ABSTRACT
Granulomatosis with polyangiitis (GPA) is a systemic necrotizing granulomatosis vasculitis characterized by predilection to affect small- and medium-sized blood vessels and commonly affects the upper and lower respiratory tract and kidneys in most cases. Genital involvement is reported in <1% of cases in large cohorts and nearly all cases have been in the setting of multisystemic disease or during the course of the disease in patients already diagnosed as GPA. A case is presented of uncommon limited urogenital GPA in a 66-year-old woman with an irregular mass occupying urethra and vagina. The patient showed a good response after Corticoids and Methotrexate.
ABSTRACT
Las crioglobulinas son inmunoglobulinas que precipitan con el frío. Su presencia puede asociarse a un tipo de vasculitis denominada crioglobulinemia. Estas, especialmente las mixtas, se asocian a infecciones como el virus de la hepatitis C hasta en el 60-90% de los casos, aunque también se ha descrito su asociación a enfermedades del tejido conectivo, en las que suele tener un curso más agresivo. Se presenta el caso de una paciente con poliartritis seronegativa que desarrolló isquemia arterial aguda en el contexto de una crioglobulinemia y que ha respondido al tratamiento con rituximab (AU)
Cryoglobulins are immunoglobulins that precipitate at cold temperatures. Their presence can be related to a type of vasculitis referred to as cryoglobulinemia. This condition, especially mixed cryoglobulinemia, has been associated with viral infections like hepatitis C virus in 60%-90% of cases, but it has also been reported in relation to connective tissue diseases, usually resulting in a more severe course. We describe the case of a patient with seronegative polyarthritis who developed acute arterial ischemia in association with cryoglobulinemia, with a good response to rituximab therapy (AU)
Subject(s)
Humans , Female , Adult , Ischemia/complications , Ischemia/diagnosis , Arthritis, Rheumatoid/complications , Arthritis, Rheumatoid/drug therapy , Cryoglobulinemia/complications , Rituximab/ultrastructure , Antirheumatic Agents/therapeutic use , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/diagnosis , Radial Artery/pathology , Radial ArteryABSTRACT
Cryoglobulins are immunoglobulins that precipitate at cold temperatures. Their presence can be related to a type of vasculitis referred to as cryoglobulinemia. This condition, especially mixed cryoglobulinemia, has been associated with viral infections like hepatitis C virus in 60%-90% of cases, but it has also been reported in relation to connective tissue diseases, usually resulting in a more severe course. We describe the case of a patient with seronegative polyarthritis who developed acute arterial ischemia in association with cryoglobulinemia, with a good response to rituximab therapy.
Subject(s)
Arterial Occlusive Diseases/etiology , Arthritis/etiology , Cryoglobulinemia/etiology , Hand/blood supply , Ischemia/etiology , Lupus Erythematosus, Systemic/diagnosis , Peripheral Vascular Diseases/etiology , Adult , Arterial Occlusive Diseases/diagnosis , Cryoglobulinemia/diagnosis , Female , Humans , Ischemia/diagnosis , Lupus Erythematosus, Systemic/complications , Peripheral Vascular Diseases/diagnosis , Radial ArteryABSTRACT
Objetivo: Estudiar la frecuencia de toxicidad retiniana y factores de riesgo asociados en una cohorte de pacientes tratados con antipalúdicos de un hospital comarcal. Material y métodos: Estudio retrospectivo de 40 pacientes. Se recogieron: tipo de antipalúdico, dosis diaria y acumulada, enfermedad reumatológica de base, enfermedad concomitante y estudio oftalmológico. Se definió toxicidad retiniana como alteración en 2 de las 4 siguientes pruebas: examen de fondo de ojo, campo visual con patrón macular, tomografía de coherencia óptica de dominio espectral y electrorretinografía de campo completo. Resultados: La frecuencia de toxicidad retiniana fue del 13,1% (intervalo de confianza [IC] del 95%, 5- 21%), con tendencia a un mayor riesgo en los pacientes en tratamiento con cloroquina (CQ). En estos pacientes con toxicidad retiniana, la dosis media acumulada de CQ fue de 229 g y la de hidroxicloroquina (HCQ) de 111 g. La dosis media diaria de CQ fue de 250 mg y la de HCQ fue de 333 mg. Encontramos una asociación positiva entre toxicidad retiniana e hipertensión arterial. Conclusiones: La frecuencia de toxicidad retiniana, valorada objetivamente mediante técnicas oftalmológicas, fue alta, con una mayor tendencia en pacientes en tratamiento con cloroquina(AU)
