[Bronchiolitis obliterans associated with Stevens-Johnson syndrome]. / Bronquiolitis obliterante asociada a síndrome de Stevens-Johnson.

Stevens-Johnson syndrome is a severe disease which is characterized by fever and mucocutaneous lesions. It has also been described as a small airway compromise in the form of bronchiolitis obliterans. We report a 22-year-old male patient with Stevens-Johnson syndrome due to antibiotic and antiepileptic drug treatment for brain abscess. After the improvement of mucocutaneous lesions, he went to the emergency department because of coughing and progressive shortness of breath. Pulmonary function test revealed a very severe irreversible obstructive defect and a computed tomography scan showed a mosaic attenuation pattern. We discuss this case of bronchiolitis obliterans associated with Stevens-Johnson because of its low incidence.

[Alveolar hemorrhage as a complication of thrombolytic therapy]. / Hemorragia alveolar como complicación del uso de trombolíticos.

Coronary thrombolysis is used as a strategy for coronary reperfusion for acute myocardial infarction. Bleeding is the main complication described. Although most of these events occur at sites of vascular access and are mild, in some cases gastrointestinal, retroperitoneal, genitourinary, lung and central nervous system bleeding may occur. These episodes are usually serious and sometimes fatal. The following report describes the case of a patient who received thrombolytic therapy with streptokinase as a treatment for myocardial infarction. Subsequently he developed acute respiratory failure, bilateral pulmonary infiltrates and fall of hematocrit compatible with diagnosis of alveolar hemorrhage.

Hemorragia alveolar como complicación del uso de trombolíticos / Alveolar hemorrhage as a complication of thrombolytic therapy

La trombolisis se usa como estrategia de reperfusión coronaria en el infarto agudo de miocardio. El sangrado es su principal complicación; la mayoría ocurre en los sitios de accesos venosos y es leve, pero también pueden presentarse hemorragia gastrointestinal, retroperitoneal, genitourinaria, pulmonar y a nivel del sistema nervioso central, episodios estos generalmente de mayor gravedad y a veces fatales. Se describe aquí el caso de un paciente que recibió terapia trombolítica con estreptoquinasa como tratamiento por un infarto de miocardio, y que posteriormente desarrolló insuficiencia respiratoria aguda, infiltrados pulmonares bilaterales, caída del hematocrito y aumento de la difusión de monóxido de carbono, cuadro compatible con diagnóstico de hemorragia alveolar.

Coronary thrombolysis is used as a strategy for coronary reperfusion for acute myocardial infarction. Bleeding is the main complication described. Although most of these events occur at sites of vascular access and are mild, in some cases gastrointestinal, retroperitoneal, genitourinary, lung and central nervous system bleeding may occur. These episodes are usually serious and sometimes fatal. The following report describes the case of a patient who received thrombolytic therapy with streptokinase as a treatment for myocardial infarction. Subsequently he developed acute respiratory failure, bilateral pulmonary infiltrates and fall of hematocrit compatible with diagnosis of alveolar hemorrhage.

Pancreatic tuberculosis.

Pancreatic tuberculosis (TB) is a rare condition in immunocompetent patients and often represents a diagnostic challenge. Pancreatic TB may present with protean manifestations. Imaging with ultrasound, computed tomographic (CT) or endoscopic ultrasound (EUS) usually reveals multicystic pancreatic masses, most frequently in the head of the pancreas. Fine needle aspiration or percutaneous biopsy guided by CT/ultrasound or EUS can be useful diagnostic tools. We report a case of a 60-year-old HIV-negative man who presented with a pancreatic mass and a pulmonary nodule that were subsequently diagnosed to be tuberculosis.

[Hyponatremia as a risk factor of death in patients with community-acquired pneumonia requiring hospitalization]. / Hiponatremia como factor de riesgo de muerte en pacientes internados por neumonia adquirida en la comunidad.

