RESUMO
INTRODUCTION: Splenic localisation of sarcoidosis is common but rare as unique location. We report a case diagnosed by US-guided biopsy. OBSERVATION: A 42-year-old woman presented atypic and recidivant epigastric pain. Abdominal ultrasound showed splenic hypoechoic nodules not characterizable with CT or MRI. PET-CT revealed hypermetabolism without any other abnormal metabolic activity. US-guided biopsy with small needle achieved diagnosis of isolated splenic sarcoidosis. CONCLUSION: Diagnosis of splenic nodular sarcoidosis can be challenging without any other localization. Splenic biopsy achieved diagnosis. This procedure is associated with a low risk of complications - in particular hemorragic ones. Diagnostic splenectomy should be an exceptional intervention.
Assuntos
Sarcoidose/diagnóstico , Baço/diagnóstico por imagem , Baço/patologia , Esplenopatias/diagnóstico , Ultrassonografia de Intervenção , Adulto , Feminino , Humanos , Biópsia Guiada por Imagem/métodos , Sarcoidose/patologia , Esplenopatias/patologiaAssuntos
Aneurisma Infectado/diagnóstico , Aneurisma da Aorta Abdominal/microbiologia , Febre/etiologia , Infecções por Salmonella/diagnóstico , Idoso de 80 Anos ou mais , Aneurisma Infectado/tratamento farmacológico , Antibacterianos/uso terapêutico , Aneurisma da Aorta Abdominal/patologia , Humanos , Masculino , Imagem Multimodal , Tomografia por Emissão de Pósitrons , Infecções por Salmonella/tratamento farmacológico , Salmonella enteritidis , Tomografia Computadorizada por Raios XRESUMO
INTRODUCTION: Fever happens frequently in colon cancer but it is rarely the presenting manifestation. PATIENTS AND METHODS: We report a case series of patients with colon cancer revealed by fever in the three military hospitals in Paris. RESULTS: Of the 11 patients studied, seven were men and four were women, and their mean age was 70 years. Cancer was localized in the sigmoid colon (n=6), left colon (n=3) and right colon (n=2). Cancer staging (UICC TNM classification 2002) was respectively pTis (n=1), I (n=4), II (n=3) and III (n=3). Fever was the only reason for admission and two patients had a recurrent fever of unknown origin. All patients but one had bacterial infection. Blood cultures grew up in six cases, Escherichia coli (n=3), Streptococcus gallolyticus (ex bovis) (n=2) and anaerobic bacteria (n=1). There was one case of infective endocarditis caused by S. gallolyticus. Imaging showed a liver abscess (n=3) and a colon cancer complicated by an abscess (n=3). In seven patients, a familial history of colon cancer and symptoms of underlying colic disease were present (neglected rectal bleeding, iron deficiency anaemia, clinical evidence of an abdominal mass). CONCLUSIONS: Fever may reveal colon cancer at an early stage. Its main cause is a bacterial infection, such as bacteremia or abscess. Fever of unknown origin is a rare presentation. Detailed history, careful clinical examination and analysis of imaging contribute to recommend the prescription of colonoscopy.
Assuntos
Neoplasias do Colo/diagnóstico , Febre/etiologia , Abscesso/microbiologia , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/microbiologia , Doenças do Colo/microbiologia , Feminino , Humanos , Abscesso Hepático/microbiologia , Masculino , Pessoa de Meia-Idade , RecidivaRESUMO
INTRODUCTION: Campylobacter fetus is a rare Gram-negative bacteria affecting especially elderly and immunocompromised patients, and that is responsible of vascular and cutaneous involvement. OBSERVATIONS: We report two cases of C. fetus infection in two diabetic male patients, aged 75 and 85 years. The first patient was admitted for chronic fever. First-line examinations were inconclusive. Combined positron emission tomography and computed imaging tomography (PET-CT) diagnosed an infection of a previously operated popliteal aneurysm. The patient underwent surgery, and per-operative samples were positive for C. fetus. The second patient was admitted for a leg cellulitis. Blood cultures were positive for C. fetus. PET-CT found a septic superficial thrombophlebitis. The outcome was favorable for both patients with prolonged antibiotic therapy. CONCLUSION: Vascular involvement should be suspected in the presence of C. fetus infections. PET-CT may be useful, as other imaging modalities are not always contributive.