Objective: To study the frequency of retinal toxicity and associated risk factors in a cohort of patients treated with antimalarials and seen at a tertiary level hospital. Material and methods: Retrospective study of 40 patients treated with antimalarials, who were referred to ophthalmology for the study of retinal toxicity during 2011. Data collection included type of antimalarial prescribed, daily and cumulative doses, presence of rheumatic disease, corticosteroid use, associated diseases and ophthalmologic examination. Retinal toxicity was confirmed if two of the following tests were altered: fundus examination, visual field with a macular pattern, changes in spectral domain optical coherence tomography and full-field electroretinography. Results: Toxic retinopathy was detected in 13.1% of patients (95% confidence interval 5-21%) and a trend for a higher risk was observed in case of chloroquine (CQ) treatment. Among the patients with retinopathy, the mean cumulative dose was 229 g for CQ and 111 g for Hydroxychloroquine (HCQ), and the mean daily dose of CQ was 250 mg and 333 mg for HCQ. Arterial hypertension had a statistically significant effect on retinopathy development. Conclusions: Toxic retinopathy defined by ophthalmological evaluation was detected in 13.1% of patients. A trend for a higher risk was observed in case of chloroquine treatment(AU)
Subject(s)
Humans , Male , Female , Antimalarials/adverse effects , Antimalarials/toxicity , Risk Factors , Hydroxychloroquine/toxicity , Hydroxychloroquine/therapeutic use , /complications , /diagnosis , Toxicity Tests/methods , Antimalarials/therapeutic use , Confidence Intervals , Retina , Retinal Diseases/drug therapy , Retinal Diseases/physiopathologyABSTRACT
OBJECTIVE: To study the frequency of retinal toxicity and associated risk factors in a cohort of patients treated with antimalarials and seen at a tertiary level hospital. MATERIAL AND METHODS: Retrospective study of 40 patients treated with antimalarials, who were referred to ophthalmology for the study of retinal toxicity during 2011. Data collection included type of antimalarial prescribed, daily and cumulative doses, presence of rheumatic disease, corticosteroid use, associated diseases and ophthalmologic examination. Retinal toxicity was confirmed if two of the following tests were altered: fundus examination, visual field with a macular pattern, changes in spectral domain optical coherence tomography and full-field electroretinography. RESULTS: Toxic retinopathy was detected in 13.1% of patients (95% confidence interval 5-21%) and a trend for a higher risk was observed in case of chloroquine (CQ) treatment. Among the patients with retinopathy, the mean cumulative dose was 229 g for CQ and 111 g for Hydroxychloroquine (HCQ), and the mean daily dose of CQ was 250 mg and 333 mg for HCQ. Arterial hypertension had a statistically significant effect on retinopathy development. CONCLUSIONS: Toxic retinopathy defined by ophthalmological evaluation was detected in 13.1% of patients. A trend for a higher risk was observed in case of chloroquine treatment.
Subject(s)
Antimalarials/adverse effects , Retinal Diseases/chemically induced , Retinal Diseases/epidemiology , Female , Humans , Male , Middle Aged , Retrospective Studies , Risk FactorsABSTRACT
La infección de tejidos blandos por Mycobacterium tuberculosis puede afectar al músculo, tendones, fascia, bursa y tejido sinovial. La bursitis trocantérea de origen tuberculoso es una entidad infrecuente, que suele afectar a pacientes inmunocomprometidos. Se manifiesta habitualmente de forma insidiosa, lo que dificulta el diagnóstico y retrasa el tratamiento. Se presenta el caso de una mujer joven, inmunocompetente, que acudió a nuestro servicio por dolor crónico de cadera izquierda. El estudio realizado confirmó el diagnóstico de bursitis trocantérea tuberculosa. Este caso demuestra la importancia de considerar el posible origen infeccioso de las bursitis en pacientes inmunocompetentes (AU)
Soft tissue infection due to Mycobacterium tuberculosis can affect muscle, tendons, fascia, bursa and synovial tissue. Tuberculous trochanteric bursitis is a rare entity that usually affects immunocompromised patients. Manifestations usually occur insidiously, which delays diagnosis and treatment. We present the case of an immunocompetent young woman who came to our department for chronic left hip pain. The study confirms the diagnosis of tuberculous trochanteric bursitis. This case demonstrates the importance of considering a possible infectious origin of bursitis in immunocompetent patients (AU)
Subject(s)
Humans , Female , Adult , Bursitis/complications , Bursitis/diagnosis , Immunocompetence/physiology , Pain/etiology , Mycobacterium tuberculosis/isolation & purification , Magnetic Resonance Imaging/methods , Biopsy, Needle , Rifampin/therapeutic use , Pyrazinamide/therapeutic use , Hip Joint/pathology , Bursitis/immunology , Bursitis/physiopathology , Immunocompetence , Immunocompetence/immunology , Radiography, Thoracic/trends , Radiography, Thoracic , Isoniazid/therapeutic use , Diagnosis, Differential , Hip/pathology , HipABSTRACT
Soft tissue infection due to Mycobacterium tuberculosis can affect muscle, tendons, fascia, bursa and synovial tissue. Tuberculous trochanteric bursitis is a rare entity that usually affects immunocompromised patients. Manifestations usually occur insidiously, which delays diagnosis and treatment. We present the case of an immunocompetent young woman who came to our department for chronic left hip pain. The study confirms the diagnosis of tuberculous trochanteric bursitis. This case demonstrates the importance of considering a possible infectious origin of bursitis in immunocompetent patients.