We investigated whether hyponatremia is a risk factor of death in patients hospitalized with community-acquired pneumonia (CAP) and estimated the relative risk of death by CAP of other risk factors. The design was prospective multicentre cohort study. In 5 centers in Buenos Aires, Argentina, we studied adults hospitalized with CAP between March 21, 2000 and December 21, 2000. Using stepwise logistic regression, we analyzed risk factors that showed a univariate association with mortality; alpha significance level was 0.05. During a 9-month period, 238 patients were admitted with CAP: 150 (63%) male and 88 (36%) female, mean age 52.99 (+/-20.35) and 55.06 (+/-20.94), respectively. Mortality was 10.5% (25/238). By multivariate analysis, the following variables were statistically associated with evolution: cerebrovascular disease (CD) (B: 2.614, p < 0.001, RRE: 13.6, IC 95%: 3.7-49.6); hyponatremia at admission or during hospitalization (B: 1.994, p<0.001, RRE: 7.3, IC 95%: 2.5-20.8); and elevated blood urea (B: 0.016, p= 0.003, RRE: 1.016, IC 95%: 1.005-1.02). We developed a formula to predict mortality by CAP: P (death) = 1/1 + exp - (-4.03 + 2.61 x l + 1.99 x 2 + 0.016x3), where: x1=CD (yes = 1/ no=0); x2= hyponatremia (yes = 1/ no=0); x3 = blood urea (mg/dl). The predictability was 91.1%. The mortality risk by CAP was statistically higher in patients with CD, hyponatremia and elevated blood urea.

Hiponatremia como factor de riesgo de muerte en pacientes internados por neumonia adquirida en la comunidad / Hyponatremia as a risk factor of death in patients with community-acquired pneumonia requiring hospitalization

Investigamos si la hiponatremia es un factor de riesgo de muerte en pacientes internados por neumoníaadquirida en la comunidad (NAC) y estimamos el peso relativo de otros factores de riesgo de muerte por NAC, en un estudio de cohorte, prospectivo, multicéntrico, en 5 Servicios de Clínica Médica del Area Metropolitana de Buenos Aires. Evaluamos adultos con NAC ingresados entre 21 de marzo de 2000 y 21 de diciembre del mismo año. Los factores de riesgo que mostraron asociación con evolución por análisis univariado, fueron sometidos a análisis de regresión logística, con un nivel de significación de α de 0.05. En 9 meses seinternaron 238 pacientes con NAC: 150 (63%) varones y 88 (36%) mujeres, con edades medias 52.99 (±20.35)y 55.06 (±20.94) años, respectivamente. Fallecieron 25/238 (10.5%). En análisis multivariado, se asociaron significativamente con evolución: enfermedad vascular encefálica (EVE) (B: 2.614, p<0.001, RRE: 13.6, IC 95%: 3.7-49.6); hiponatremia al ingreso o durante la internación (B: 1.994, p<0.001, RRE: 7.3, IC 95%: 2.5-20.8); urea plasmática elevada (B: 0.016, p= 0.003, RRE: 1.016, IC 95%: 1.005-1.02). Desarrollamos una fórmula deprobabilidad de fallecer por NAC: P (óbito)= 1/1+ exp. ¹ (-4.03 + 2.61x1 + 1.99x2 + 0.016x3), donde: x1= EVE(sí =1/no =0); x2= hiponatremia (sí =1/no =0); x3 = urea plasmática (mg/dl). La predictibilidad fue 91.1%. Elriesgo de fallecer por NAC fue significativamente mayor entre quienes presentaron EVE, hiponatremia y ureaplasmática elevada (AU)

We investigated whether hyponatremia is a risk factor of death in patients hospitalized with community-acquired pneumonia (CAP) and estimated the relative risk of death by CAP of otherrisk factors. The design was prospective multicentre cohort study. In 5 centers in Buenos Aires, Argentina, westudied adults hospitalized with CAP between March 21, 2000 and December 21, 2000. Using stepwise logisticregression, we analyzed risk factors that showed a univariate association with mortality; α significance level was0.05. During a 9-month period, 238 patients were admitted with CAP: 150 (63%) male and 88 (36%) female,mean age 52.99 (±20.35) and 55.06 (±20.94), respectively. Mortality was 10.5% (25/238). By multivariate analysis, the following variables were statistically associated with evolution: cerebrovascular disease (CD) (B: 2.614,p<0.001, RRE: 13.6, IC 95%: 3.7-49.6); hyponatremia at admission or during hospitalization (B: 1.994, p<0.001, RRE: 7.3, IC 95%: 2.5-20.8); and elevated blood urea (B: 0.016, p= 0.003, RRE: 1.016, IC 95%: 1.005-1.02). We developed a formula to predict mortality by CAP: P (death) = 1/1+ exp ¹ (-4.03 + 2.61x1 + 1.99x2 + 0.016x3), where: x1= CD (yes=1/no =0); x2= hyponatremia (yes=1/no =0); x3 = blood urea (mg/dl). The predictability was 91.1%. The mortality risk by CAP was statistically higher in patients with CD, hyponatremia and elevated blood urea (AU)

