Vasculitis por reacción de hipersensibilidad tipo III / Vasculitis for type III hypersensitivity reaction

Los procesos inmunitarios son utilizados por el organismo para defenderse de la agresión de agentes infecciosos; no obstante, en ciertos casos, el organismo reacciona de forma inapropiada o excesiva ocasionando diversos tipos de daño tisular. Estas situaciones, que conocemos como hipersensibilidad, pueden tener aspectos positivos o negativos al poder causar ellos mismos la enfermedad. Se presenta el caso de una niña de 14 años de edad, que acude al Hospital Pediátrico Docente William Soler después de varios ingresos en otros centros de salud, donde se planteó el diagnóstico de un pie de madura. Después de varias investigaciones y con el antecedente de alergia a diferentes medicamentos, los cuadros de amigdalitis a repetición, los datos del laboratorio y la clínica que presentaba la paciente, se estableció el diagnóstico de una vasculitis por reacción de hipersensibilidad tipo III. Por las características tan atípicas del cuadro clínico de esta paciente y la dificultad para llegar a un diagnóstico es importante la presentación de este caso(AU)

The immune processes are used by the body to defend against the aggression of infectious agents; however, in certain cases, the body reacts inappropriately or excessively causing various types of tissue damage. These situations, which we know as hypersensitivity, can have positive or negative aspects by being able to cause the disease themselves. We present the case of a 14-year-old girl who attended the William Soler Pediatric Teaching Hospital after several admissions to other health centers, where the diagnosis of a mature foot was raised. After several investigations and with the history of allergy to different drugs, the recurrent tonsillitis symptoms, the laboratory data and the clinic presented by the patient, the diagnosis of a vasculitis due to type III hypersensitivity reaction was established. Because of the atypical characteristics of this patient's clinical picture and the difficulty in reaching a diagnosis, the presentation of this case is important(AU)

O Teste do Fator Antinúcleo (FAN) na prática clínica: quando solicitar e como interpretar / The antinuclear factor (ANF) test in clinical practice: when to apply and how to interpret

O teste do Fator Antinúcleo (FAN) é um importante teste para triagem de doenças autoimunes, porém outras condições clínicas alteram esse exame. Ademais, poucos clínicos e generalistas sabem avaliar o seu resultado e, em consequência disso, revisamos como o teste deve ser usado na prática clínica.

The Test for Antinuclear Antibodies (ANA) is a very important factor in the evaluation of autoimmune diseases, however the test can be positive in other conditions in clinical practice, furthermore few generalists and physicians know how to use the results of the test, thereby we reviewed how to correctly use the test in everyday clinical practice.

Use of complement receptor 1 (CD35) assay in the diagnosis and prognosis of immune complex mediated glomerulopathies.

Complement Receptor 1 (CR1) is a polymorphic glycoprotein expressed on erythrocytes, leukocytes and glomerular podocytes and has a major role in immune complex processing. In addition, it regulates the complement cascade activation by preventing formation of classical and alternative pathway convertases and by acting as a cofactor for Factor I mediated cleavage of C3. In this study, we have examined the expression of erythrocyte CR1 (E-CR1) and glomerular CR1 (G-CR1) in different kinds of nephropathies using ELISA and immunofluorescence microscopy to understand their role in immune complex (IC) mediated renal diseases. E-CR1 was significantly reduced in all categories of lupus nephritis in comparison to normal subjects and non-IC renal diseases. However, other IC mediated diseases like IgA nephropathy and membranoproliferative glomerulonephritis had normal E-CR1 levels. G-CR1 showed distinct differences between IC and non-IC mediated diseases. G-CR1 was virtually absent in lupus kidneys. In other IC mediated diseases, there was a correlation of G-CR1 expression to the IC and complement fragment deposition. G-CR1 serves as a useful diagnostic marker for IC mediated diseases while E-CR1 is useful as a prognostic marker to monitor the course of disease after the treatment has initiated.

Glomerulonefritis por inmunocomplejos asociada a tuberculosis pulmonar / Glomerulonephritis by immune complexes associated with pulmonary tuberculosis

Se presenta el caso de un varón de 32 años que ingresó por dispnea de esfuerzo, hemoptisis, hematuria macroscópica, hipertensión, edemas perifáricos y descompensación hemodinámica con radiología compatible con edema de pulmón y cavidad en vértice izquierdo. Los exámines de laboratorio mostraron función renal alterada con cifras elevadas de urea y creatinina y síndrome nefrótico. Se encontró leucocituria, hematuria y cilindruria intensas. Se hizo diagnóstico de tuberculosis pulmonar por baciloscopía positiva comenzando tratamiento tuberculostático. El paciente persistió con su función renal gravada con cifras estables de uremia, creatininemia y potasemia con ritmo diurético conservado e hipertenso. Se efectuó punción-biopsia renal con diagnóstico anatomopatológico de glomerulonefritis proliferativa difusa endocapilar con formación de semilunas (15 por ciento) y esclerosis glomerular total (33 por ciento). Por inmunofluorescencia se detectaron depósitos difusos de inmunocomplejos granulares localizados en mesangio, con positividad IgM ++ C3 +. El paciente se recuperó gradualmente hacia una función renal normal, disminuyó sus derrames pleurales y normalizó su función cardíaca con el tratamiento tuberculostático. Se comenta la asociación entre glomerulonefritis y tuberculosis pulmonar a la luz de la bibliografía disponible y se sugiere una relación causal entre ambas entidades