Résumé
Relato de caso de paciente de 38 anos, feminina, com lúpus eritematoso sistêmico (LES) que apresentou evento tromboembólico arterial agudo em membro inferior direito. A investigação evidenciou a presença de anticorpos antifosfolípides e vegetação asséptica em válvula mitral, endocardite de Libman-Sacks (eLS). São discutidas as possíveis causas de eventos tromboembólicos arteriais no LES, com ênfase nas recomendações atuais para diagnóstico e tratamento da eLS.
Case report of a 38-year-old female patient with systemic lupus erythematosus (SLE) who presented an acute arterial thromboembolic event in the right lower limb. Investigation showed the presence of antiphospholipid antibodies and sterile vegetation in the mitral valve, Libman-Sacks endocarditis (LSE). Possible causes of thromboembolic events in SLE are discussed, with emphasis on current recommendations for diagnosis and treatment of LSE.
Sujets)
Adulte , Femelle , Humains , Anticorps antiphospholipides/immunologie , Endocardite/étiologie , Endocardite/immunologie , Lupus érythémateux disséminé/complications , Lupus érythémateux disséminé/immunologie , Thrombose/étiologie , Thrombose/immunologieRésumé
OBJECTIVE: To analyze the immune response in peripheral blood of patients with infective endocarditis. METHODS: We studied 10 patients with infective endocarditis, age range from 20 to 50 years-old, males and females, and 20 healthy subjects in the same age range. The diagnosis of the disease was based on the clinical picture, echocardiogram, and hemoculture based upon samples drawn and tested before the treatment started. The were no history of atopy or malnutrition, no autoimmune disease, and they were not using any immunosuppressant or antibiotic medication. RESULTS: The patients with endocarditis had significantly higher T and B lymphocyte, CD4+ and CD8+ cell counts, IgM and IgG serum levels, and C4 component of the complement than the control group; no significant difference concerning serum IgA and neutrophil oxidative metabolism; a significant decrease in C3, chemotaxis, and monocyte phagocytosis;cryoglobulins were detected in 66.6 percent of patients and they were formed by IgG, IgM, IgA, C3, and C4. CONCLUSION: The patients with infective endocarditis were immunocompetent in most sectors of immune response and, at a certain moment, an autoimmune component may be present
Sujets)
Humains , Mâle , Femelle , Adulte , Adulte d'âge moyen , Anticorps monoclonaux/sang , Endocardite/immunologie , Anticorps monoclonaux/immunologie , /sang , /sang , Auto-immunité/immunologie , Études cas-témoins , Cryoglobulines/analyse , Cryoglobulines/immunologie , Immunodiffusion , Immunoglobuline A/sang , Immunoglobuline G/sang , Immunoglobuline M/sang , Numération des lymphocytesRésumé
Na evoluçäo de uma endocardite infecciosa subaguda, a uma fase de bacteriemia transitória, sucede-se uma etapa de interaçäo imunológica entre o microorganismo invasor e o hospedeiro. Os autores fazem uma revisäo e atualizaçäo dos aspectos imunológicos, tanto dos métodos laboratoriais, quanto da correlaçäo clínica dependente da etapa imunológica, ressaltando e analisando a patogênese dos principais sintomas e sinais, interando a participaçäo do sistema imunitário com a magnitude dos comemorativos clínicos, ressaltando a utilizaçäo de provas de atividade imunológica que possam corroborar com o diagnóstico mais precoce da doença