Hiponatremia como factor de riesgo de muerte en pacientes internados por neumonia adquirida en la comunidad / Hyponatremia as a risk factor of death in patients with community-acquired pneumonia requiring hospitalization

Investigamos si la hiponatremia es un factor de riesgo de muerte en pacientes internados por neumoníaadquirida en la comunidad (NAC) y estimamos el peso relativo de otros factores de riesgo de muerte por NAC, en un estudio de cohorte, prospectivo, multicéntrico, en 5 Servicios de Clínica Médica del Area Metropolitana de Buenos Aires. Evaluamos adultos con NAC ingresados entre 21 de marzo de 2000 y 21 de diciembre del mismo año. Los factores de riesgo que mostraron asociación con evolución por análisis univariado, fueron sometidos a análisis de regresión logística, con un nivel de significación de α de 0.05. En 9 meses seinternaron 238 pacientes con NAC: 150 (63%) varones y 88 (36%) mujeres, con edades medias 52.99 (±20.35)y 55.06 (±20.94) años, respectivamente. Fallecieron 25/238 (10.5%). En análisis multivariado, se asociaron significativamente con evolución: enfermedad vascular encefálica (EVE) (B: 2.614, p<0.001, RRE: 13.6, IC 95%: 3.7-49.6); hiponatremia al ingreso o durante la internación (B: 1.994, p<0.001, RRE: 7.3, IC 95%: 2.5-20.8); urea plasmática elevada (B: 0.016, p= 0.003, RRE: 1.016, IC 95%: 1.005-1.02). Desarrollamos una fórmula deprobabilidad de fallecer por NAC: P (óbito)= 1/1+ exp. ¹ (-4.03 + 2.61x1 + 1.99x2 + 0.016x3), donde: x1= EVE(sí =1/no =0); x2= hiponatremia (sí =1/no =0); x3 = urea plasmática (mg/dl). La predictibilidad fue 91.1%. Elriesgo de fallecer por NAC fue significativamente mayor entre quienes presentaron EVE, hiponatremia y ureaplasmática elevada (AU)

We investigated whether hyponatremia is a risk factor of death in patients hospitalized with community-acquired pneumonia (CAP) and estimated the relative risk of death by CAP of otherrisk factors. The design was prospective multicentre cohort study. In 5 centers in Buenos Aires, Argentina, westudied adults hospitalized with CAP between March 21, 2000 and December 21, 2000. Using stepwise logisticregression, we analyzed risk factors that showed a univariate association with mortality; α significance level was0.05. During a 9-month period, 238 patients were admitted with CAP: 150 (63%) male and 88 (36%) female,mean age 52.99 (±20.35) and 55.06 (±20.94), respectively. Mortality was 10.5% (25/238). By multivariate analysis, the following variables were statistically associated with evolution: cerebrovascular disease (CD) (B: 2.614,p<0.001, RRE: 13.6, IC 95%: 3.7-49.6); hyponatremia at admission or during hospitalization (B: 1.994, p<0.001, RRE: 7.3, IC 95%: 2.5-20.8); and elevated blood urea (B: 0.016, p= 0.003, RRE: 1.016, IC 95%: 1.005-1.02). We developed a formula to predict mortality by CAP: P (death) = 1/1+ exp ¹ (-4.03 + 2.61x1 + 1.99x2 + 0.016x3), where: x1= CD (yes=1/no =0); x2= hyponatremia (yes=1/no =0); x3 = blood urea (mg/dl). The predictability was 91.1%. The mortality risk by CAP was statistically higher in patients with CD, hyponatremia and elevated blood urea (AU)

Hiponatremia como factor de riesgo de muerte en pacientes internados por neumonia adquirida en la comunidad / Hyponatremia as a risk factor of death in patients with community-acquired pneumonia requiring hospitalization

