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Resumen La enfermedad de Kikuchi-Fujimoto, también llamada linfadenitis necrotizante histiocítica, es un padecimiento raro y benigno de causa desconocida; se distingue por linfadenopatía cervical y fiebre frecuentemente en mujeres jóvenes previamente sanas. Las manifestaciones clínicas, el antecedente de lupus eritemaso sistémico y el análisis histopatológico sugieren una respuesta inmunitaria celular mediada por células T e histocitos como parte de la fisiopatología. El diagnóstico de enfermedad de Kikuchi-Fujimoto requiere biopsia por escisión de los ganglios linfáticos afectados en los que se evidencia necrosis con infiltrados de histiocitos y característicamente ausencia de neutrófilos. No existe tratamiento efectivo contra la enfermedad de Kikuchi-Fujimoto, el cuadro se alivia de manera espontánea en uno a cuatro meses; ante síntomas persistentes y severos se administran glucocorticoides y antiinflamatorios no esteroides. La siliconosis es una condición en la que el silicón, componente de implantes mamarios, actúa como coadyuvante inmunogénico provocando una respuesta local y sistémica autoinmunitaria con síntomas inespecíficos que constituyen el síndrome autoinmunitario inducido por coadyuvantes. El tratamiento de este síndrome se basa en la eliminación del estímulo externo y en la mayoría de los casos se observa una respuesta favorable a largo plazo sin necesidad de iniciar tratamiento inmunomodulador. Se necesitan más casos para poder establecer a la siliconosis como una probable causa de enfermedad de Kikuchi-Fujimoto y conocer más a fondo la relación entre ambos padecimientos.
Abstract Kikuchi-Fujimoto disease, also called histiocytic necrotizing lympha-denitis, is a rare and benign condition of unknown etiology, characte-rized by cervical lymphadenopathy with fever that frequently occurs in previously young healthy women. The clinical manifestations, a history of systemic lupus erythematous and histopathologic analysis suggest an immune response of T cells and histiocytes as a part of the pathophysiology. The diagnosis of Kikuchi disease requires lymph node biopsy, in which there is evidence of necrosis with histiocyte infiltrates and characteristically absence of neutrophils. No effective treatment exists for Kikuchi disease, it is self-limited into 1-4 weeks; with severe and persistent symptoms, glucocorticoids and nonsteroidal anti-inflammatory drugs are prescribed. Silicosis is a condition in which silicone, a component of breast implants, acts as an immunogenic adjuvant, causing a local and systemic autoimmune response with non-specific symptomatology constituting the adjuvant-induced autoimmune syndrome (ASIA). The treatment of ASIA is based on the elimination of the external stimulus and in most cases a favorable long-term response is observed without initiating immunomodulatory treatment. More cases are needed in order to establish silicosis as a cause of Kikuchi-Fujimoto disease and to know more about the relationship between these conditions.
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Abstract Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the presence of autoantibodies and multisystemic disease. Viruses are widely associated with autoimmunity, and are also implicated in the pathogenesis of systemic lupus erythematosus. Two cases are described that have an autoimmune response related to dengue infection. The clinical presentation of systemic lupus erythematosus is very diverse, and in these cases it was important to consider SLE as a diagnosis.
Resumen El lupus eritematoso sistémico (LES) es una enfermedad autoinmune, caracterizada por la presencia de autoanticuerpos y afección multisistémica. Los virus se encuentran ampliamente asociados a autoinmunidad y también se han encontrado implicados en la patogénesis del LES. A continuación se presentan 2 casos con respuesta autoinmune relacionada con infección por el virus del dengue. La presentación clínica del LES es muy diversa, en estos casos fue importante tener la sospecha diagnóstica.
Assuntos
Humanos , Feminino , Pré-Escolar , Criança , Dengue , Lúpus Eritematoso Sistêmico , Autoanticorpos , Doenças Autoimunes , Autoimunidade , Vírus da DengueRESUMO
Insulin autoimmune syndrome (IAS) is characterized by spontaneous hypoglycemia with extremely high insulin levels and the presence of circulating autoantibodies against insulin, in patients who have never been exposed to exogenous insulin. We report two patients with the syndrome. A 36 years old male presenting with hypoglycemia in the emergency room had an oral glucose tolerance test showed basal and 120 min glucose levels of 88 and 185 mg/dl. The basal and 120 min insulin levels were 2,759 and 5,942 μUI/ml. The presence of an insulin secreting tumor was discarded. Anti-insulin antibodies were positive. He was successfully treated with a diet restricted in carbohydrates and frequent meals in small quantities. A 65 years old female presenting with hypoglycemia in the emergency room had the fasting insulin levels of 1,910 µUI/ml. No insulin secreting tumor was detected by images and anti-insulin antibodies were positive. The polyethylene glycol precipitation test showed a basal and after exposition insulin level 1,483 and 114 µUI/ml, respectively. She responded partially to diet and acarbose and required the use of prednisone with a good clinical response.
