ABSTRACT
Se describe el caso de una mujer de 80 años, con antecedentes de trombosis venosa profunda en tratamiento con apixaban, que presenta clínica focal neurológica. Las pruebas de imagen evidencian múltiples émbolos arteriales en cerebro, riñones y bazo, así como imagen sugestiva de neoplasia uterina. Una biopsia tras histeroscopia, confirma el diagnóstico de adenocarcinoma de endometrio. La ecocardiografía transesofágica constata la existencia de vegetaciones en válvulas cardíacas, siendo los estudios infecciosos negativos. Es diagnosticada de endocarditis trombótica no bacteriana relaciona con una neoplasia. Se cambia apixaban por heparina de bajo peso molecular, confirmando la práctica desaparición delas vegetaciones. (AU)
We present a case of an 80-year-old woman with a history of deep vein thrombosis, treated with apixaban, which has a focal neurological clinic. Imaging tests show multiple arterial ischemic lesions in brain, kidneys and spleen, as well as suggestive imaging of uterine neoplasia. A biopsy after hysteroscopy confirms the diagnosis of endometrial adenocarcinoma. Transesophageal echocardiography shows vegetations in valves, with negative blood cultures. The diagnostic was non-bacterial thrombotic endocarditis related to cancer. The anticoagulant was changed to low molecular weight heparin, confirming the disappearance of vegetations. (AU)
Subject(s)
Humans , Female , Aged, 80 and over , Endocarditis, Non-Infective/diagnosis , Endocarditis, Non-Infective/therapy , Carcinoma, Endometrioid/diagnosis , Carcinoma, Endometrioid/therapy , Heparin/administration & dosage , Heparin/therapeutic use , Intracranial Embolism , EmbolismABSTRACT
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Subject(s)
Humans , Coronavirus Infections/epidemiology , Pulmonary Embolism/epidemiology , Venous Thrombosis/epidemiology , Blood Coagulation Disorders/epidemiology , Pulmonary Embolism/diagnosis , Severe Acute Respiratory Syndrome/complications , Severe acute respiratory syndrome-related coronavirus/pathogenicity , Anticoagulants/therapeutic use , Pandemics/statistics & numerical dataSubject(s)
Arteriovenous Fistula/complications , Iliac Aneurysm/complications , Iliac Artery , Iliac Vein , Venous Thrombosis/etiology , Aged , Anticoagulants/therapeutic use , Arteriovenous Fistula/diagnostic imaging , Arteriovenous Fistula/surgery , Computed Tomography Angiography , Humans , Iliac Aneurysm/diagnostic imaging , Iliac Aneurysm/surgery , Iliac Artery/diagnostic imaging , Iliac Vein/diagnostic imaging , Male , Phlebography , Risk Factors , Treatment Outcome , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/drug therapyABSTRACT
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Subject(s)
Humans , Male , Aged , Cat-Scratch Disease/microbiology , Parotitis/microbiology , Meningitis, Aseptic/microbiology , Bartonella henselae/isolation & purificationABSTRACT
IgG4-related disease (IgG4-RD) is a rare entity consisting of inflammation and fibrosis that has been described in multiple organs. Concrete diagnostic criteria have been established recently and there is a lack of large series of patients.To describe the clinical presentation, histopathological characteristics, treatment and evolution of a series of IgG4-RD Spanish patients.A retrospective multicenter study was performed. Twelve hospitals across Spain included patients meeting the current 2012 consensus criteria on IgG4-RD diagnosis.Fifty-five patients were included in the study, 38 of whom (69.1%) were male. Median age at diagnosis was 53 years. Thirty (54.5%) patients were included in the Histologically Highly Suggestive IgG4-RD group and 25 (45.5%) in the probable IgG4-RD group. Twenty-six (47.3%) patients had more than 1 organ affected at presentation. The most frequently affected organs were: retroperitoneum, orbital pseudotumor, pancreas, salivary and lachrymal glands, and maxillary sinuses.Corticosteroids were the mainstay of treatment (46 patients, 83.6%). Eighteen patients (32.7%) required additional immunosuppressive agents. Twenty-four (43.6%) patients achieved a complete response and 26 (43.7%) presented a partial response (<50% of regression) after 22 months of follow-up. No deaths were attributed directly to IgG4-RD and malignancy was infrequent.This is the largest IgG4-RD series reported in Europe. Patients were middle-aged males, with histologically probable IgG4-RD. The systemic form of the disease was frequent, involving mainly sites of the head and abdomen. Corticosteroids were an effective first line treatment, sometimes combined with immunosuppressive agents. Neither fatalities nor malignancies were attributed to IgG4-RD.
