Lesiones destructivas de la línea media facial secundarias al consumo de cocaína: caso clínico / Cocaine induced midline destructive lesions: report of one case

Vasculitic midline destructive lesions can be a complication of cocaine use. We report a 44-year-old man who presented with a two months history of left facial pain associated with ipsilateral facial paralysis and a cheek phlegmon. Magnetic resonance imaging showed broad soft tissue destruction linked to important cranial nerve involvement. Antibiotic and antifungal therapy was started and multiple surgical debridement procedures were performed, with no clinical improvement. Microbiological analysis was negative. Finally, thanks to the histologic findings corresponding to vasculitis and granuloma formation and the history of cocaine abuse, a cocaine induced midline destructive lesion was diagnosed.

Enteritis lúpica como manifestación inicial de lupus eritematoso sistémico: caso clínico / Lupus enteritis as initial manifestation of systemic lupus erythematosus: report of one case

Although gastrointestinal symptoms are not rare in Systemic lupus erythematosus, enteritis is an atypical manifestation of the disease. We report a 54 year-old woman who presented acute symptoms of diarrhea, fever and abdominal pain, receiving empiric antibiotic therapy for bacterial enteritis with no response. Computed tomography showed diffuse small intestine inflammation and serositis. Antinuclear antibodies, anti-Ro and anti-La were positive on blood tests. A lupic enteropathy was diagnosed and steroid treatment was initiated, with subsequent clinical improvement.

Utilidad de la ultrasonografía en la orientación diagnóstica en una artritis indiferenciada a raíz de un caso clínico / Utility of ultrasonography in diagnostic orientation for undifferentiated arthritis, based on a clinical case

La ultrasonografía se ha convertido en un examen muy útil para el estudio de artritis inflamatorias indiferenciadas, ya que posee mayor sensibilidad que el examen físico para detectar sinovitis y entesitis. La necesidad de realizar el diagnóstico de forma precoz, ha permitido que esta herramienta se vuelva un pilar fundamental en el enfrentamiento de estas patologías. Se presenta el caso de una paciente de 37 años que consulta por cuadro de seis meses de evolución de poliartralgias de distribución asimétrica en manos, hombros y codos. Al examen físico se detecta sinovitis en articulaciones metacarpofalángicas e interfalángicas proximales. Finalmente se solicita ultrasonografía de manos, la cual revela sinovitis activa en articulaciones interfalángicas distales. En base a esto se rescata antecedente familiar de psoriasis, se realiza HLA-B27 que resulta negativo y un TAC de sacroiliacas sugerente de sacroileítis bilateral. Por los hallazgos y el nuevo antecedente se diagnostica como Artritis Psoriática.

Ultrasonography has become a useful imaging test in the assessment of undifferentiated arthritis, due to its greater sensitivity in detecting synovitis and enthesitis in comparison with physical examination. In the need of making an early diagnosis, this exam has turn into a cornerstone when approaching certain arthritis. We present the case of a 37 years old women, with a six months history of asymmetric polyarthralgias in hands, shoulders and elbows. Synovitis is detected with physical exam in metacarpophalangeal and proximal interphalangeal joints. An ultrasonography is requested, revealing active synovitis in distal interphalangeal joints. Based on these information, the family background of psoriasis is obtained. HLA-B27 results negative and a sacroiliac CT suggests bilateral sacroiliitis. According to these findings the diagnosis of Psoriatic Arthritis is finally made.