Common variable immunodeficiency and isosporiasis: first report case / Imunodeficiência comum variável e isosporíase: primeiro relato de caso

We report a severe case of diarrhea in a 62-year-old female HIV-negative patient from whom Giardia lamblia and Isospora belli were isolated. Because unusual and opportunistic infections should be considered as criteria for further analysis of immunological status, laboratory investigations led to a diagnosis of common variable immunodeficiency (CVID). This is the first reported case of isosporiasis in a patient with CVID and illustrates the importance of being aware of a possible link, particularly in relation to primary immunodeficiency.

Trata-se de relato de caso de uma paciente de 62 anos, sexo feminino, HIV negativo apresentando um quadro grave de diarréia, sendo isolados Giardia lamblia e Isospora belli. Infecções incomuns e oportunistas devem ser consideradas como um sinal para alerta para que se analise o sistema imunológico. O diagnóstico de imunodeficiência de comum variável foi realizado após investigação. Este é o primeiro caso relatado de isosporíase em pacientes com imunodeficiência comum variável e mostra a importância de estar alerta tambem em relação a imunodeficiências primárias.

The significantly reduced number of interstitial cells of Cajal in chagasic megacolon (CM) patients might contribute to the pathophysiology of CM.

In addition to neurons, interstitial cells of Cajal (ICC) play an important role in coordinating intestinal motility with a pacemaker function. This study aimed to quantitatively analyze ICC, neurons, and muscular area, the latter to correct for quantitation errors resulting from dilation in case of a megacolon and from the dispersion of ICC that can be attributed to muscular hypertrophy. We analyzed 30 colon samples: ten chagasic megacolon (CM), ten chagasic colons without megacolon (CXM), and ten nonchagasic control patients (NC). We measured the area of muscularis propria and counted the number of neurons of the myenteric plexus in a histological section of an intestinal ring and the number of ICC at the level of the myenteric plexus and circular muscle layer, the latter in a section immunohistochemically stained for CD117. Muscular hypertrophy occurred only in the CM group. Compared to the NC group, we found in the CM group a statistically significant reduction of 80 % in the number of neurons, 60 % in the number of ICC in the myenteric plexus, and 38 % in the area of circular muscle. In the CXM group, these numbers were highly variable, and their reduction, less pronounced. We conclude that the number of ICC is significantly reduced in CM patients, and that this might contribute to the pathophysiology of CM. However, the development of CM requires severe denervation, whereas CXM generally exhibits less than 50 % denervation, favoring the hypothesis that the reduction in ICC number is, in part, a consequence of denervation.

Testes cutâneos de leitura tardia para alimentos na dermatite atópica de difícil controle / Food atopy patch test in atopic dermatitis with problematic control

Objetivo: Descrever um caso de dermatite atópica de difícil controle e o uso dos testes cutâneos de leitura tardia para alimentos no intuito de auxiliar o manejo do paciente. Descrição: Lactente do sexo feminino que aos quatro meses de vida iniciou quadro de lesões em rosto e períneo que disseminaram por todo o corpo e não apresentou resposta satisfatória com o uso das medicações habituais. A investigação IgE mediada para alérgenos alimentares foi negativa. Foi realizado o teste cutâneo de leitura tardia para leite, ovo, soja, trigo e milho, que se mostrou positivo para ovo, trigo e milho. Iniciou-se a dieta de exclusão dos alimentos referidos, associada ao tratamento medicamentoso com rápida melhora das lesões. Realizada em seguida a prova de provocação que demonstrou exacerbação das lesões com os alimentos descritos acima. Comentários: A dermatite atópica é considerada uma doença de padrão misto, IgE e não IgE mediada. Nos casos de difícil controle a utilização dos testes cutâneos de leitura tardia podem ajudar no diagnóstico de alergias alimentares não IgE mediadas e no controle da doença.

Objective: To describe a case of atopic dermatitis of difficult control and the use of food atopy patch test in order to assist the management of patients. Description: Female infant who at four months of life developed lesions on her face and perineum that spread throughout the body and did not show a satisfactory response to the use of medications. Search for IgE-mediated food allergens was negative. It was performed the atopy patch test to milk, egg, soy, wheat and corn, which was positive for egg, wheat and corn. She started the food elimination diet mentioned, associated with drug therapy with rapid improvement of the lesions. After that, she accomplished the challenge test which showed exacerbation of lesions with the described foods. Comments: Atopic dermatitis is considered a disease of mixed pattern, IgE and non IgE mediated. The use of food atopy patch test can help diagnose non-IgE mediated food allergies and to control the disease in cases of difficult control.

Common variable immunodeficiency and isosporiasis: first report case.

We report a severe case of diarrhea in a 62-year-old female HIV-negative patient from whom Giardia lamblia and Isospora belli were isolated. Because unusual and opportunistic infections should be considered as criteria for further analysis of immunological status, laboratory investigations led to a diagnosis of common variable immunodeficiency (CVID). This is the first reported case of isosporiasis in a patient with CVID and illustrates the importance of being aware of a possible link, particularly in relation to primary immunodeficiency.

Benign and malignant neoplasias in 261 necropsies for HIV-positive patients in the period of 1989 to 2008.

