Frequência da Covid-19 em pacientes com diagnóstico de lúpus eritematoso sistêmico / Frequency of Covid-19 in followed patients diagnosed with systemic erythematous lupus

Objetivos: Determinar a frequência da Covid-19 em indivíduos com lúpus eritematoso sistêmico, bem como descrever aspectos relacionados a esse adoecimento. Métodos: Estudo observacional longitudinal, com 418 indivíduos, divididos em um grupo caso, composto de 224 portadores de doenças reumáticas imunomediadas, e grupo controle, composto de 194 contactantes domiciliares sem essas doenças. Resultados: A ocorrência de Covid-19 entre indivíduos com lúpus foi de 5,8% (n=13), por outro lado, 41,1% (n=92) relataram sintomas gripais. Dentre os casos da Covid-19 em indivíduos com lúpus, 15,4% (n=2) necessitaram da internação hospitalar e 7,7% (n=1) tiveram necessidade de ventilação mecânica. Nenhum paciente evoluiu a óbito. Foram 11 (84,6%) as pessoas que relataram não ter havido piora dos sintomas do lúpus com a infecção da Covid-19. Conclusão: As mani- festações da Covid-19 nos indivíduos com lúpus foram compatíveis com aquelas demonstradas para a população geral. O uso de hidroxicloroquina e de corticoides não demonstrou associação protetora ou de risco para a ocorrência da Covid-19, sendo necessários estudos adicionais, também para determinar se indivíduos com lúpus estão mais suscetíveis a formas graves da Covid-19.

Objectives: To determine the frequency of Covid-19 in people with systemic lupus erythematosus, as well as to describe aspects related to this illness. Methods: A longitudinal observational study was conducted with 418 individuals, who were divided in one case group, consisting of 224 people with immune-mediated rheumatic diseases, and a control group, composed of 194 home contacts with none of these illnesses. Results: The occurrence of Covid-19 among people with lupus was 5,8% (n=13). On the other hand, 41,1% (n=92) reported flu-like symptoms. Among the cases of Covid-19 in people with lupus, 15,4% (n=2) needed hospitalization and 7,7% (n=1) needed mechanical ventilation. No patient progressed to death. Eleven individuals (84,6%) reported no worsening of the manifestations of lupus while with Covid-19. Conclusion: The manifestations of Covid-19 among the people with lupus were consistent with those reported for the general population. The use of hydroxychloroquine and corticoids did not show risky or protective association to the occurrence of Covid-19, with additional studies therefore being required also to determine if individuals with lupus are more susceptible to severe presentations of Covid-19.

Pseudoangiomatous stromal hyperplasia of the breast presenting as gigantomastia: case report

Pseudoangiomatous stromal hyperplasia (PASH) of the breast is a benign condition generally seen as an incidental finding of biopsies for other causes. In some rare cases, it can evolve with expressive growth of breast tissue, leading to large breasts. The present study presents a case report of a patient who started with breast hypertrophy during lactation, evolving with gigantomastia, and arrived at the office 3 years after gestation with breasts of 6.2 and 4.3 kg and growth of accessory breast and axillary lymph nodes. The patient was emaciated, with bodily pain and psychological distress. Computed tomography was performed with the finding of diffuse retroglandular nodules and axillary and mediastinal lymph node enlargement, without being able to rule out the lymphoproliferative process. Then, core biopsies were made in several places on the breast whose pathological examination revealed PASH samples. Bilateral mastectomy was performed as a surgical treatment, with resection of the left accessory breast and left axillary lymph node, and breast reconstruction, with placement of silicone prostheses and graft of the areola-papillary complex, together with a plastic surgeon. She evolved in the postoperative period with good healing of the surgical wound, weight gain, necrosis of the areola-papillary complex and with severe psychiatric disorder, which was treated appropriately by psychiatrists, with remission of symptoms. This case report presents a rare evolution of PASH with gigantomastia, bringing intense physical and psychological distress to the patient, whose treatment chosen was total surgical resection of the breast tissue and aesthetic reconstruction.