Síndrome de Cushing iatrogénico por corticoides tópicos en dos adultos / Iatrogenic Cushing’s syndrome caused by topical steroid therapy in two adults

Los corticoides tópicos representan el escalón principal en el tratamiento de muchas enfermedades dermatológicas no infecciosas. Si se usan de forma apropiada son seguros y efectivos, pero sin una supervisión médica adecuada pueden producir efectos secundarios graves, tanto locales como sistémicos. Presentamos dos pacientes adultos diagnosticados de síndrome de Cushing iatrogénico en nuestro hospital. Aunque es una complicación poco frecuente, se debe tener en cuenta en pacientes con dermatosis inflamatorias de larga evolución, ya que puede ser de difícil diagnóstico si no se sospecha (AU)

Topical corticosteroids are the mainstay of treatment for many non- infectious dermatoses. If used appropriately they are a safe and effective therapy, but without medical supervision severe local and systemic adverse effects may occur. We report two patients followed at our Dermatology unit that developed iatrogenic Cushing's syndrome after using topical corticosteroids. Although it's an extremely rare complication in adults, we must be aware of this adverse effect in patients with chronic inflammatory dermatoses, as diagnosis requires a high grade of suspicion (AU)

Fiebre Q: 54 nuevos casos de un hospital terciario de Madrid / Q fever: 54 new cases from a tertiary hospital in Madrid

Objetivos. Describir las características epidemiológicas y clínicas de la fiebre Q en una zona urbana de la Comunidad de Madrid. Material y métodos. Estudio observacional retrospectivo de cohorte de los casos diagnosticados de fiebre Q en un único centro desde enero de 2001 hasta diciembre de 2008. El diagnóstico de fiebre Q aguda se realizó mediante la detección de anticuerpos frente a antígenos fase II por técnica de enzyme-linked immunosorbent assay (ELISA) e inmunofluorescencia indirecta (IFI), en base a un título aislado ≥ 1/80 o cuando se demostró seroconversión o serorrefuerzo. El de fiebre Q crónica se realizó mediante anticuerpos frente antígenos fase I positivo si IgG >= 1/800. Resultados. Se diagnosticaron 54 casos de fiebre Q en adultos. Cincuenta y un pacientes con fiebre Q aguda y 3 con fiebre Q crónica. Predominaron los varones de más de 50 años de edad y residentes en medio urbano. La clínica más frecuente fue la neumonía, la insuficiencia renal (33%), la hepatitis y el síndrome febril sin focalidad (25% ambas), con infección concomitante en el 37% de los casos. El seguimiento clínico y serológico en la mayoría de los pacientes fue inadecuado. La doxiciclina fue el tratamiento de mayor respuesta en enfermedad aguda, aunque en 10% con duración inadecuada(AU)

Objectives. To describe the epidemiological and clinical characteristics of Q fever in an urban zone of the Community of Madrid (Spain). Material and methods. An observational, retrospective study was performed of a cohort of cases diagnosed of Q fever within a single center in Madrid from January 2001 to December 2008. The diagnosis of acute Q fever was made by detection of antibodies against phase II antigen by Enzyme-Linked Immunosorbent Assay (ELISA) and indirect immunofluorescence (IFA), based on isolated titer ≥ 1/80 or when they showed seroconversion or seroreinforcement. Chronic Q fever was diagnosed using antibodies against phase I with a positive value if IgG >= 1/800. Results. A total of 54 cases of Q fever in adults were diagnosed; 51 patients had acute Q fever and only 3 chronic. There was a predominance of men over > 50years and from urban areas. The most frequent manifestation was pneumonia (54%), followed by renal failure (33%), hepatitis and fever without focality (25% in both), with concomitant infection in 37% of the cases. The clinical and serological monitoring in most of the patients were inadequate. The best response to treatment was with doxycycline in acute illness, although duration was inadequate in 10%(AU)

[Q fever: 54 new cases from a tertiary hospital in Madrid]. / Fiebre Q: 54 nuevos casos de un hospital terciario de Madrid.

OBJECTIVES: To describe the epidemiological and clinical characteristics of Q fever in an urban zone of the Community of Madrid (Spain). MATERIAL AND METHODS: An observational, retrospective study was performed of a cohort of cases diagnosed of Q fever within a single center in Madrid from January 2001 to December 2008. The diagnosis of acute Q fever was made by detection of antibodies against phase II antigen by Enzyme-Linked Immunosorbent Assay (ELISA) and indirect immunofluorescence (IFA), based on isolated titer ≥ 1/80 or when they showed seroconversion or seroreinforcement. Chronic Q fever was diagnosed using antibodies against phase I with a positive value if IgG ≥ 1/800. RESULTS: A total of 54 cases of Q fever in adults were diagnosed; 51 patients had acute Q fever and only 3 chronic. There was a predominance of men over > 50 years and from urban areas. The most frequent manifestation was pneumonia (54%), followed by renal failure (33%), hepatitis and fever without focality (25% in both), with concomitant infection in 37% of the cases. The clinical and serological monitoring in most of the patients were inadequate. The best response to treatment was with doxycycline in acute illness, although duration was inadequate in 10%.

Budesonide combined with ursodeoxycholic acid in primary biliary cirrhosis with advanced liver damage.

We describe two patients with primary biliary cirrhosis who rapidly suffered progressive liver failure and developed jaundice, despite having undergone correct therapy using ursodeoxycholic acid. Both cases showed an extraordinary clinical and biochemical response 2 months after budesonide was added to standard therapy, leading to recovery of normal liver function.