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Doenças Autoimunes/complicações , Hipoglicemia/etiologia , Anticorpos Anti-Insulina/sangue , Doenças Autoimunes/sangue , Doenças Autoimunes/diagnóstico , Dieta para Diabéticos , SíndromeRESUMO
Se realizó un estudio observacional, descriptivo e inmunológico de 42 pacientes con diagnóstico de enfermedad autoinmune o sospecha de esta, atendidos en la consulta de Inmunología del Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, desde marzo del 2010 hasta mayo del 2011, quienes presentaron hepatitis virales u otras infecciones, a fin de demostrar la posible asociación entre la entidad clínica y los virus. Fueron empleados otros sueros de integrantes del plan de trasplante renal, por su alta incidencia de hepatitis B o C (o ambas), de los estudios de histocompatibilidad y se determinaron los niveles de autoanticuerpos por medio del método inmunodiagnóstico para detectar anticuerpos antinucleares de la inmunoflourescencia indirecta (cualitativamente), de manera que se pudiera identificar la influencia de los virus en los procesos autoinmunes y, a la vez, recuperar la utilización de la citada técnica. Los resultados mostraron que 28 % de la casuística tenían positividad de anticuerpos antinucleares.
A descriptive observational and immunological study was carried out in 42 patients with diagnosis of autoimmune disease or suspicion of this, attended at the Immunology Department of "Saturnino Lora Torres" Provincial Clinical Surgical Teaching Hospital of Santiago de Cuba, from March 2010 to May 2011, who presented with viral hepatitis or other infections, in order to demonstrate the possible association between the clinical entity and viruses. Other serums of members of renal transplantation plan, belonging to histocompatibility studies, were used because of their high incidence of hepatitis B or C (or both), and levels of autoantibodies were determined by means of the immunodiagnosis method to detect antinuclear antibodies of the indirect immunofluorescence (qualitatively), so that the influence of viruses could be identified in autoimmune processes and, simultaneously, to recover the use of this technique. The results showed 28% of antinuclear antibodies-positive cases.
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Objective To investigate the curative effects of dexamethasone in the prevention of delayed encephalopathy after acute carbon monoxide poisoning in the rats.Methods Eighty healthy male Wistar rats were randomly(random number)divided into hyperbaric group(H),dexamethasone group (D),combined treatment group(C)and model control group(M)after carbon monoxide poisoning,twenty rats in each group.Twelve air-modeling rats were selected as normal control group(N).Using eight-arm maze training and testing,the rat's function of cognitive and memory was detected.The serum MBP levels were detected by enzyme-linked immunosorbent assays(ELISA).Magnetic resonance imaging was used for observing the demyelination of the head and the morbidity of delayed encephalopathy.Measured data was analyzed with single factor analysis of variance(one-way ANOVA).Results The result of eight-arm maze showed that there were 6,7,1,1 rats with delayed encephalopathy in groups M,H,C,D,respectively.At 3 days after poisoning,except N group,the serum MBP levels of every groups increased significantly.At 10 days after poisoning,serum MBP levels in groups C and D were significantly decreased,then returned to normal levels at day 18.The serum MBP in groups M and H was higher than normal levels at all the time.Head MRI showed except D group,the rest groups were abnormal signals,which appeared 7 in M group,6in H group and 1 in C group.Conclusions Dexamethasone administrated as soon as possibly after acute carbon monoxide poisoning may reduce the serum MBP levels,prevent demyelination occurs,decrease the pathological damage,eventually play a preventive role in DE.
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Dating of injury and the discrimination in trauma and disease is always an important hot topic in the field of forensic medicine. Lumbar disc herniation is a kind of physiological degeneration. To seek a method for deducing the occurrence time of traumatic LDH exactly, this article reviewed the correlation between humoral, celllur immunity and the occurrence time of LDH. It is suggested that some characteristic changes of the expression of IgG,IgM,macrophages may be a helpful method for the occurrence time deduction of traumatic LDH.