ABSTRACT
Presentamos el caso de una lactante de cinco meses que presenta irritabilidad y distensión abdominal en la presentación de una anomalía congénita del uraco. El texto repasa la sintomatología, las pruebas complementarias y el tratamiento, así como los principales diagnósticos diferenciales (AU)
We report the case of a 5-month old infant who presents irritability and abdominal distention in the context of a congenital anomaly of the urachus. Symptomatology, additional tests and treatment, as well as the main differential diagnoses, are reviewed in the text (AU)
Subject(s)
Humans , Female , Infant , Urachus/pathology , Urachus/surgery , Urachus , Diagnosis, Differential , Granuloma/complications , Granuloma/surgery , Granuloma , Urachus/abnormalities , Urachus/physiopathology , Heart Rate/physiologyABSTRACT
Presentamos el caso de una niña de nueve años que presenta una tumoración del músculo esternocleidomastoideo en el contexto de un traumatismo con diagnóstico definitivo de piomiositis. El texto repasa la sintomatología, las pruebas complementarias y el tratamiento, así como los principales diagnósticos diferenciales (AU)
We report the case of a nine-year-old girl who presents a post-traumatic sternocleidomastoid tumoration with final diagnosis of pyomyositis. Symptomatology, diagnostic tests, treatment and main differential diagnosis are reviewed (AU)
Subject(s)
Humans , Female , Child , Pyomyositis/complications , Pyomyositis/drug therapy , Pyomyositis , Muscle, Skeletal , Muscle, Skeletal/pathology , Muscle, Skeletal , Anti-Bacterial Agents/therapeutic use , Amoxicillin-Potassium Clavulanate Combination/therapeutic use , Clindamycin/therapeutic use , Diagnosis, Differential , Staphylococcus aureus , Staphylococcus aureus/isolation & purification , Lymphadenitis/diagnosis , Lymphadenitis/drug therapy , Muscles/pathology , Muscles , Penicillin G/therapeutic useABSTRACT
INTRODUCTION: Understanding of celiac disease has changed with the advent of serological markers (antigliadin IgA, anti-endomysial IgA and anti-transglutaminase IgA antibodies) and with the identification of major susceptibility genes (HLA-DQA1*05-DQB1*02). Reports of the efficacy of these diagnostic tests have varied, depending on the methodology used and the population investigated. OBJECTIVES: To determine the clinical utility of genetic and serological markers in the diagnosis of celiac disease, their relationship with histological lesions and their changes during treatment, in order to establish an optimal diagnostic algorithm in our environment. PATIENTS AND METHODS: We performed a retrospective study of 590 patients from the health area of Badajoz referred to the Immunology Laboratory for screening or follow-up of celiac disease. The results of intestinal histology, serological markers (antigliadin IgA, anti-endomysial IgA and anti-transglutaminase IgA antibodies), and genomic typing (HLA-DQA1*05-DQB1*02) were analyzed. RESULTS: The sensitivity and specificity of serological tests were greater than 90 %, with a negative predictive value of 98-100 %. HLA-DQA1*05-DQB1*02 was detected in 97 % of celiac patients, with a very high negative predictive value (99 %). On biopsy, 95 % of the patients with some grade of intestinal lesion were positive for antigliadin and/or anti-endomysial antibodies. CONCLUSION: To avoid missed diagnoses, the diagnostic algorithm of celiac disease should include at least two serological markers (antigliadin antibodies and anti-endomysial and/or anti-transglutaminase antibodies) and IgA quantification. Genomic typing should be carried out if one or more markers are positive or if the subject belongs to any of the risk groups. The physician should decide on the advisability of intestinal biopsy on the basis of the patient's clinical and immunological history.
Subject(s)
Celiac Disease , Atrophy/pathology , Biopsy , Celiac Disease/blood , Celiac Disease/genetics , Celiac Disease/pathology , Child, Preschool , Duodenum/pathology , Follow-Up Studies , Genetic Markers , HLA-DQ Antigens/blood , HLA-DQ Antigens/genetics , HLA-DQ alpha-Chains , HLA-DQ beta-Chains , Humans , Immunoglobulin A/blood , Immunoglobulin A/genetics , Immunoglobulin E/blood , Immunoglobulin E/genetics , Infant , Infant, Newborn , Jejunum/pathology , Retrospective StudiesABSTRACT
OBJECTIVE: Antineutrophil cytoplasmic antibodies (ANCA) have been described in a great variety of diseases in addition to the ANCA-associated systemic vasculitis (Wegener's granulomatosis (WG), microscopic polyangiitis (MPA) and Churg-Strauss syndrome (CSS)) and the pauci-immune rapidly progressive glomerulonephritis (RPGN). The objective of this work is to describe the clinical-pathological diagnosis of a series of patients with ANCA. MATERIAL AND METHODS: Retrospective review of patients with positive ANCA by indirect immunofluorescence in our hospital between January 1997 and December 1998. RESULTS: We identify 82 patients with ANCA. Six cases (7.3%) showed a C-ANCA pattern, 19 (23.2%) a P-ANCA pattern and 57 (69.5%) an atypical pattern. Eight patients (9.7%) had an ANCA-associated systemic vasculitis (5 WG, 2 MPA and 1 SCS). Four patients (4.9%) had a pauci-immune RPGN without systemic vasculitis. One only case (1.2%) in our series presented a C-ANCA pattern without evidence of an ANCA-associated systemic vasculitis or a pauci-immune RPGN. CONCLUSIONS: The atypical pattern is the most frequent in patients with ANCA. A minority of patients with ANCA have an ANCA-associated systemic vasculitis (WG, MPA or SCS) or a pauci-immune RPGN. The occurrence of a C-ANCA pattern is exceptional in patients without an ANCA-associated systemic vasculitis or a pauci-immune RPGN.
