Cutaneous tuberculosis on the scalp: a case report.

Tuberculosis is a disease that usually affects the lungs, although other systems may also be infected, resulting in atypical clinical presentations. We report the case of a 76-year-old man who was admitted to the hospital in Brazil with a 3-week history of a painful, enlarging ulcer on the scalp and cough. His medical history was notable for non-metastatic prostatic adenocarcinoma and esophageal squamous cell carcinoma. On physical examination, the ulcer measured 10 cm in diameter and was tender, with a firm border and yellow crusts. A punch-biopsy specimen of the edge of the ulcer showed acute and chronic non-specific inflammation and neutrophilic infiltrates. Acid-fast bacilli were seen on microscopic examination, molecular testing detected Mycobacterium tuberculosis DNA and pan-sensitive M. tuberculosis was cultured. Computed tomography (CT) scan of the head showed a frontoparietal osteolytic lesion under the ulcer, chest CT revealed areas of consolidation in the lower lobes and M. tuberculosis was also identified in a bronchoalveolar lavage specimen. After one month of combination therapy with rifampin, isoniazid, pyrazinamide and ethambutol his symptoms were found to be improving and the size of the ulcer was markedly reduced.

Liver damage in a patient with Gaucher's disease type 1 and alpha-1 antitrypsin deficiency: a potential epigenetic effect?

Gaucher's disease and alpha-1 antitrypsin deficiency are genetic diseases that can cause different kinds of liver damage, but are rarely associated with cirrhosis. Here, we describe the case of a patient with both diseases who presented with cirrhosis, followed by liver failure and death. Although the interaction between these two diseases remains unclear, we suspect the involvement of an epigenetic factor in the evolution of the aggressive liver disease.

Mediastinal lymph node amyloidosis in a patient with sarcoidosis.

A 27-year-old male patient presented with respiratory symptoms, bilateral enlargement of the cervical lymph nodes and enlarged liver. In the imaging studies, bilateral enlargement of the hilar nodes was observed, together with pulmonary infiltrate. The patient was submitted to lung and liver biopsies, which revealed noncaseating granulomas. The clinical, radiological and histopathological findings were consistent with sarcoidosis and lymph node amyloidosis. The combination of sarcoidosis and amyloidosis has rarely been reported.

Pulmonary lymphangiomatosis: a report of two cases.

Lymphangiomatosis, a rare diseases of controversial origin, occurs in individuals of any age, regardless of gender, but is predominantly seen in younger individuals. It often presents with thoracic involvement, although, the bones, spleen and liver can also be affected. Histologically, the pulmonary involvement includes proliferation, complex anastomoses and secondary dilatation of the lymphatic vessels. Clinically, the presentation is variable. Although radiographic findings can be suggestive of the disease, the final diagnosis is made histologically. We report two cases of lymphangiomatosis, both in females: one was oligosymptomatic and is being treated for the disease; the other had a more progressive form, was diagnosed quite late and ultimately died of the disease.

Spontaneous chylothorax associated with light physical activity.

Chylothorax occurs when there is rupture, laceration or obstruction of the thoracic duct, resulting in the release of chyle into the pleural space. Chylothorax can occur in cases of congenital lymphatic malformation, lymphoma, mediastinal tumor and infectious disease, as well as during surgical procedures and after traffic accident-related trauma. It can also be idiopathic. The condition presents clinical signs of dyspnea, hypotension, generalized edema and cyanosis. The diagnosis is usually made through thoracocentesis, and the treatment is conservative. Spontaneous chylothorax is an uncommon form of pleural effusion, and its diagnosis should be hypothesized only after all other causes have been ruled out. Herein, we describe a case of spontaneous chylothorax associated with light physical activity at a fitness center.

[Hepatopulmonary syndrome in liver transplantation candidates]. / Prevalência da síndrome hepatopulmonar em candidatos a transplante hepático.

BACKGROUND: Hepatopulmonary syndrome is an important clinical problem associated with chronic liver disease. Liver transplantation can result in complete resolution of the arterial hypoxemia associated with this syndrome, even in its most severe presentation. AIM: To determine the prevalence of hepatopulmonary syndrome in adult liver transplant candidates. PATIENTS AND METHODS: Fifty-four consecutives adult patients (> or = 18 years) with severe liver disease waiting for liver transplant were screened for arterial hypoxemia (PaO2 < 70 mm Hg) while they were seated, at rest, and breathing room air. Patients with arterial hypoxemia underwent contrast-enhanced two-dimensional echocardiography and pulmonary function testing. Hypoxemia (PaO2 < 70 mm Hg) was present in 7 of 54 patients (12.9%), although only 1 of them complained of dyspnea. The Child's classification of the patients were: A = 1, B = 4, and C = 1. All seven hypoxemic patients had positive contrast-enhanced two-dimensional echocardiography, consistent with hepatopulmonary syndrome. CONCLUSION: The prevalence of hepatopulmonary syndrome in adult liver transplant candidates is elevated. The screening for hepatopulmonary syndrome should be part of the routine evaluation of liver transplant candidates even in the absence of pulmonary symptoms.