Type 1 diabetes and subcutaneous insulin resistance syndrome treated with pancreas transplantation.

We present a case of subcutaneous insulin resistance syndrome, a rare entity, consisting of subcutaneous and intramuscular insulin resistance, with normal or almost normal sensitivity to insulin when administered intravenously. Its cause is unknown and its treatment is challenging. Our patient required a pancreas transplant.

Presentamos un caso de síndrome de resistencia subcutánea a la insulina, entidad infrecuente, que consiste en resistencia a la insulina por vía subcutánea e intramuscular, con sensibilidad normal o casi normal a la insulina cuando se aplica por vía intravenosa. Se desconoce su causa y su tratamiento es un desafío. Nuestra paciente requirió trasplante de páncreas.

Type 1 diabetes and subcutaneous insulin resistance syndrome treated with pancreas transplantation / Diabetes tipo 1 y síndrome de resistencia subcutánea a la insulina tratada con trasplante de páncreas

Abstract We present a case of subcutaneous insulin resistance syndrome, a rare entity, consisting of subcutaneous and intramuscular insulin resistance, with normal or almost normal sensitivity to insulin when administered intravenously. Its cause is unknown and its treatment is challenging. Our patient required a pancreas transplant.

Resumen Presentamos un caso de síndrome de resistencia subcutánea a la insulina, entidad in frecuente, que consiste en resistencia a la insulina por vía subcutánea e intramuscular, con sensibilidad normal o casi normal a la insulina cuando se aplica por vía intravenosa. Se desconoce su causa y su tratamiento es un desafío. Nuestra paciente requirió trasplante de páncreas.

Tibial brown tumor as a presentation of primary hyperparathyroidism / [Tumor pardo tibial como forma de presentación de un hiperparatiroidismo primario]

Cystic fibrous osteitis is a complication of a very evolved hyperparathyroidism. Because the determination of calcium, parathyroid hormone and vitamin D have become routine studies, this bone complication is uncommon in western countries. However, it should be considered in the differential diagnosis of hypercalcemia and lytic bone lesions. The treatment is to suppress the excess parathyroid hormone by parathyroidectomy and osteosynthesis in pathological fracture. We present the case of a female patient with primary hyperparathyroidism and a brown tumor in the right tibia.

La osteítis fibrosa quística es la complicación de un hiperparatiroidismo muy evolucionado. Debido a que la determinación del calcio, hormona paratiroides y vitamina D han pasado a ser estudios rutinarios, esta complicación ósea es infrecuente en los países occidentales. Sin embargo, debe ser considerada en el diagnóstico diferencial de hipercalcemia y lesiones óseas líticas. El tratamiento de esta entidad va dirigido a suprimir el exceso de hormona paratiroides mediante la paratiroidectomia y osteosíntesis en los casos de fracturas patológicas. Se presenta el caso de una paciente con hiperparatiroidismo primario y un tumor pardo en la tibia derecha.

Emphysematous cystitis in an 87 year old man. / [Cistitis enfisematosa en un varón de 87 años.]

Emphysematous cystitis is a complicated form of urinary tract infection, characterized by the presence of air inside the wall and in the light of the bladder, affecting more diabetics, elderly and immunosuppressed. The microorganisms that most frequently cause this entity are Escherichia coli and Klebsiella pneumoniae. Its treatment is based on broad-spectrum antibiotics, bladder catheterization and partial or total cystectomy in severe cases.

La cistitis enfisematosa es una forma complicada de infección urinaria, que se caracteriza por la presencia de aire dentro de la pared y en la luz de la vejiga, que afecta más a diabéticos, ancianos e inmunosuprimidos. Los microorganismo que con mayor frecuencia causan esta entidad son Escherichia coli y Klebsiella pneumoniae. Su tratamiento se basa en antibióticos de amplio espectro, sondaje vesical y cistectomía parcial o total en los casos graves.

Agranulocytosis Induced by Vancomycin. Case Report and Literature Review.

