[Pregnancy and systemic lupus erythematosus]. / Embarazo y lupus eritematoso sistémico.

BACKGROUND: The interrelations between systemic lupus erythematosus (SLE) and pregnancy are reason for debate. Patients with SLE may present antiphospholipid antibodies (APL), anti-Ro (a-Ro) or anti-La (a-La) with their influence in pregnancy not being well defined. METHODS: The pregnancies in a series of 96 fertile age women with SLE, followed during the period of 1975-1991 with a mean follow up of 6.2 years were studied. The spontaneous or provoked abortions, prematurity and the number of flares of the disease during pregnancy and during the year after birth were analyzed. The number of flares was compared with that presented by a control group of women with SLE of similar clinical features followed over the same time period. RESULTS: Twenty-seven patients had 35 pregnancies with 23 full term pregnancies, 5 spontaneous abortions and 7 provoked abortions. Twenty-six percent of the deliveries were premature. One or two flares related with 43% of the pregnancies with viable fetus (11 flares in total) were registered. The number of flares in the control group was 6%. The difference was not statistically significant (p = 0.55) but the relative risk was of 1.6. No relation was found between the presence of APL, a-Ro and a-La and the course of the pregnancy. No case of lupus neonatorum was observed. CONCLUSIONS: Pregnancy is not advised in patients with systemic lupus erythematosus in remission. Patients should be more frequently controlled during pregnancy and post partum. The presence of antiphospholipid antibodies or anti-Ro does not modifies the prognosis.

[Infection and systemic lupus erythematosus: analysis of a series of 145 patients]. / Infección y lupus eritematoso sistémico: análisis de una serie de 145 pacientes.

Systemic lupus erythematosus (SEL) is a chronic inflammatory disease, which often requires corticosteroid treatment, being infection a common cause of both morbidity and mortality. We report the infectious episodes from 145 SLE patients revisited through 1975-1991, with a 6.8 years mean follow-up period. The relationship between each episode and several variables, especially corticosteroid treatment a month before the infectious episode, was analyzed. Forty two infections were diagnosed in 32 patients (22.06%). A significant increase in the number of infections among SLE patients with daily corticosteroids treatment was observed with respect to that of SLE patients with alternate day treatment (p < 0.001). The administration corticosteroids in alternate day form, if possible, can decrease the infection incidence in SLE patients.

[Neurosarcoidosis: presentation of 14 cases]. / Neurosarcoidosis: presentación de 14 casos.

BACKGROUND: The involvement of the nervous system in sarcoidosis occurs with a frequency of approximately 5%. The aim of this study was to review the frequency and characteristics of the neurologic manifestations of the a series of sarcoidosis. METHODS: During a period of 18 years (1974-1991) 270 patients were diagnosed with sarcoidosis in the Hospital de Bellvitge-Prínceps d'Espanya. The diagnosis of neurosarcoidosis was performed in those presenting neurologic symptoms no attributable to other causes. The clinical histories were retrospectively reviewed collecting clinical, radiologic, analytic, therapeutic and evolutive data. RESULTS: Fourteen patients (5.1%) were diagnosed of neurosarcoidosis. Neurologic symptomatology was the first manifestation of the disease in 12 (85%). All showed extra-neurologic manifestations of sarcoidosis with the lung being the most frequently affected organ (78%). The clinical picture consisted of cranial neuropathy in 11 cases of which nine presented peripheral facial paralysis and 4 cases involvement of the central nervous system. In 13 patients the treatment schedule included glucocorticoids. All the patients (100%) with alteration of the central nervous system continued with active disease at 2 years while this only occurred in 33% of the cases with paralysis of the cranial pairs. CONCLUSIONS: The frequency of neurosarcoidosis in the authors' series was similar to that described in the literature and its most frequent clinical form was cranial neuropathy. The treatment of choice was glucocorticoid and the involvement of the cranial pairs presents a better prognosis than that of the central nervous system.

Multiple atypical bone involvement in sarcoidosis.

We describe a patient with right paratracheal and left hilar lymph nodes detected by chance on chest radiography that followed a spontaneous remission. However, a few months later she complained of multiple scalp nodules. Skull roentgenogram and computerized tomogram scan showed multiple osteolytic lesions with increased uptake in bone and gallium scans. Lytic lesions were also detected in her right mandibular bone and right clavicle. Noncaseating granulomas were demonstrated in skull and cervical lymph node biopsies.

Sarcoidosis in Spain.

We review the Spanish literature on sarcoidosis, and describe the most important epidemiological and clinical findings. Recent epidemiological data show a cumulative annual incidence rate of 1.36 per 100,000 inhabitants. The most relevant clinical aspects are the high incidence of Löfgren syndrome (48% of the cases), and the low percentage of cases diagnosed by routine chest X-ray (9%). Findings of intrathoracic and extrathoracic sarcoidosis, biopsy procedures, Kveim test, lung function tests, as well as the activity markers are, in general, similar to those previously described in the literature. The overall prognosis of sarcoidosis in Spain is good.

