Non-Islet Cell Tumor Hypoglycemia Caused by Recurrent Pelvic Solitary Fibrous Tumor.

Non-islet cell tumor hypoglycemia is a rare paraneoplastic condition caused by an extra-pancreatic tumor. We report a rare case of hypoglycemia caused by a relapsing pelvic solitary fibrous tumor associated with Big-IGF-2 production. A 72-year-old woman was admitted to our hospital because of loss of consciousness and hypoglycemia. She had a history of ovarian solitary fibrous tumor, which has relapsed. From investigation, serum levels of insulin and C-peptide were suppressed; IGF-1 was slightly reduced and IGF-2 was within the normal range, but the IGF-2: IGF-1 ratio was elevated, indicating the presence of Big-IGF-2 secreting non-islet cell tumor. Contrast-enhanced computed tomography (CT) showed a large pelvic mass. She was then submitted to surgical resection of the mass, which histologically proved to be a solitary fibrous tumor. Three months later, she remains asymptomatic. Non-islet cell tumor hypoglycemia should be considered in the differential diagnosis of patients presenting with tumors and recurrent hypoglycemia.

A Phantom Opacity on Chest Radiograph.

The authors present a case of phantom tumour of the lung. This is a type of pleural effusion where fluids accumulate in the interlobar fissures, typically in the transverse fissure. Its prompt recognition avoids additional, unnecessary or expensive examination and treatment mistakes. LEARNING POINTS: Phantom tumour of the lung should be considered as a differential diagnosis for a radiographic opacity because it can be misdiagnosed as a lung mass or consolidation.Its rapid disappearance after management of the underlying condition, in this case of cardiac decompensation with diuretics, confirms the diagnosis.Prompt recognition avoids additional, unnecessary or expensive examination and treatment mistakes.

Successful Management of Prosthetic Valve Brucella Endocarditis with Antibiotherapy Alone.

OBJECTIVES: To report a case of mechanical aortic prosthesis Brucella endocarditis successfully treated with antibiotics alone.Materials and methods: We describe a clinical case and present a review of the literature. RESULTS: A 60-year-old female farmer with a mechanical aortic prosthetic valve presented with low back pain and fever. She was diagnosed with prosthetic valve Brucella mellitensis endocarditis and was cured with antibiotic therapy alone. Few cases of successfully treated prosthetic valve Brucella endocarditis without surgery have been reported. CONCLUSION: Prosthetic valve Brucella endocarditis usually requires surgical valve replacement. However, selected patients may be successfully treated with antibiotic therapy alone. LEARNING POINTS: Brucella endocarditis is responsible for most fatal cases of brucellosis.Brucellosis relapse after treatment in patients with a cardiac valve prosthesis should arouse suspicion for endocarditis.Long-term medical treatment alone can be successful in selected patients with Brucella endocarditis, even in those with prosthetic valve endocarditis..

Unilateral swollen optic disc: do not forget neurosyphilis.

A 51-year-old man presented with a 3 month history of progressive right visual loss. On examination, the only abnormal findings were a right visual acuity of 4/10 and a swollen right optic disc. The patient had previously undergone MRI that had been reported as being normal and a trial of corticosteroids under the care of the referring ophthalmologist. An extensive battery of blood tests was normal apart from a rapid plasmatic reagin titre of 1:64. ELISA revealed elevated levels of total and immunoglobulin M antibodies against Treponema pallidum. Cerebrospinal fluid analysis revealed a mild leucocytosis and mildly elevated protein content. The patient was treated with a 5 week course of penicillin. Three months after starting treatment, his right visual acuity had improved to 8/10 and his right optic disc swelling had resolved.

[Hepatic granulomas in a feverish patient]. / Granulomas hepáticos num doente febril.

Fever of unknown origin is a diagnostic challenge. When the diagnosis remains elusive despite extensive non-invasive diagnostic studies, it can be necessary to conduct more invasive procedures, such as liver biopsy. We report a male with fever of unknown origin who had tender enlarged liver and raised liver enzymes whose hepatic biopsy disclosed epithelioid granulomas, with the etiological diagnosis made by the positivity of Coxiella burnetii serology.

[A family with a rare disease]. / Uma família com uma doença rara.

