Manifestaciones sistémicas asociadas al consumo de cocaína: comunicación de un caso / Systemic manifestations associated with cocaine use: report of a case

Mujer de 38 años que ingresa a la emergencia por disnea, hemoptisis y pérdida hemática vaginal. Antecedente de hipertiroidismo, tabaquismo, etilismo y consumo de cocaína de 20 años de evolución. Se constató fiebre, petequias en paladar duro y miembros inferiores, úlcera en fosas nasales, equimosis y hepatoesplenomegalia. El laboratorio mostró anemia, plaquetopenia (5.0 K/uL), elevación de enzimas hepáticas, FAN (HeP-2), ANCA C y anticuerpo anti-Ro positivos. El lavado broncoalveolar confirmó la presencia de hemorragia alveolar. Se trató con gammaglobulina, tres pulsos de 1 g de metilprednisona y ciclofosfamida, con respuesta parcial. Desarrolla un accidente cerebrovascular hemorrágico en lóbulo temporal izquierdo, con hematoma subdural. Se agrega rituximab 375 mg/m² semanal durante 4 semanas, mejorando la hemorragia pulmonar, el recuento plaquetario y el cuadro neurológico.

A 38 year old woman came to the emergency room due to shortness of breath, hemoptysis and genital bleeding. Personal history: hyperthyroidism, alcoholism, tobacco and cocain use during the last 20 years. She presented with fever, petechiae on hard palate and legs, ulcers on nasal septum, liver and spleen enlargement, and ecchymosis. Lab exams showed anemia, thrombocytopenia (5.0 K/uL), elevated liver enzymes and positive AAN (HeP-2), C-ANCA and Ro antibodies. Bronchoalveolar lavage confirmed the presence of alveolar hemorrhage, so she was treated with intravenous gammaglobulin, methylprednisone and cyclophosphamide with partial response. The patient developed a cerebrovascular accident in left temporal lobe, with intracranial bleeding. Rituximab 375 mg/m² / week for four weeks was added, improving the alveolar hemorrhage, thrombocytopenia and neurological event.

Repercussão sistêmica e terapêutica utilizada em pacientes hospitalizados com doença pulmonar obstrutiva crônica / Repercussão sistêmica e terapêutica utilizada em pacientes hospitalizados com doença pulmonar obstrutiva crônica

A Doença Pulmonar Obstrutiva Crônica tem como característica principal a limitação ao fluxo aéreo, não sendo totalmente reversível, mas podendo ser prevenida e tratada. As repercussões sistêmicas da doença podem levar a internação hospitalar por consequências de características próprias da doença e inflamação nas vias aéreas. A pesquisa objetiva conhecer as principais repercussões sistêmicas e a terapêutica utilizada em pacientes, com Doença Pulmonar Obstrutiva Crônica, internados em uma unidade hospitalar. Trata-se de um estudo prospectivo, quantitativo e documental, realizado em um Hospital Público de referência na assistência a patologias cardiopulmonares, composto por pacientes de ambos os sexos internados com diagnóstico de Doença Pulmonar Obstrutiva Crônica confirmado no prontuário. As variáveis analisadas estiveram relacionadas à história clínica (etilismo, tabagismo, doenças associadas), as repercussões sistêmicas (fraqueza muscular, perda de peso e retenção CO2), as complicações clínicas (desconforto e infecção respiratória), a terapêutica clínica (oxigenoterapia, ventilação não invasiva e ventilação mecânica) e terapêutica fisioterápica. Utilizou-se a estatística descritiva. Foram coletados dados de 31 prontuários de pacientes com Doença Pulmonar Obstrutiva Crônica, 21(68%) do sexo feminino e 10(32%) do sexo masculino com média de idade de 66,5 anos. As repercussões sistêmicas mais presentes foram: retenção de CO2 19(61%), fraqueza muscular 13(42%) e perda de peso 12(39%). No que se refere à terapêutica clínica, farmacológica e fisioterápica foram utilizados: oxigenoterapia 30(97%), corticóides 25(81%), broncodilatadores 23(74%), antibióticos 20(65%), e alguns utilizaram VNI 5 (16%) e, 23(74%) tinham indicação de fisioterapia. Constatou-se que as principais repercussões sistêmicas foram a retenção de CO2, fraqueza muscular e perda de peso. As terapêuticas utilizadas foram propostas para melhorar e/ou reverter os sintomas apresentados pelos pacientes a fim de reduzir o tempo de internamento e morbimortalidade.

