ABSTRACT
La enfermedad de Behçet, proceso inflamatorio de etiología desconocida, suele presentarse en forma de aftas orales recurrentes, úlceras genitales, uveítis y lesiones cutáneas. De todas formas su espectro clínico es amplio y puede afectar a otros órganos y sistemas como el sistema nerviosos central, articulaciones, vasos sanguíneos y el aparato digestivo.Su aproximación terapéutica es compleja y diferente en función de los distintos órganos afectados. En la aftosis compleja se suele iniciar el tratamiento con fármacos tópicos, colchicina y dapsona. La utilización de talidomida, prednisona por vía oral y metotrexate se reserva para casos en que no hay respuesta a los fármacos anteriores.En la afectación ocular severa y en la afectación sistémica el tratamiento es más agresivo y suele combinar corticoides con fármacos inmunosupresores, siendo los más utilizados la ciclosporina, azatioprina, ciclofosfamida, interferón-alfa-2a y el clorambucil (AU)
Subject(s)
Humans , Thalidomide , Methotrexate , Prednisone , Behcet Syndrome , Colchicine , DapsoneABSTRACT
Behçet's disease is an inflammatory process of unknown origin, which usually presents with recurrent oral ulcers, genital aphthae, uveitis and cutaneous lesions. However, a wide variety of clinical manifestations have been reported, and virtually any organ system may be affected, showing central nervous system, joints, blood vessels or gastrointestinal tract involvement. Therapeutic approach remains complex, and varies in basis of the affected organs. Complex aphthosis may respond to topical therapy, colchicine and dapsone. If this therapy does not result in adequate disease control, thalidomide, oral prednisone and methotrexate may be useful. When severe ocular lesions or systemic manifestations are present, therapies tend to be more aggressive, usually combining corticosteroids with immunosuppressive agents as cyclosporin, azathioprine, cyclophosphamide, interferon-alfa-2a, and chlorambucil.
Subject(s)
Behcet Syndrome/drug therapy , Behcet Syndrome/diagnosis , Colchicine/therapeutic use , Dapsone/therapeutic use , Humans , Methotrexate/therapeutic use , Prednisone/therapeutic use , Thalidomide/therapeutic useABSTRACT
Mucormycosis is an infection caused by fungi in the Mucorales order, of which the most relevant family is Mucoraceae, which includes the Rhizopus, Mucor and Absidia genera. It is a severe infection which involves diabetic patients with ketoacidotic decompensation and immunosuppressed patients. We report here five cases (four with rhino-cerebral forms) attended at our hospital in the last ten years. Three patients had diabetes, one was infected with the human immunodeficiency virus, and the other was on a programme of peritoneal dialysis due to renal failure. The most relevant clinical manifestation was the presence of the necrotic lesion in three of the four patients with rhinocerebral involvement (two in the palate, one in the nasal mucosa). Two patients died as a result of the direct infection a few days after diagnosis. In summary, mucormycosis is an infection with a low prevalence but still maintaining a high mortality rate. An early diagnosis is essential and thereby a high index of clinical suspicion is required in patients with predisposing factors.
Subject(s)
Mucormycosis/diagnosis , Opportunistic Infections/diagnosis , Adult , Aged , Central Nervous System Fungal Infections/diagnosis , Fatal Outcome , Female , Humans , Male , Middle Aged , Mucormycosis/therapy , Nose Diseases/diagnosis , Nose Diseases/microbiology , Opportunistic Infections/therapy , Peritoneal Diseases/diagnosis , Peritoneal Diseases/microbiologyABSTRACT
La mucormicosis es una infección producida por los hongos del orden Mucorales, de los cuales la familia más importante es la de los Mucoraceae, que incluye los géneros Rhizopus, Mucor y Absidia. Es una infección grave que afecta a pacientes diabéticos con descompensación cetoacidótica e inmunodeprimidos de diversa índole. Presentamos 5 casos (4 con formas rinocerebrales y uno peritoneal) tratados en nuestro hospital en los últimos 10 años. Tres eran diabéticos, uno estaba infectado por el virus de la inmunodeficiencia humana (VIH) y otro estaba en programa de diálisis peritoneal por insuficiencia renal. Clínicamente destacó la presencia de lesión necrótica en 3 de los 4 pacientes con afectación rinocerebral (2 en paladar y otra en mucosa nasal).Dos pacientes fallecieron como consecuencia directa de la infección a los pocos días del diagnóstico. En resumen, la mucormicosis es una infección con una baja incidencia, pero que mantiene una alta tasa de mortalidad. Es preciso realizar un diagnóstico precoz, para lo cual se ha de mantener un alto índice de sospecha clínica en pacientes con factores predisponentes (AU)
Subject(s)
Middle Aged , Adult , Aged , Male , Female , Humans , Fatal Outcome , Mucormycosis , Nose Diseases , Opportunistic Infections , Peritoneal Diseases , Central Nervous System Fungal InfectionsABSTRACT
El síndrome de Sneddon es una arteriopatía no inflamatoria de vasos de mediano calibre. Las manifestaciones clásicas son enfermedad cerebrovascular en pacientes jóvenes, habitualmente mujeres, con livedo reticularis.Puede existir un patrón de herencia autosómico dominante, aunque la base etiopatogénica es desconocida. Es motivo de discusión la participación de los anticuerpos antifosfolípido que presentan algunos pacientes en la patogenia del síndrome. El diagnóstico suele establecerse a partir de pruebas de radioimagen como la resonancia magnética y por la biopsia de piel y arteria digital. El pronóstico a término medio con antiagregantes plaquetarios es bueno (AU)
Subject(s)
Adult , Female , Male , Middle Aged , Humans , Sneddon Syndrome/diagnosis , Sneddon Syndrome/complications , Sneddon Syndrome/therapy , Tomography, X-Ray Computed , Prognosis , Magnetic Resonance SpectroscopyABSTRACT
OBJECTIVE: To describe the clinical spectrum of bronchopulmonary infections caused by Pseudomonas aeruginosa in patients infected with HIV. METHODS: A retrospective study of cases with P. aeruginosa pneumonia and tracheo-bronchitis in patients infected with HIV, diagnosed over a 5-year period (January 1990-December 1994) in a third level university hospital. RESULTS: Seven patients with pneumonia and 15 with tracheobronchitis were identified, with a mean age of 33 years. All patients were in an advanced stage of immunosuppression (median CD4 count 11/mm3) and 21 (95%) had AIDS. In 6 cases (86%) pneumonia was acquired in the community and no patient had severe neutropenia. Clinical presentation ranged from severe pneumonia with respiratory insufficiency and shock to subacute less severe disease. Two patients (29%) died in the first episode as a result of pneumonia. The combination of cough, purulent expectoration and fever was the usual presenting form of tracheo-bronchitis. Nine out of the 15 patients (60%) had been treated previously because of tracheo-bronchitis and/or bacterial pneumonia episodes not caused by P. aeruginosa. Twelve patients required hospital admission; ten patients (83%) because of tracheo-bronchitis symptoms. The initial response to therapy was satisfactory, but 12 (80%) relapsed, with 2.6 relapses per patient after a mean follow-up of 7.4 months. CONCLUSIONS: P. aeruginosa bronchopulmonary infections emerge in late stages of HIV disease. P. aeruginosa should be considered in the differential diagnosis of every patient with pneumonia and advanced AIDS, even in the absence of the traditionally reported risk factors. Initially, tracheo-bronchitis responds well to therapy, but its management is difficult because of the frequent relapses and the development of antibiotic resistance.