Fabry disease (FD) is a rare disorder resulting from mutations of the alpha-Galactosidase A lysosomal enzyme gene. Accumulation of enzyme substrates leads to multisystemic clinical manifestations and multiorgan progressive damage with high morbidity and mortality. Recombinant enzyme replacement therapy (RERT) now available aims to delay or even avoid the complications of FD. The index case was a 50-year-old man with bone pain since childhood, coarse facies, angiokeratomas, anemia, renal failure, proteinuria, sinus node disease, valvular disease and massive left ventricular hypertrophy and brain ischemic alterations. FD diagnosis was confirmed during hospital admission for bacterial endocarditis leading to death. Family screening revealed an affected brother with acroparesthesia, chronic cough, sinus bradycardia, long QT interval and near-nephrotic proteinuria, now under RERT. Their mother was not screened due to stroke sequelae. This report illustrates the need for early diagnosis, family screening and treatment, aiming to change the natural history of FD.

[Thymus hyperplasia in a patient with antiphospholipid syndrome]. / Hiperplasia do timo em doente com síndrome antifosfolipídico.

Thymus is an important central lymphoid organ that plays a pivotal role in the generation of peripheral T-lymphocytes. Thymoma and thymus hyperplasia have been associated with various autoimmune disorders, mainly myasthenia gravis. There is no established relationship between thymus pathology and antiphospholipid syndrome; however, there are some reported cases of antiphospholipid syndrome associated with myasthenia gravis or following thymectomy. We present the case of a patient with antiphospholipid syndrome and thymic lymphoid follicular hyperplasia. We discuss the association between both entities and suggest a diagnostic approach of a patient with a radiological disorder of the thymus and antiphospholipid syndrome.

[Lower lung field tuberculosis]. / Tuberculose do lobo pulmonar inferior.

Lower lung lobe tuberculosis is less common than the classical radiological forms of pulmonary tuberculosis. However this radiological presentation has a particular relevance in patients with some associated pathological conditions, such as diabetes mellitus, HIV infection and chronic alcoholism. We make a review of this entity in reference to an illustrative clinical case.

[Mediastinal seminoma: in reference to a case report]. / Seminoma mediastínico: A propósito de um caso clínico.

In reference to a clinical report, the authors of this article make a review about semiology, diagnosis and treatment of mediastinal seminoma.

[Cryptococcosis]. / Criptococose.

Cryptococcus neoformans infection is an opportunistic infection affecting mainly patients lacking cell mediated immunity whose incidence has dramatically risen with the advent of HIV infection. This infection has rarely been reported in patients with humoral immunity deficiencies. We report two patients with Cryptococcus neoformans infection with a fatal outcome: a man with disseminated criptococcosis leading to the diagnosis of AIDS; and a woman with stage III- B K light chains multiple myeloma presenting with meningitis to both Cryptococcus neoformans and Listeria monocytogenes.

[Idiopathic hypoparathyroidism and systemic lupus erythematosus: a rare association]. / Hipoparatiroidismo idiopático e lúpus eritematoso sistémico: associação rara.

A 20-year-old woman was admitted to our hospital after two generalized seizures with severe hypocalcemia. She was diagnosed with Idiopathic Hypoparathyroidism. In the follow-up she was diagnosed with Systemic Lupus Erythematosus (SLE) by the presentation of four criteria of the American College of Rheumatology (ACR) for SLE. This is the sixth reported case of this association.

[Spinal epidural abscess due to group C Streptococcus]. / Abcesso Epidural Vertebral a Estreptococo do grupo C.

Spinal epidural abscess is a rare clinical entity, presenting insidiously with nonspecific clinical manifestations. The diagnosis is usually difficult and, if not made early, the consequences may be disastrous. The therapeutic strategy consists of surgical drainage and systemic antibiotherapy for 4 to 6 weeks; in carefully selected patients, the surgical intervention may be avoided. We describe the case of a diabetic woman who presented with a spinal epidural abscess due to Streptococcus equi subsp. zooepidemicus, a group C Streptococcus, treated successfully with parenteral antibiotherapy followed by oral antibiotherapy. Group C streptococci are bacteria typically associated with disease in animals, nowadays emerging as important human pathogens. This is the first reported case of spinal epidural abscess due to a Group C Streptococcus.

[Endobronchial sarcoidosis: in reference to a clinical report]. / Sarcoidose endobrônquica: A propósito de um caso clínico.

In reference to a clinical report, the authors make a review on sarcoidosis and it's endobronchial involvement.