[Predictive factors of the persistence of sarcoidosis activity 2 years after diagnosis]. / Factores predictivos de persistencia de activad de la sarcoidosis a los 2 años del diagnóstico.

BACKGROUND: The prognosis of sarcoidosis is difficult to predict. In general, sarcoidosis is considered as chronic when it remains active for over 2 years. The aim of this study was to analyze predictive factors in the persistence of sarcoidosis activity 2 years after diagnosis. METHODS: One hundred fifty-five patients diagnosed of having sarcoidosis over a period of 14 years were included in a protocol of prospective study and were followed for at least 2 years. RESULTS: Four variables independently related to the persistence of activity of the disease at 2 years of diagnosis were identified by means of multiple logistic regression analysis: absence of erythema nodosum (relative risk = 23.3), confidence interval 95% = 12.7-44.6), age equal to or greater than 40 years of age (RR = 7.7, IC = 4.3-13.6), presence of splenomegaly (RR = 21.1, IC = 7, 5-59.7) and presence of parenchymatous infiltrates in thorax x-ray (RR = 3.5, IC 2-5.9). CONCLUSIONS: Although the persistence in the activity of sarcoidosis does not always have the same clinical repercussion and does not necessarily imply treatment, these results may permit a greater approximation to the prognosis of the disease and the indication of corticotherapy.

[Pericardial tamponade as a complication of T-cell cutaneous lymphoma]. / Taponamiento pericárdico como complicación de un linfoma cutáneo de células T.

Mycosis fungoides is a T cell lymphoma characterized by the initial skin involvement. Organ infiltration generally occurs many years after the cutaneous presentation. The organ disease is accompanied of peripheral blood involvement (more than 20% lymphocytes have atypical convolute nucleus and there are palpable adenopathies. Pericardic involvement is a rare complication as the initial manifestation of the visceral disease, in patients with mycosis fungoides of long evolution. We present a patient suffering mycosis fungoide who presented a pericardic tamponade. The visceral disease in our patient was not accompanied by blood anomalies or palpable adenopathies.

Long-term survival of a patient with prosthetic valve endocarditis due to Trichosporon beigelii.

A case is described of a 49-year-old man with rheumatic aortic valve disease who developed endocarditis seven years after valvular replacement. Trichosporon beigelii was isolated from the blood, a peripheral thrombus, and the removed prosthesis. After two valve prosthesis replacements and prolonged antifungal therapy, the patient survived for four years, but eventually died as a consequence of multiple septic complications due to the same organism. To the authors' knowledge, this is the longest survival time of any reported case of Trichosporon prosthetic valve endocarditis.

[Cerebral tuberculoma. Report of 8 cases]. / Tuberculoma cerebral. A propósito de ocho casos.

A series of eight patients with cerebral tuberculoma seen between 1980 and 1990 is reported. Headache was the leading clinical finding, followed by focal neurological findings and seizures. Papilledema was the most uniform examination finding associated with intracranial hypertension. Five patients had another localization of tuberculosis: three had tuberculous meningitis, one had tuberculous pericarditis and only one had associated active pulmonary involvement. Cerebrospinal fluid was investigated in seven patients. In three patients data of tuberculous meningitis were found, with positive culture in Löwenstein medium. Two patients had the acquired immunodeficiency syndrome. All patients received medical treatment with good response, except in one who developed paradoxical expansion of the lesions after two months of therapy.

[Uveitis: an etiological study of 200 cases following a protocol]. / Uveítis: estudio etiológico de 200 casos según protocolo.

BACKGROUND: To evaluate the usefulness of a systematic study of patients with uveitis and to assess the associated systemic diseases. METHODS: 200 patients seen in an outpatient clinic for the evaluation of uveitis between 1981 and 1988 were included in the study. Patients with eye disease associated with drug abuse or human immunodeficiency virus were excluded. The study protocol included an initial clinical and ophthalmological evaluation followed by selected specific investigations. RESULTS: Anatomical localization: anterior uveitis 122 (61%), posterior 41 (20.5%), panuveitis 30 (15%) and intermediate 7 (3.5%). ETIOLOGY: 74 cases (37%) were secondary, 101 (50.5%) were idiopathic, and 25 (12.5%) were specific syndromes of uveitis of unknown cause. Toxoplasmosis was the most common cause of infective uveitis, and ankylosing spondylitis was the most common noninfective cause. Diagnostic process: group 1, diagnosed by the ophthalmological investigation (25 cases); group 2, diagnosed on the basis of the accompanying clinical features and/or specific investigations (66 cases); and group 3, diagnosed by wider detection methods (8 cases). CONCLUSIONS: There was a remarkably high rate uveitis without etiological diagnosis. The evaluation of patients with uveitis requires a careful evaluation of ocular and systemic features, followed by selected specific investigation. The indiscriminate use of diagnostic tests is not warranted.

