapeutic use , Asthma/drug therapy , Bronchiectasis/diagnosis , Bronchiectasis/drug therapy , Bronchitis/drug therapy , Cell Count , Clinical Protocols , Cross-Sectional Studies , Cough/drug therapy , Cough/etiology , Eosinophilia/drug therapy , Eosinophils/cytology , Prospective Studies , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/drug therapy , Surveys and Questionnaires , Sputum
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