BACKGROUND Vancomycin has been used for decades to treat infections by Gram-positive bacteria, particularly those caused by methicillin-resistant staphylococci. Agranulocytosis is an infrequent complication of this antibiotic, postulated in its genesis a mechanism immune-mediated by antineutrophil antibodies and antineutrophil cytoplasm antibodies (ANCA). Treatment includes discontinuing vancomycin, and granulocyte colony-stimulating factor administration. CASE REPORT We present the case of a patient who developed agranulocytosis secondary to vancomycin during the treatment of an infectious endocarditis, which was reversed when the antibiotic was stopped. Concomitantly to neutropenia, he had ANCA positivity, which subsequently became negative. CONCLUSIONS Agranulocytosis induced by vancomycin is infrequent and generally occurs after day 12 of treatment. In most cases, like in our case, it is caused by an immune-mediated mechanism. More studies are needed to determine the pathogenic mechanism and the ANCA role in this adverse effect.

Fitz-Hugh-Curtis Syndrome Caused by Gonococcal Infection in a Patient with Systemic Lupus Erythematous: A Case Report and Literature Review.

BACKGROUND Fitz-Hugh-Curtis (FHC) syndrome is a perihepatitis linked to inflammatory pelvic disease. It can be caused by Neisseria gonorrhoeae or Chlamydia trachomatis infections. FHC syndrome usually presents with pain in the right hypochondrium and fever, associated with symptoms and signs of pelvic infection in women. CASE REPORT We present the case of a 22-year-old woman with systemic lupus erythematous (SLE) who presented with polyarthritis, cutaneous lesions, and abdominal pain. The diagnosis of FHC syndrome was based on the findings of abdominal computerized tomography (CT) and the isolation of Neisseria gonorrhoeae (NG) in blood cultures. The association of arthritis and cutaneous lesions was diagnosed as a syndrome of arthritis-dermatitis, also caused by systemic NG infection. The patient had a favorable outcome with antibiotic treatment. CONCLUSIONS FHC syndrome should be considered in sexually active young patients, mainly women, with pelvic infection and perihepatitis. It may be caused by disseminated gonococcal infection. An important risk factor is the serum complement deficit, which may predispose to severe forms. Low serum complement level is a frequent manifestation of active SLE. CT images showing the typical findings of perihepatitis allow making the correct diagnosis.

Takotsubo Myocardiopathy and Hyperthyroidism: A Case Report and Literature Review.

BACKGROUND Takotsubo cardiomyopathy (TM), also called stress myocardiopathy or transient left ventricular apical ballooning syndrome, is characterized by acute left ventricular dysfunction with reversible wall motion abnormalities. TM resembles acute coronary syndrome (ACS) in the absence of coronary artery disease (CAD). In several reports, TM has been described in association with hyperthyroidism, suggesting the potential role of thyrotoxicosis in the pathophysiology. CASE REPORT We present the case of a 34-year-old man with TM associated with hyperthyroidism caused by Graves' disease. In this case, TM was also preceded by an emotional trigger. The diagnosis of TM was based on clinical manifestations, electrocardiographic and echocardiographic abnormalities, and the absence of coronary artery disease (CAD) in the angiography. A diagnosis of hyperthyroidism was made based on hormonal and antibody measurements. The patient had a favorable outcome, and the cardiac and thyroid disorders resolved. CONCLUSIONS Our case illustrates that thyroid disease, mainly hyperthyroidism, should be considered in patients with TM with or without previous emotional triggers. As in our patient, the outcome in TM is usually favorable, with reversibility of cardiac abnormalities.

Intravascular Large B Cell Lymphoma Presenting as Fever of Unknown Origin and Diagnosed by Random Skin Biopsies: A Case Report and Literature Review.

BACKGROUND Intravascular lymphoma (IVL) is a rare lymphoproliferative disorder characterized by the proliferation of large B lymphoma cells within the lumen of small-caliber blood vessels. Clinical features are nonspecific, presenting as a systemic disease with fever and may be life-threatening. Antemortem diagnosis is difficult but may be made with biopsies of affected tissues or with random skin biopsies. CASE REPORT We report the case of a 66-year-old white woman presenting with fever of unknown origin (FUO) who developed neurologic, pulmonary, and hematologic manifestations. The diagnosis of intravascular large B cell lymphoma (IVLBCL) was made by random skin biopsies. She received treatment with steroids, rituximab, cyclophosphamide, vincristine, and doxorubicin (R-CHOP). Her disease evolution was unfavorable and she died after her first cycle of chemotherapy. CONCLUSIONS Our case illustrates that IVL can present as FUO and should be considered in the differential diagnosis of this syndrome, especially in patients with neurologic compromise and persistently elevated serum lactate dehydrogenase. In this case, the diagnosis was made with cutaneous biopsies of visibly unaffected skin. As in our patient, the course of IVL is usually fatal within a few months.