ABSTRACT
Mixed connective tissue disease is an autoimmune disorder with overlapping features of systemic lupus erythematosus, systemic sclerosis and polymyositis. Cardiac involvement is common, being pericarditis the most frequent manifestation, as also pulmonary hypertension. The authors present a case of a woman with one year of symptoms of polyarthritis and myalgia with gradual muscle weakness and weight loss, with severe impaired mobility in the last months. The initial evaluation showed an inflammatory systemic condition with an infiltrative pattern in echocardiogram, with pulmonary hypertension, that was confirmed by cardiac magnetic resonance. After an extensive study, where infiltrative cardiomyopathies were a differential diagnosis, the patient meet criteria to mixed connective disease with signs of pulmonary hypertension and an atypical cardiac involvement. Immunosuppressive treatment and rehabilitation were initiated and one year after the patient remains asymptomatic without any limitations. (AU)
La enfermedad mixta del tejido conectivo es un trastorno autoinmune con características superpuestas de lupus eritematoso sistémico, esclerosis sistémica y polimiositis. La afectación cardiaca es común, siendo la pericarditis la manifestación más frecuente, al igual que la hipertensión pulmonar. Los autores presentan el caso de una mujer con un año de síntomas de poliartritis y mialgia con debilidad muscular gradual y pérdida de peso, con grave deterioro de la movilidad en los últimos meses. La evaluación inicial mostró un cuadro inflamatorio sistémico con patrón infiltrativo en ecocardiograma, con hipertensión pulmonar, que se confirmó por resonancia magnética cardiaca. Tras un amplio estudio, en el que las miocardiopatías infiltrativas constituyeron un diagnóstico diferencial, la paciente cumplía criterios de conectivopatía mixta con signos de hipertensión pulmonar y una afectación cardiaca atípica. Se inició tratamiento inmunosupresor y rehabilitación y un año después la paciente permanece asintomática sin limitaciones. (AU)
Subject(s)
Humans , Female , Middle Aged , Mixed Connective Tissue Disease/diagnosis , Mixed Connective Tissue Disease/drug therapy , Hypertension, Pulmonary/diagnosis , Magnetic Resonance Spectroscopy , Diagnosis, DifferentialABSTRACT
Syphilis is a sexual transmitted disease caused by Treponema pallidum and an underdiagnosed and underreported cause of acute hepatitis. In recent years, reported cases of primary and secondary syphilis have been increasing, mostly in men who have sex with men. Clinical manifestations of syphilis are diverse, earning the name of "the great imitator" which can affect virtually any organ. Nonetheless, hepatic involvement is rare, but it can occur at any stage of the disease. We present the case of a 41-year-old immunocompetent male, that presents to us with a cholestatic hepatitis and a diffuse erythematous rash with palmo-plantar affection. The patient had no history of primary syphilis. After throughout aetiologic study, he was diagnosed with syphilitic hepatitis and treated with intramuscular Benzathine benzylpenicillin, with the disappearance of the rash and normalization of liver enzymes after 3 months. We would like to highlight that this aetiology should be considered in patients with unexplained elevation of liver enzymes (mainly cholestatic enzymes) and an epidemiologic context of unsafe sexual exposure.
ABSTRACT
Strongyloides stercoralis is a parasite capable of surviving for decades in a single host, due to its ability of auto-infection. Strongyloidiasis usually presents a chronic and asymptomatic evolution, and isolated eosinophilia, cutaneous or gastrointestinal abnormalities are the most frequent findings. Between the 1910s and 1980s, several cases of autochthonous strongyloidiasis in Portugal have been described. We report the case of a patient with abdominal pain, ascites and marked eosinophilia. The diagnostic investigation excluded frequent causes of eosinophilia. The diagnosis of strongyloidiasis was confirmed by immunoenzymatic positivity of the antibody to Strongyloides stercoralis. Since the patient lived in a region where several cases of strongyloidiasis were diagnosed in the past, and given the absence of previous trips abroad, this is the first case identified in recent decades of autochthonous strongyloidiasis in Portugal. The authors point out the possibility of chronic infection acquired in regions previously considered foci of great endemicity.
O Strongyloides stercoralis é um parasita capaz de sobreviver durante décadas num só hospedeiro, graças à sua capacidade de autoinfecção. A estrongiloidíase apresenta uma evolução habitualmente crónica e assintomática, sendo a eosinofilia isolada, as alterações cutâneas e gastrointestinais as manifestações mais frequentes. Entre as décadas de 1910 e 1980, vários casos de estrongiloidíase autóctone de Portugal foram descritos. Os autores apresentam o caso de uma doente com dor abdominal, ascite e eosinofilia marcada. O estudo etiológico excluiu causas frequentes de eosinofilia, sendo confirmado o diagnóstico de estrongiloidíase pela positividade imunoenzimática do anticorpo para Strongyloides stercoralis. Residindo a doente numa região onde foram, no passado, diagnosticados vários casos de estrongiloidíase e na ausência de viagens previas para o estrangeiro, este representa o primeiro caso identificado nas últimas décadas de estrongiloidíase autóctone em Portugal. Os autores alertam para a possibilidade de infeção crónica adquirida em regiões consideradas, previamente, focos de grande endemicidade.