Investigamos si la hiponatremia es un factor de riesgo de muerte en pacientes internados por neumoníaadquirida en la comunidad (NAC) y estimamos el peso relativo de otros factores de riesgo de muerte por NAC, en un estudio de cohorte, prospectivo, multicéntrico, en 5 Servicios de Clínica Médica del Area Metropolitana de Buenos Aires. Evaluamos adultos con NAC ingresados entre 21 de marzo de 2000 y 21 de diciembre del mismo año. Los factores de riesgo que mostraron asociación con evolución por análisis univariado, fueron sometidos a análisis de regresión logística, con un nivel de significación de α de 0.05. En 9 meses seinternaron 238 pacientes con NAC: 150 (63%) varones y 88 (36%) mujeres, con edades medias 52.99 (±20.35)y 55.06 (±20.94) años, respectivamente. Fallecieron 25/238 (10.5%). En análisis multivariado, se asociaron significativamente con evolución: enfermedad vascular encefálica (EVE) (B: 2.614, p<0.001, RRE: 13.6, IC 95%: 3.7-49.6); hiponatremia al ingreso o durante la internación (B: 1.994, p<0.001, RRE: 7.3, IC 95%: 2.5-20.8); urea plasmática elevada (B: 0.016, p= 0.003, RRE: 1.016, IC 95%: 1.005-1.02). Desarrollamos una fórmula deprobabilidad de fallecer por NAC: P (óbito)= 1/1+ exp. – (-4.03 + 2.61x1 + 1.99x2 + 0.016x3), donde: x1= EVE(sí =1/no =0); x2= hiponatremia (sí =1/no =0); x3 = urea plasmática (mg/dl). La predictibilidad fue 91.1%. Elriesgo de fallecer por NAC fue significativamente mayor entre quienes presentaron EVE, hiponatremia y ureaplasmática elevada

We investigated whether hyponatremia is a risk factor of death in patients hospitalized with community-acquired pneumonia (CAP) and estimated the relative risk of death by CAP of otherrisk factors. The design was prospective multicentre cohort study. In 5 centers in Buenos Aires, Argentina, westudied adults hospitalized with CAP between March 21, 2000 and December 21, 2000. Using stepwise logisticregression, we analyzed risk factors that showed a univariate association with mortality; α significance level was0.05. During a 9-month period, 238 patients were admitted with CAP: 150 (63%) male and 88 (36%) female,mean age 52.99 (±20.35) and 55.06 (±20.94), respectively. Mortality was 10.5% (25/238). By multivariate analysis, the following variables were statistically associated with evolution: cerebrovascular disease (CD) (B: 2.614,p<0.001, RRE: 13.6, IC 95%: 3.7-49.6); hyponatremia at admission or during hospitalization (B: 1.994, p<0.001, RRE: 7.3, IC 95%: 2.5-20.8); and elevated blood urea (B: 0.016, p= 0.003, RRE: 1.016, IC 95%: 1.005-1.02). We developed a formula to predict mortality by CAP: P (death) = 1/1+ exp – (-4.03 + 2.61x1 + 1.99x2 + 0.016x3), where: x1= CD (yes=1/no =0); x2= hyponatremia (yes=1/no =0); x3 = blood urea (mg/dl). The predictability was 91.1%. The mortality risk by CAP was statistically higher in patients with CD, hyponatremia and elevated blood urea

[Normotensive scleroderma renal crisis]. / Crisis de esclerodermia renal normotensiva.

A 60 year old male patient having systemic scleroderma and normotensive scleroderma renal crisis was admitted in our hospital. He presented polyarticular, esophagic, lung and skin compromise. Before admission he had been treated with high doses of corticosteroids. We believe corticosteroids led to the worsening of renal damage with renal failure, microangiopathic hemolytic anemia without high blood pressure. The 10% of these cases have normal blood pressure. The patient was treated with enalapril and hemodialysis. There was no favourable response to this treatment and he died seven days after admission.

Crisis de esclerodermia renal normotensiva / Normotensive scleroderma renal crisis

A 60 year old male patient having systemic scleroderma and normotensive scleroderma renal crisis was admitted in our hospital. He presented polyarticular, esophagic, lung and skin compromise. Before admission he had been treated with high doses of corticosteroids. We believe corticosteroids led to the worsening of renal damage with renal failure, microangiopathic hemolytic anemia without high blood pressure. The 10% of these cases have normal blood pressure. The patient was treated with enalapril and hemodialysis. There was no favourable response to this treatment and he died seven days after admission

Crisis de esclerodermia renal normotensiva / Normotensive scleroderma renal crisis

A 60 year old male patient having systemic scleroderma and normotensive scleroderma renal crisis was admitted in our hospital. He presented polyarticular, esophagic, lung and skin compromise. Before admission he had been treated with high doses of corticosteroids. We believe corticosteroids led to the worsening of renal damage with renal failure, microangiopathic hemolytic anemia without high blood pressure. The 10% of these cases have normal blood pressure. The patient was treated with enalapril and hemodialysis. There was no favourable response to this treatment and he died seven days after admission (AU)

Crisis de esclerodermia renal normotensiva. / [Normotensive scleroderma renal crisis]

A 60 year old male patient having systemic scleroderma and normotensive scleroderma renal crisis was admitted in our hospital. He presented polyarticular, esophagic, lung and skin compromise. Before admission he had been treated with high doses of corticosteroids. We believe corticosteroids led to the worsening of renal damage with renal failure, microangiopathic hemolytic anemia without high blood pressure. The 10

of these cases have normal blood pressure. The patient was treated with enalapril and hemodialysis. There was no favourable response to this treatment and he died seven days after admission.

