ABSTRACT
INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has increased concern regarding SARS-CoV-2 infection in inflammatory bowel disease (IBD) patients, especially those on immunosuppressive therapies or with active disease. There are limited reports describing the clinical features of COVID-19 in an IBD population, and the impact of immunosuppression on the severity of the infection remains unclear. CASE REPORT: A 33-year-old female patient with a long history of ulcerative colitis, poorly controlled, was admitted with COVID-19 a few days after being discharged from the hospital for treatment of acute severe ulcerative colitis. High-risk factors for COVID-19 complications, i.e., high-dose steroids (40 mg prednisone) and severe active disease, were present at admission. Despite the development of extensive pulmonary involvement, the patient had a favorable outcome. DISCUSSION: Management of IBD patients during the COVID-19 pandemic has been challenging. Measures to minimize the potential risk of SARS-CoV-2 infection, including strict social distancing and self-isolation, in the IBD population have been recommended, especially for high-risk patients. Although steroid tapering and persistence of biologics are advised by professional groups, the best treatment strategy for IBD patients presenting a flare during the outbreak has yet to be defined.
ABSTRACT
BACKGROUND The treatment of inflammatory bowel disease aims to induce and maintain disease remission, avoid complications, and restore quality of life. The treatments include the use of immunosuppressants and biological therapy. Despite the effectiveness of these treatments in controlling disease activity and in limiting complications, there remains an increased risk of developing malignancies. CASE REPORT A 70-year-old male patient with ulcerative colitis who had pancolitis was initially treated with mesalazine. In 2010, the medication was changed to azathioprine due to clinical disease activity. The patient demonstrated clinical and endoscopic response to the medication, but presented recurrent facial lesions identified as non-melanoma skin cancer in 2014, 2015, and 2016. Azathioprine was discontinued and anti-TNF therapy was started, but no satisfactory clinical or endoscopic response was observed. The patient developed hematuria and a ureter tumor was found with subsequent ureteronephrectomy. Moreover, the patient underwent total colectomy with ileostomy as a treatment for refractory ulcerative colitis. CONCLUSIONS Immunosuppressive therapy can facilitate the development of malignant neoplasms, accelerate tumor growth, and favor the onset of metastases. The types of tumors most associated with its use are lymphoproliferative tumors and non-melanoma skin cancer. The benefits of adequate control of inflammatory bowel disease are clear and the use of immunosuppressants should not be limited by these potential adverse outcomes; however, the risk-benefit profile of immunosuppression should always be assessed on a case-by-case basis.
Subject(s)
Colitis, Ulcerative/drug therapy , Immunosuppressive Agents/adverse effects , Skin Neoplasms/etiology , Ureteral Neoplasms/etiology , Aged , Colectomy , Colitis, Ulcerative/surgery , Humans , Ileostomy , Immunosuppressive Agents/administration & dosage , Male , Nephroureterectomy , Risk Assessment , Skin Neoplasms/immunology , Skin Neoplasms/surgery , Ureteral Neoplasms/immunology , Ureteral Neoplasms/surgeryABSTRACT
Objetivo: O diabetes mellitus tipo 1 representa condição crônica de saúde frequente na população pediátrica e possui impacto significativo sobre qualidade de vida destes indivíduos. O objetivo do presente estudo é avaliar a qualidade de vida em indivíduos com diabetes mellitus tipo 1 de curta duração, sob a ótica dos pacientes e dos seus cuidadores. Métodos: Aplicação dos questionários PedsQL 4.0 e Instrumento de Qualidade de Vida para Jovens com Diabetes. Resultados: Dentre os 15 pacientes (e seus cuidadores) avaliados, observou-se que a maior parte dos indivíduos entrevistados considerou sua saúde como boa, em relação à das demais pessoas e a autopercepção da qualidade de vida não se mostrou, de forma geral, prejudicada pelo diabetes. Conclusão: Tendo em vista que a ausência de complicações crônicas e a percepção de boa saúde estão intimamente relacionadas, destaca-se a importância da intervenção precoce, por parte da equipe de saúde, com objetivo de promover atividades de educação em saúde, voltadas às necessidades desse grupo de indivíduos.
ABSTRACT
JUSTIFICATIVA E OBJETIVOS: A paracoccidioidomicose é uma doença fúngica, granulomatosa crônica, que acomete principalmente os pulmões, o sistema linfático e a pele. Pode ser dividida nas formas aguda e subaguda, que ocorre principalmente em crianças e acomete preferencialmente pele e sistema linfático e, crônica que ocorre principalmente em adultos, particularmente no pulmão. O objetivo deste estudo foi apresentar a manifestação da paracoccidioidomicose subaguda em adulto jovem imunocompetente.RELATO DO CASO: Paciente do sexo feminino, 29 anos, internada para investigação de dor abdominal, sendo diagnosticada paracoccidioidomicose subaguda. Apresentou colestase intra-hepática, devido à linfoadenomegalia intra-abdominal. Evoluiu sem complicações após tratamento instituído.CONCLUSÃO: O caso relatado reflete uma manifestação incomum,em adulto jovem, residente em zona urbana, das formas aguda e subaguda de paracoccidioidomicose, com acometimento linfonodal profundo intra-abdominal causando colestase intra-hepática, icterícia e anemia.
BACKGROUND AND OBJECTIVES: Paracoccidioidomycosis is a chronic, fungal, granulomatous disease, which mainly affects the lungs, lymphatic system and skin. It can be divided into acute and subacute, occurring primarily in children and affecting mainly the skin and lymphatic system, and chronic, occurring primarily in adults and affecting mainly the lungs. This report describes the manifestation of subacute paracoccidioidomycosis in an immunocompetent young adult.CASE REPORT: Female patient, 29 year-old, imunocompetent, hospitalized with abdominal pain, was diagnosed with subacute paracoccidioidomycosis. She showed intrahepatic cholestasis due to intra-abdominal lymphadenopathy. She presented uneventful recovery after treatment.CONCLUSION: This case reflects an unusual manifestation in young adults living in urban areas of the subacute/acute paracoccidioidomycosis, with deep intra-abdominal lymphadenopathy causing intrahepatic cholestasis, jaundice and anemia. There was improvement after treatment