The chronic obstructive pulmonary disease (COPD) is characterized chiefly by the airflow limitation and is not fully reversible, but can be prevented and treated. The systemic effects of the disease can lead to hospitalization for consequences of characteristics of the disease and airway inflammation. Objective: To know the main effects and systemic therapy used in patients with COPD admitted to a hospital. Methodology: A prospective, quantitative and documentary. Performed in a public hospital reference in assisting cardiopulmonary pathologies. Composed of patients of both sexes admitted with diagnosis of COPD confirmed in the medical record. The variables analyzed were related to clinical history (alcoholism, smoking, associated diseases), the systemic effects (muscle weakness, weight loss and CO2 retention), the clinical complications (discomfort and respiratory infection), clinical therapy (oxygen, ventilation is not and invasive mechanical ventilation) and physiotherapy treatment. We used descriptive statistics. Results: Data were collected from medical records of 31 patients with COPD, 21 (67.7%) females and 10 (32.2%) were male with a mean age of 66.5 years. The systemic effects were more present: CO2 retention 19 (61.2%), muscle weakness 13 (41.9%) and weight loss 12 (38.7%). With regard to medical therapy, physical therapy and drug were used: oxygen 30 (96.7%), corticosteroids, 15 (80.6%), bronchodilators 23 (74.1%), antibiotics 20 (64.5%) and some used NIV 5 (15.1%) and 23 (74.1%) were referred for physiotherapy. Conclusion: It was found that the main effects were systemic CO2 retention, muscle weakness and weight loss. The treatments used were proposals to improve and / or reverse the symptoms of the patients in order to reduce the length of stay and mortality.

Diagnóstico de granulomatosis de Wegener en pacientes con enfermedades oculares inflamatorias / Diagnosis of Wegener's granulomatosis in patients with ocular inflamatory disease

Objetivo. Informar las manifestaciones oftalmológicas en pacientes con granulomatosis de Wegener (GW). Método. Se revisó la base de datos del Instituto de Oftalmología Conde de Valenciana. Se recolectó la exploración oftalmológica completa, los exámenes de laboratorio y de gabinete, el tratamiento y la evolución. Resultados. Se incluyeron 11 pacientes con GW (18 ojos). Siete pacientes masculinos y 4 femeninos con edad promedio de 43.7 años (28-55). Tres habían tenido diagnóstico previo de GW y los 8 restantes se diagnosticaron en nuestro departamento. Siete presentaron cuadros bilaterales y 4 unilaterales. Las formas de presentación clínica fueron escleritis necrosante con queratitis ulcerativa periférica (QUP) (7/18), escleritis difusa (3/18), escleritis nodular (1/18), uveítis anterior no granulomatosa (1/18), neuropatía óptica isquémica (1/18), neuropatía óptica retrobulbar (1/18), desprendimiento de retina seroso (2/18) y dacriocistitis (2/18). De los 18 ojos, la capacidad visual final fue mejor o igual a 20/40 en 13, 20/400 en 3, cuenta dedos a 30cm o no-percepción de luz en 1. Actualmente 7 pacientes se encuentran en fase inactiva. Conclusiones. Las manifestaciones oftalmológicas más frecuentes en pacientes con GW fueron: escleritis necrosante y QUP. En la mayoría, la GW se diagnosticó después de las manifestaciones oftalmológicas, sin embargo, todos presentaron síntomas sistémicos u oftalmológicos previos.

OBJECTIVE: Report the ophthalmologic manifestations among patients with Wegener 's Granulomatosis (WG). METHOD: We reviewed the database of the Instituto de Oftalmologia Fundación Conde de Valenciana in order to collect information regarding complete ophthalmic examination, laboratory and cabinet tests, treatment, and disease progression. RESULTS: We included 11 patients with WG (18 eyes). Seven men and four women, mean age 43.7 years (range = 28-55). Three patients had a prior diagnosis of WG and the remaining eight patients were diagnosed by our study team. Seven subjects developed a bilateral affection and four had unilateral involvement. The clinical presentation was necrotizing scleritis with peripheral ulcerative keratitis (PUK) (7/18), diffuse scleritis (3/18), nodular scleritis (1/18), non-granulomatous uveitis (1/18), optic ischemic neuropathy (1/18), retrobulbar neuritis (1/18), serous retinal detachment (2/18), and dacryocystitis (2/18). Final visual acuity was better or equal to 20/40 (13/18), 20/400 (3/18), finger-counting or no-perception of light in 1/18. Currently, seven patients are symptom free. CONCLUSIONS: The most frequent ophthalmic manifestations among our patients with WG were: necrotizing scleritis and PUK. In most cases, WG was diagnosed after ophthalmic manifestations; however, all patients displayed prior systemic or ocular symptoms.