Respuesta inmune disfuncional en pacientes con COVID-19. ¿Qué nos dice la evidencia? / Dysfunctional immune response in COVID-19 patients. What does the evidence tell us?

In December 2019 a novel coronavirus (SARS-CoV-2) was identified in Wuhan, China, and became rapidly the worst pandemic in 100 years. Coronaviruses are respiratory viruses that can cause diseases ranging from mild to fatal lower respiratory tract infections. In a fraction of the affected patients, coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, can lead to acute respiratory distress syndrome (ARDS) and intensive care unit (ICU) admission, both associated with high mortality. To date, the existing evidence suggests a leading role of the immune system in the pathogenesis of severe COVID-19, including mechanisms associated with hyperinflammation, immune evasion, cytokine release syndrome, depletion of functional T cells, and ineffective humoral immunity. Here we discuss the current evidence regarding these findings.

Neutropenia febril asociada a LES: reporte de un caso clínico / Systemic lupus erythematosus-associated febrile neutropenia: a case report

Introducción: Fiebre de Origen Desconocido (FOD) es una entidad clínica poco prevalente y amplio es el repertorio patologías conocidas como causales. Caso clínico. Se describe el caso de una mujer de 43 años, hipertensión arterial y "sífilis" tratada en 1994. Dos meses con Síndrome Febril Prolongado, baja de peso, poliartritis y compromiso del estado general progresivo, vómitos y diarrea. Destacaba en el examen físico temperatura axilar de 39°C, candidiasis oral, evidentemente enflaquecida y sensibilidad difusa del abdomen sin signos de alarma. Estudio revelo neutropenia febril y parámetros inmunológicos alterados, compatibles con Lupus Eritematoso Sistémico. Discusión.

Edema de la médula ósea de la rodilla / Bone marrow edema of knee

Bone marrow edema (BME) or transient bone marrow edema syndrome (TMES) affects the joints, particularly thehip and less frequently the knee and ankle. Knee problemsare usually related to traumatic causes, nevertheless, this can also be caused by micro traumatisms brought on bydaily life or overload. Diagnosis is confirmed by usingnuclear magnetic resonance (NMR), since both x-rays andcomputer assisted tomographies (CAT) are unsupportive,and scintigraph, though sensitive, is none specific. It isdescribed as the cause of pain in osteoarthritis and canalso be observed in transitory osteoporosis, in migratoryregional osteoporosis, and in the first stage of avascularbone necrosis (ABN), which is its main differential diagnosis. We present three cases of patients with knee pain, with no history of contusion. Two cases presented minor signs of osteoarthritis, two presented a decrease in bone density, and one presented hyperlaxity. NMRs were required, since normal procedures led to no results, and showed the existence of BME. Treatment was conservative, specially oriented towards unloading the joints, with a favorable evolution prior to six months.