Juvenile paracoccidioidomycosis in urban area: report of two cases

We present two cases of juvenile form of paracoccidioidomycosis (PCM), a systemic mycosis frequently found in rural areas, whose prognosis is poor in children and young adults. They are a 14-year-old boy and a 25-year-old woman, both residents in an urban area in São Paulo - Brazil, without any history of travelling to an endemic area. They have been admitted to the hospital due to fever, weight loss and lymphadenopathy. The diagnosis was confirmed by serologic and histopathologic study. Patients have recovered after therapy with oral itraconazole and were discharged from hospital, maintaining outpatient visits. In this article, the authors discuss the unusual presentation of PCM in an urban area.

Hemorrhagic encephalopathy in dengue shock syndrome: a case report

Dengue fever is the most important arboviral infection in the world, with an estimated 100 million cases per year and 2.5 billion people at risk. Encephalopathy is a rare complication of dengue virus infection and may occur as a consequence of intracranial hemorrhage, cerebral edema, hyponatremia, cerebral anoxia, fulminant hepatic failure with portosystemic encephalopathy, microcapillary hemorrhage or release of toxic products. We report a rare case of hemorrhagic encephalopathy in dengue shock syndrome caused by type 3 dengue virus.

Doença de Castleman multicêntrica / Multicentric Castleman's disease

A doença de Castleman (DC) é uma rara desordem linfoproliferativa de origem desconhecida. É classificada histologicamente em três tipos: hialinovascular, o mais comum, células plasmocitárias e mista. O tipo hialinovascular é usualmente caracterizado por um curso benigno sem apresentar sintomas sistêmicos. Relataremos o raro caso de um paciente de 45 anos com doença de Castleman tipo hialinovascular com queixas de emagrecimento e fraqueza muscular de dois anos de evolução

Aminotransferase changes and acute hepatitis in patients with dengue fever: analysis of 1, 585 cases

INTRODUCTION: Type 3 dengue virus caused an extensive epidemic in the state of Rio de Janeiro in summer 2002. In some of the patients, it was found in an atypical form with increased aminotransferase levels and acute hepatitis. MATERIAL AND METHODS: An analysis was made of 1,585 serologically confirmed dengue cases at the Dengue Reference Center in Campos dos Goytacazes, Rio de Janeiro state. The grade of hepatic aggression was established according to the alterations in the aminotransferase levels: grade A - normal levels of aminotransferase; grade B - elevated aminotransferase, with increased levels of at least one of the enzymes; grade C - elevated aminotransferase, with the levels of at least one of the enzymes increased to more than three times the reference values; grade D - acute hepatitis, with aminotransferase levels increased to at least 10 times their normal values. RESULTS: Among the 1,585 serologically confirmed dengue cases, 44.5 percent presented alterations in the aminotransferase levels (grade B), 16.9 percent presented grade C liver involvement and 3.8 percent of the patients had progressed to acute hepatitis (grade D). The average values for the rise in aspartate aminotransferase and alanine aminotransferase were 93.3 U/L and 86.0 U/L. The greatest alterations were observed among females (p<0.001), cases of dengue hemorrhagic fever (p<0.001), and cases with sequential infections (p=0.001). CONCLUSIONS: Liver damage with elevation of aminotransferases and reactive hepatitis was a common complication of dengue virus infection in these patients.

Doença de Von Recklinghausen e feocromocitoma / Von Recklinghausen`s disease and pheochromocytoma

A doença de Von Recklinghausen (Neurofibromatose tipo I) tem como uma de suas características a associaçäo com doenças neoplásicas, dentre elas o feocromocitoma. Neste artigo é apresentado o caso de um paciente de 36 anos, portador de neurofibromatose de Von Recklinghausen, associada a feocromocitoma, que procurou atendimento médico para esclarecinento de hipertensäo arterial e tumor abdominal doloroso.