Considering that there are some studies with autopsies from AIDS describing only malignant neoplasias and that changes can occur after the introduction of Highly Active Antiretroviral Therapy (HAART), our objectives were to analyze the frequency of benign and malignant neoplasms in AIDS patients in the periods of both pre- and post-HAART. This is a retrospective study with 261 autopsies of HIV-positive patients between 1989 and 2008 in Uberaba, Brazil. Sixty-six neoplasms were found (39 benign, 21 malignant and six premalignant) in 58 patients. The most frequent malignant neoplasms were lymphoid, in 2.7% (four Non-Hodgkin lymphoma, one Hodgkin, one multiple myeloma and one plasmablastic plasmacytoma), and Kaposi's Sarcoma, in 2.3% (six cases). The most frequent benign neoplasms were hepatic hemangiomas in 11 (4.2%) of 261 cases and uterine leiomyoma in 11 (15.7%) of 70 woman. In the pre-HAART period eight (9.8%) benign neoplasias and four (4.9%) malignant occurred in 82 patients; in the post-HAART period, 29 (16.2%) benign and 17 (9.5%) malignant were present; however, the differences were not significant. We conclude that the introduction of HAART in our region doesn't look to have modified the frequency of neoplasms occurring in patients with HIV.

Benign and malignant neoplasias in 261 necropsies for HIV-positive patients in the period of 1989 to 2008 / Neoplasias benignas e malignas em 261 necropsias de pacientes HIV positivos no período de 1989 a 2008

Considering that there are some studies with autopsies from AIDS describing only malignant neoplasias and that changes can occur after the introduction of Highly Active Antiretroviral Therapy (HAART), our objectives were to analyze the frequency of benign and malignant neoplasms in AIDS patients in the periods of both pre- and post-HAART. This is a retrospective study with 261 autopsies of HIV-positive patients between 1989 and 2008 in Uberaba, Brazil. Sixty-six neoplasms were found (39 benign, 21 malignant and six premalignant) in 58 patients. The most frequent malignant neoplasms were lymphoid, in 2.7 percent (four Non-Hodgkin lymphoma, one Hodgkin, one multiple myeloma and one plasmablastic plasmacytoma), and Kaposi's Sarcoma, in 2.3 percent (six cases). The most frequent benign neoplasms were hepatic hemangiomas in 11 (4.2 percent) of 261 cases and uterine leiomyoma in 11 (15.7 percent) of 70 woman. In the pre-HAART period eight (9.8 percent) benign neoplasias and four (4.9 percent) malignant occurred in 82 patients; in the post-HAART period, 29 (16.2 percent) benign and 17 (9.5 percent) malignant were present; however, the differences were not significant. We conclude that the introduction of HAART in our region doesn't look to have modified the frequency of neoplasms occurring in patients with HIV.

Tendo em vista que trabalhos sobre necropsias de AIDS analisam apenas neoplasias malignas e que ocorreram alterações após a terapia antiretroviral altamente eficaz (HAART), este estudo foi feito com objetivo de avaliar a frequência de neoplasias benignas e malignas nos períodos pré e pós-HAART. Estudo retrospectivo de 261 necropsias de HIV positivos entre 1989 e 2008 em Uberaba - Brasil. Foram encontradas 66 neoplasias (39 benignas, 21 malignas e seis lesões pré-invasivas) em 58 pacientes. As neoplasias malignas mais frequentes foram linfóides, em 2,7 por cento (quatro linfomas não Hodgkin, um Hodgkin, um mieloma múltiplo e um plasmocitoma plasmoblástico) e, sarcoma de Kaposi, em 2,3 por cento (seis casos). As benignas mais frequentes foram hemangiomas hepáticos em 11 (4,2 por cento) dos 261 casos e leiomiomas uterinos em 11 (15,7 por cento) das 70 mulheres. No período pré-HAART ocorreram oito (9,8 por cento) neoplasias benignas e quatro (4,9 por cento) malignas em 82 pacientes; no pós-HAART, 29 (16,2 por cento) benignas e 17 (9,5 por cento) malignas; entretanto, essas diferenças não foram estatisticamente significantes. Concluímos que a introdução da HAART em nossa região não parece ainda ter alterado a frequência de neoplasias em pacientes HIV.

Acquired non-Chagas megacolon associated with the use of psychiatric medication: case report and differential diagnosis with Chagas megacolon.

A case of acquired megacolon in a 62-year-old man with acute abdomen due to sigmoid volvulus is reported. The case was associated with the use of psychiatric medications. The aim in this report was to emphasize the differential diagnosis with Chagas megacolon. Anatomopathological examination did not show any evidence of denervation, ganglionitis and/or myositis, and the serological test for Chagas disease was negative.

Acquired non-Chagas megacolon associated with the use of psychiatric medication: case report and differential diagnosis with Chagas megacolon / Megacólon adquirido não chagásico associado ao uso de medicação psiquiátrica: relato de caso e diagnóstico diferencial com megacólon chagásico

A case of acquired megacolon in a 62-year-old man with acute abdomen due to sigmoid volvulus is reported. The case was associated with the use of psychiatric medications. The aim in this report was to emphasize the differential diagnosis with Chagas megacolon. Anatomopathological examination did not show any evidence of denervation, ganglionitis and/or myositis, and the serological test for Chagas disease was negative.

Relata-se caso de megacólon adquirido, associado ao uso de medicamentos psiquiátricos, em homem de 62 anos, com abdome agudo por volvo de sigmóide, com o objetivo de destacar o diagnóstico diferencial de megacólon chagásico. O exame anátomo-patológico não evidenciou denervação, ganglionite e/ou miosite e a sorologia para doença de Chagas foi negativa.