RESUMO
Secondary amyloidosis is a severe complication of refractory rheumatoid arthritis for which no effective treatment exists. Although the benefits of tumor necrosis factor alpha inhibitors in rheumatoid arthritis treatment are well known, their role in renal amyloidosis secondary to rheumatoid arthritis is unclear and their safety in patients with chronic kidney disease is not well reported. We present an unusual case of a 65-year-old female with moderate renal failure and severe proteinuria, who was diagnosed with secondary amyloidosis associated with refractory rheumatoid arthritis subsequent to treatment with corticosteroids, methotrexate, hydroxychlorquine, and leflunomide. She was treated with etanercept 25 mg, administered as a subcutaneous injection twice weekly for 8 months. The patient had no complications following the treatment. Treatment with etanercept led to a decrease in proteinuria and stabilization of renal function over time.
Assuntos
Idoso , Feminino , Humanos , Corticosteroides , Amiloidose , Artrite Reumatoide , Injeções Subcutâneas , Metotrexato , Proteinúria , Insuficiência Renal , Insuficiência Renal Crônica , Fator de Necrose Tumoral alfa , EtanercepteRESUMO
We present the first case of enthesitis in the lumbar spine in a woman with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). Enthesopathy is defined as pathological alterations at the site of insertion of a tendon, ligament, joint capsule, or fascia to bone. In particular, enthesitis is the universal hallmark of seronegative spondyloarthropathies (SpA), including ankylosing spondylitis, reactive arthritis, psoriatic arthritis, and spondyloarthropathies associated with inflammatory bowel diseases. A 36-year-old female SLE patient with a history of lupus nephritis and thrombosis from APS presented with low back pain that had been gradually worsening for several months. She reported no previous episodes of trauma. Plain radiography indicated sclerosis at the anterior superior bodies of L3 and L5. Magnetic resonance imaging (MRI) showed low-intensity lesions on T1-weighted images and high-intensity lesions on T2-weighted images at the anterior superior bodies of L3, L4, and L5, consistent with osteitis or enthesitis. A nonsteroidal antiinflammatory drug (NSAID) was used as the first-line therapy in this patient, which improved her symptoms. This is the first report of enthesitis in the context of SLE. Although the possibility of coincidental occurrence of SpA and SLE cannot be excluded, the observations in this case suggest that enthesitis may be one of the manifestations of SLE.
Assuntos
Adulto , Feminino , Humanos , Síndrome Antifosfolipídica , Artrite Psoriásica , Artrite Reativa , Colódio , Fáscia , Doenças Inflamatórias Intestinais , Cápsula Articular , Ligamentos , Dor Lombar , Lúpus Eritematoso Sistêmico , Nefrite Lúpica , Imageamento por Ressonância Magnética , Osteíte , Doenças Reumáticas , Esclerose , Coluna Vertebral , Espondiloartropatias , Espondilite Anquilosante , Tendões , TromboseRESUMO
X-linked agammaglobulinemia is a common type of primary immunodeficiency disorder that's caused by mutation of the BTK gene. The absence of B lymphocytes and plasma cells causes recurrent infections. Patients with X-linked agammaglobulinemia also have a high risk for developing hematological malignancies and, to a lesser degree, carcinoma. We report here on a 26-years-old male patient who suffered with X-linked agammaglobulinemia that was caused by BTK gene mutation, and he developed a gastric cancer in the antrum. He was noted to have chronic atrophic gastritis and diffuse intestinal metaplasia on the endoscopic examination that was done 7 years previously. We recommend regular esophagogastroduodenoscopic evaluation for a patient with X-linked agammaglobulinemia in order to make an early diagnosis of stomach carcinoma.
Assuntos
Humanos , Masculino , Adenocarcinoma , Agamaglobulinemia , Linfócitos B , Diagnóstico Precoce , Gastrite Atrófica , Doenças Genéticas Ligadas ao Cromossomo X , Neoplasias Hematológicas , Metaplasia , Plasmócitos , Estômago , Neoplasias GástricasRESUMO
Idiopathic proximal hemimegacolon is a disorder characterized by bowel dilatation proximal to the splenic flexure. It is a very rare and therefore a poorly understood clinical entity. This report describes a case of idiopathic proximal hemimegacolon in a 44-year-old woman. The patient suffered from 2 episodes of constipation and bowel dilatation over 4 years and was successfully treated by medical therapy.
Assuntos
Adulto , Feminino , Humanos , Colo Transverso , Constipação Intestinal , Dilatação , Futilidade MédicaRESUMO
No abstract available.