Fatal necrotizing Candida esophagitis in a patient with leukocytoclastic cutaneous vasculitis and ankylosing spondylitis

Esophageal infection by Candida spp. is a common opportunistic entity in immunocompromised hosts; however, systemic fungal dissemination due to perforation or transmural necrosis, also known as necrotizing Candida esophagitis (NCE), is rare. We report the case of a 61-year-old male patient with diagnosed ankylosing spondylitis, severe arteriosclerosis, and vasculitis under immunosuppressive therapy who presented NCE with fungal and bacterial septicemia diagnosed at autopsy. Necrotizing esophagitis is a rare manifestation of Candida infection, which may be a final complication in severely ill patients. Unfortunately, it may be underdiagnosed, and we call attention to this devastating complication in patients with leukocytoclastic cutaneous vasculitis and ankylosing spondylitis.

Traumatic injury to the internal carotid artery by the hyoid bone: a rare cause of ischemic stroke

Central nervous system (CNS) ischemic events, besides being a common and devastating disease, are accompanied by severe disability and other morbidities. The cause of such events is not always that simple to diagnose, and among the young, a broad spectrum of possibilities should be considered. We present the case of a young man who presented two episodes of CNS ischemia with a 1 year gap between them, which occurred in the same situation while he was walking and carrying a heavy backpack. The second event first presented as a transient ischemic attack followed by a stroke the day after. The diagnostic work-up showed an indentation of the greater cornu of the hyoid bone over the internal carotid artery, which injured the media and intimal layers. At the arterial injury site, a micro thrombus was found, which explained the source of the embolic event to the CNS. The patient was operated on, and the procedure included the resection of the posterior horn of the hyoid bone, the resection of the injured segment of the internal carotid artery followed by carotid­carotid bypass with the great saphenous vein. The postoperative period and the recovery were uneventful as was the 5-month follow-up. We call attention to this unusual cause of stroke and present other cases reported in the literature.

Native-valve endocarditis caused by Achromobacter xylosoxidans: a case report and review of literature

Achromobacter xylosoxidans is a Gram-negative aerobic bacterium first described by Yabuuchi and Ohyama in 1971. A. xylosoxidans is frequently found in aquatic environments. Abdominal, urinary tract, ocular, pneumonia, meningitis, and osteomyelitis are the most common infections. Infective endocarditis is rare. As far as we know, until now, only 19 cases have been described, including this current report. We report the case of community-acquired native valve endocarditis caused by A. xylosoxidans in an elderly patient without a concomitant diagnosis of a malignancy or any known immunodeficiency. The patient presented with a 2-month history of fever, weight loss, and progressive dyspnea. On physical examination, mitral and aortic murmurs were present, along with Janeway's lesions, and a positive blood culture for A. xylosoxidans. The transesophageal echocardiogram showed vegetation in the aortic valve, which was consistent with the diagnosis of infective endocarditis

Avaliaçäo em larga escala do diclofenaco colestiramina em síndromes dolorosas lombares / Post-marketing of diclofenac cholestyramine in low back pain

Os autores descrevem os resultados da observaçäo em larga escala, relatando a experiência pós-comercializaçäo de uma nova formulaçäo galênica de um AINE (diclofenaco-colestiramina - Flotac) utilizado como terapia em casos de síndrome dolorosa lombar. Foram observados por cerca de 500 médicos generalistas de todo o Brasil um total de 1.852 pacientes com lombalgia inespecífica. Os pacientes receberam o diclofenaco-colestiramina na dose de uma capsula a cada doze horas durante 10 dias. Todos os sintomas regrediram após o tratamento de forma estatísticamente significativa, com 80 porcento dos pacientes voltando a ter atividades diárias normais ao final do tratamento. O escore médio de dor no início do tratamento foi de 6,81 pela Escala Visual Analógica e, ao final do tratamento, foi de 1,42, uma reduçäo estatísticamente significativa. Considerando-se a avaliaçäo global de eficácia, 93,7 porcento dos médicos e 91,3 porcento dos pacientes relataram o tratamento como sendo eficaz. Em relaçäo à avaliaçäo global de tolerabilidade, 90,9 porcento dos médicos e 88,7 porcento dos pacientes relataram o tratamento como sendo bem tolerado. Os eventos adversos ocorridos foram os esperados para um AINE e foram considerados leves e somente 1,8 porcento dos pacientes interromperam o tratamento por causa deles. Em conclusäo, o diclofenaco colestiramina (FLOTAC) foi considerado um tratamento adjuvante eficaz para os quadros de síndrome dolorosa lombar onde a sintomatologia inflamatória-dolorosa é um grande incomodo para o paciente, e bem tolerado, tanto para a avaliaçäo do médico como pelo paciente, sem nenhum evento adverso que näo fosse desconhecido.(au)