Liver enzyme alteration in response to dengue virus.

Infectious diseases are extremely important in the global health landscape, specifically dengue and its severe forms. Clinical characterization is very variable due to the wide spectrum of manifestations the virus induces. Dengue is a viral infection caused by the dengue virus and is transmitted to humans by mosquitos of the Aedes family. Dengue is the most important arthropod-borne disease and if symptoms occur, could appear suddenly, characterized by biphasic fever, headache, retroocular pain, pain in various parts of the body, prostration and rash. It has also been described that the Dengue virus can also cause liver dysfunction that could vary from mild injury to severe hepatocyte injury, commonly in tropical and subtropical climates. We report the case of a 24-year-old female who came to the emergency room due to fever and myalgia, in the context of a recent trip to Cuba. Physical examination included positive tourniquet test and laboratory findings showed anaemia and thrombocytopenia, as well as elevated transaminase levels. Serologic tests for dengue virus are requested and a positive result of specific antibodies-IgM classified the patient as presumptive being necessary to confirm authorities the outbreak and explain the patient it requires a close monitoring. Abdominal ultrasound showed mild splenomegaly. Because of progressive analytical normalization, the patient asked for outpatient care.

Immune checkpoint inhibitor-mediated colitis in a patient with epidermoid metastatic lung cancer: new and emerging toxicities.

In recent years, the development of immunotherapy has been stablished with monoclonals antibodies against control immune molecules in T lymphocytes, tumor cells and other cells, which block lymphocyte activation and suppress immune response. These molecules are Cytotoxic T-Lymphocyte Antigen 4 (CTLA-4) and Programmed Death-ligand 1 (PD-1). Despite clinical benefits, these therapies are not exempt from side effects known as immune-related adverse events (irAEs). We report the case of a 68-year-old female with stage IIIB epidermoid lung cancer diagnosed in 2017.

Uncommon etiology of Cullen´s sign and Grey Turner sign.

Cullen´s sign and Grey Turner sign are, respectively, the cutaneous ecchymoses located in periumbilical region and tissues flanks along the lower portion of the abdomen. Both have been observed in <1% of individuals with acute pancreatitis, suggesting poor prognosis in terms of gravity and mortality. However, these signs are not exclusive for acute pancreatitis, as they can appear in other identities such as: ruptured ectopic pregnancy, aortic aneurysm, rectus abdominis muscle hematoma, perforated duodenal ulcer, common bile duct rupture and biliary peritonitis, idiopathic perirenal hemorrhage, infectious mononucleosis with splenic rupture, metastatic esophageal and thyroid cancer, non-Hodgkin lymphoma, amoebic liver abscess, portal hypertension, and liver tumor disease. Based on the review of the literature, it is patent that Cullen´s sign and Grey Turner sign are neither sensitive nor specific for acute pancreatitis, therefore it may be best to relate these findings in the physical examination to conditions associated with abdominal pathology and retroperitoneal hemorrhage. We report the case of a 60-year-old Spanish female, with previous history of squamous small cell neuroendocrine lung carcinoma with hepatic extension in follow-up by palliative care services. Due to disease progression after two palliative chemotherapy sessions, the patient came to the emergency room with jaundice and abdominal pain in superior regions. On physical examination, notable findings included ecchymoses in the right flank and periumbilical region. Laboratory findings showed elevated bilirubin and transaminase levels, as well as a small increase in the serum amylase and lipase levels. Cholangioresonance was performed to discard acute biliary pancreatitis. The imaging revealed no enlargement of the pancreas, dilatation of the common bile duct without visible stone, and a liver full of new cancerous liver implants. These findings were consistent with diffuse distribution metastases lesions, concluding the progression of liver disease.

Multicentric infantile myofibromatosis with extensive involvement limited to bone.

Infantile myofibromatosis (IM) is the most common benign fibrous tumor of infancy, characterized by the development of single or multiple nodules in the skin, soft tissues, bone, and/or viscera. Multicentric forms are less frequent and can affect different tissues simultaneously and their prognosis depends on their extension and visceral involvement. Rarely, these forms are limited to the skeleton, in which case the absence of extraosseous lesions makes it difficult to suspect this entity. We present the case of an infant with multiple radiolucent lesions involving the skull, ribs, spine, and long bones, discovered in a radiological study performed after a minor trauma. A broad differential diagnosis was considered based on the osteolytic and polyostotic nature of the lesions on imaging studies. This report details and illustrates the typical radiological findings in bony involvement of IM, which suggest this disorder over other diagnostic options.

Orbital neuromuscular choristoma of the ophthalmic nerve.

INTRODUCTION: Neuromuscular choristoma (NC) is a rare tumor composed of striated muscle fibers admixed with nerve fibers that often affects large peripheral nerve trunks in children. To the best of our knowledge, this is the first reported case in the literature of a NC of the ophthalmic nerve in an adult. CASE DESCRIPTION: A 27-year-old woman presented with a 20-day history of left periorbital headache radiating to the frontotemporal region, with associated tearing, nausea, and vomiting. The examination was normal, except for hypoesthesia in the distribution of the first trigeminal nerve branch (V1). Cranial computerized tomography showed a lesion in the left orbit and cavernous sinus with widening of the superior orbital fissure. On magnetic resonance imaging, the lesion was well-defined with fusiform morphology and showed a central cystic component and peripheral enhancement. An extradural approach was performed with subtotal tumor resection. Biopsy showed proliferation of striated muscle cells admixed with nerve fascicles and Schwann cells. A pathological diagnosis of NC of V1 was determined. Six months after surgery, left hypotropia with limitation of supraduction was observed, as well as hypoesthesia and paralysis of the left forehead with ipsilateral eyebrow ptosis. The rest of the examination remained within normal limits. CONCLUSION: NC should be considered in the differential diagnosis of a young patient with periorbital headache and hypoesthesia in the V1 region.