[Factors associated with generalized forms of arteriosclerosis in patients with coronary disease]. / Factores asociados a formas generalizadas de arteriosclerosis en pacientes con enfermedad coronaria.

We studied the lipidic metabolism and the atherogenic risk factors non related to lipidic metabolism in two groups of patients: group 1 with only coronary disease and group 2 with coronary disease and atherosclerosis in the cerebral and/or peripheric artery territories. Patients of group 2 showed a cholesterol, cLDL, and B-apoprotein titers significantly higher than group 1. Systolic and diastolic blood pressure were higher in group two. Also the incidence of diabetes mellitus in group 2 was higher than in group 1. In a stepwise discriminating analysis the diastolic arterial pressure and cholesterol titers were the parameters with a greatest predictive potential for the presence of localized or generalized ischemic disease. B-apoprotein was the lipidic parameter with the greatest predictive potential. All together these data suggest that in coronary patients, a discrete increase in plasma cholesterol can imply a risk of suffering ischemia in some other arterial territories. Diastolic blood pressure, cholesterol and diabetes mellitus are the factors with the highest predictive potential for the generalization of arteriosclerosis.

[Hairy leukoplakia: a new disease of the oral mucosa associated with infection by the human immunodeficiency virus]. / Leucoplasia vellosa: una nueva enfermedad de la mucosa oral asociada a infección por el virus de la inmunodeficiencia humana.

In 23 out of 227 patients with positive serological tests for the human immunodeficiency virus (10%), seen between June 1987 and May 1988, lingual lesions of hairy leukoplakia (HL) were found. HL was present in 16/188 drug abusers (9%) and in 7/19 homosexuals (32%). In 3 cases HL was the only clinical manifestation of disease, in 11 it was associated with other symptoms of acquired immunodeficiency syndrome related complex (ARC), and in 9 it was found in patients with a previous or concomitant diagnosis of acquired immunodeficiency syndrome. The mean count of CD4 lymphocytes in the 23 patients was 0.22 X 10(9)/l. The diagnosis was made on the basis of the characteristic clinical features. In 3 cases biopsy was carried out, and parakeratosis and vacuolization of the spinous layer cells were found. Remarkably, particles of the herpesvirus group were also found. The lesions oscillated in size or even spontaneously disappeared, at least transiently; however, in the patients treated with zidovudine the improvement appeared to be more significant. The detection of HL discloses a likely infection by the HIV; it is usually associated with other features of ARC and/or severe immune depression, and it requires the institution of antiretroviral treatment.

Recurrent sarcoidosis.

A 39-year-old woman was admitted with symptoms of erythema nodosum. A chest film showed right paratracheal and hilar bilateral lymphadenopathy and basal lung infiltrates. The diagnosis of subacute sarcoidosis was made despite the lack of histological proof. The disorder resolved spontaneously in a few months. Five years later Löfgren syndrome reappeared with cutaneous nodules, a biopsy of which showed noncaseating epithelioid granulomas. The Kveim test was positive. All features showed progressive regression without treatment. Four years later the patient presented right paratracheal and bilateral hilar lymph nodes and cutaneous nodules, and a biopsy again showed noncaseating granulomas. Spontaneous regression ensued and in the last four years she has remained symptom-free.

Brucellar spondylitis: a detailed analysis based on current findings.

Three hundred thirty-one cases of brucellosis included in a 10-year prospective protocol were reviewed to identify and follow up patients with spondylitis. Of 20 patients (17 male and three female; mean age, 54 years), spondylitis was diagnosed soon after onset of the brucellosis in 15, there were significant systemic symptoms in 17, and blood cultures were positive for Brucella melitensis in 14. The main symptom was vertebral pain. The commonest radiographic changes were narrowing of the disk and epiphysitis. The discrete character of radiographic alterations and negative uptake on bone scanning caused diagnostic delays in three patients. 99mTc bone scans finally became abnormal in all patients, but were not useful for follow-up because low uptake persisted after the clinical status stabilized. Three patients had paravertebral abscesses; in two of them fever and pain persisted despite antibiotic therapy until diagnosis and surgical drainage. Finally, all patients were cured, ten with sequelae. Brucellar spondylitis often had an acute clinical course with bacteremia. Because neither clinical nor radiographic changes one year after onset were significant, long-term follow-up is not considered necessary except when paravertebral abscess is suspected.