Sindrome nefrotico agudo asociado a sifilis secundaria / Acute nephrotic syndrome associated with secondary syphilis

Se presenta a una paciente de 38 años con síndrome nefrótico y rash cutáneo, sin antecedentes patológicos. Al ingreso presentaba lesiones máculo papulares no pruriginosas en tronco y extremidades de veinte días de evolución, edema bipalpebral bilateral y de miembros inferiores desde la semana previa. El laboratorio informó función renal normal com proteinuria de 10g/día, proteínas séricas de 4.20 g/dl., albúmina 1.78 g/dl., colesterol 334 mg/l, VDRL(+) 1/32 dils, FTA abs.(+), HIV no reactivo, colagenograma normal. Se interpretó el cuadro como síndrome nefrótico asociado a sífilis secundaria y se trató con penicilina, reposo, restricción de sal, observándose buena evolución aún antes de completado el tratamiento y resolución completa después de la tercera semana. La incidencia de compromiso renal asociado a estadios precoces de la sífilis es menor de 0.3 por ciento. Creemos de interés llamar la atención de esta asociación que por ser rara puede pasar inadvertida.

Sindrome nefrotico agudo asociado a sifilis secundaria / Acute nephrotic syndrome associated with secondary syphilis

Se presenta a una paciente de 38 años con síndrome nefrótico y rash cutáneo, sin antecedentes patológicos. Al ingreso presentaba lesiones máculo papulares no pruriginosas en tronco y extremidades de veinte días de evolución, edema bipalpebral bilateral y de miembros inferiores desde la semana previa. El laboratorio informó función renal normal com proteinuria de 10g/día, proteínas séricas de 4.20 g/dl., albúmina 1.78 g/dl., colesterol 334 mg/l, VDRL(+) 1/32 dils, FTA abs.(+), HIV no reactivo, colagenograma normal. Se interpretó el cuadro como síndrome nefrótico asociado a sífilis secundaria y se trató con penicilina, reposo, restricción de sal, observándose buena evolución aún antes de completado el tratamiento y resolución completa después de la tercera semana. La incidencia de compromiso renal asociado a estadios precoces de la sífilis es menor de 0.3 por ciento. Creemos de interés llamar la atención de esta asociación que por ser rara puede pasar inadvertida. (AU)

Síndrome febril: miocarditis y brucelosis / Febrile syndrome: myocarditis and brucellosis

A 20 year-old white man was admitted with fever and weight loss since 60 days previous to his admission and cardiac failure (functional class IV). The heart was enlarged in the echocardiographic examination without valvular involvement. Liver biopsy showed granulomatous hepatitis with a necrosis focus. The patient was treated with a combination of venous dilators and digital. Serum agglutination test for Brucella showed a titer of 1/250, and complement fixation 1/40. Seven days later, agglutination titer was 1/4000. He was treated with rifampin and trimethoprimsulfametoxazol. He got better; fever disappeared, and the signs of cardiac failure improved. Brucellosic myocarditis is an uncommon complication of brucellosis in the absence of endocarditis. In our knowledge, this case would be the first reported in Argentina and the third in adult patients out of the five cases reported worldwide.

Síndrome febril: miocarditis y brucelosis / Febrile syndrome: myocarditis and brucellosis

A 20 year-old white man was admitted with fever and weight loss since 60 days previous to his admission and cardiac failure (functional class IV). The heart was enlarged in the echocardiographic examination without valvular involvement. Liver biopsy showed granulomatous hepatitis with a necrosis focus. The patient was treated with a combination of venous dilators and digital. Serum agglutination test for Brucella showed a titer of 1/250, and complement fixation 1/40. Seven days later, agglutination titer was 1/4000. He was treated with rifampin and trimethoprimsulfametoxazol. He got better; fever disappeared, and the signs of cardiac failure improved. Brucellosic myocarditis is an uncommon complication of brucellosis in the absence of endocarditis. In our knowledge, this case would be the first reported in Argentina and the third in adult patients out of the five cases reported worldwide.(Au)