Assuntos
Aneurisma Infectado/microbiologia , Infecções por Campylobacter/complicações , Campylobacter fetus , Tromboflebite/microbiologia , Idoso , Idoso de 80 Anos ou mais , Infecções por Campylobacter/diagnóstico , Humanos , MasculinoRESUMO
INTRODUCTION: Tropical sprue is a postinfective malabsorption syndrome that occurs in some tropical endemic areas. CASE REPORT: A 65-year-old Caucasian patient, with no significant past medical history, living in Cambodia for 10 years, presented with a 23 kg weight loss and chronic diarrhea. Clinical examination was unremarkable. Laboratory tests showed a moderate nutritional deficiency syndrome. The upper gastrointestinal endoscopy showed duodenal villous atrophy and histological analysis confirmed subtotal villous atrophy with important intraepithelial lymphocytosis. The diagnosis of tropical sprue was considered on the epidemiological, clinical and biological context, and the absence of other cause of villous atrophy. A three-month duration treatment with antibiotics, folic acid and vitamin B12 was initiated. The clinical course was favorable with disappearance of diarrhea in 15 days. One year later, the patient had resumed his usual weight, and laboratory tests and duodenal biopsies were normal. CONCLUSION: The diagnosis of tropical sprue should be systematically discussed in any malabsorption syndrome with villous atrophy in a patient living or having lived in the tropics.
Assuntos
Espru Tropical , Idoso , Camboja , Humanos , Masculino , Espru Tropical/diagnóstico , Espru Tropical/tratamento farmacológicoAssuntos
Congressos como Assunto , Medicina Interna/tendências , Anticoagulantes/uso terapêutico , Drogas em Investigação/uso terapêutico , França , Terapia Genética/métodos , Terapia Genética/tendências , Humanos , Medicina Interna/educação , Medicina Interna/métodos , Medicina Interna/organização & administração , Pneumopatias/etiologia , Sociedades Médicas/organização & administração , Medicina de Viagem/métodos , Medicina de Viagem/tendênciasRESUMO
FDG-PET, now hybrid positron emission tomography/computed tomography (PET-CT), has become an established diagnostic tool in oncology. Fluorodesoxyglucose ((18)F-FDG) is not specific for malignant lesions, as uptake of the tracer depends on its accumulation in cells with an increased glucose metabolism as it is also the case in infectious and inflammatory lesions, like sarcoidosis. Thus, FDG-PET has been proposed for internal medicine indications, one of whom is sarcoidosis. The main characteristics of FDG-PET are its better sensitivity compared to (67)Ga scintigraphy and its ability to be used as an earlier marker of therapeutic response as compared with anatomy-based and conventional scintigraphic imaging. However, FDG-PET should be used in atypical or advanced stage of the disease. Future prospective studies should be awaited before integrating FDG-PET in clinical routine for treatment outcome and disease activity assessment in sarcoidosis. New radiopharmaceutical probes are under development and will improve the performance of PET.
Assuntos
Tomografia por Emissão de Pósitrons , Sarcoidose/diagnóstico , Fluordesoxiglucose F18 , Humanos , Compostos RadiofarmacêuticosRESUMO
Early studies on prolonged fever date back to the 1960s. Fifty years later, prolonged unexplained fever remains a diagnostic challenge to the general internists. Although the aetiologies of prolonged fevers have not changed much in the general population, the distribution between the various causes is not the same anymore. A regular decrease in infectious and neoplastic causes is noticed whatever the age. Prolonged fevers related to inflammatory disorders and fevers that remain of unknown origin still represent approximately 30 to 50% of the cases. In the young adult population, as in the older patients, prolonged fevers can be attributed to four groups: infection, inflammation, neoplasic and other aetiologies (including drug-related fevers). In the young adult population, the management of prolonged fever presents some specific issues that are the purpose of this review coupled with our own experience. The prognosis of undiagnosed prolonged fever is usually favourable, as a life-threatening aetiology is exceptionally diagnosed during the follow-up if the initial management was complete and accurate.
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Febre de Causa Desconhecida/etiologia , Adolescente , Adulto , Anti-Inflamatórios não Esteroides/uso terapêutico , Diagnóstico Diferencial , Febre de Causa Desconhecida/epidemiologia , Febre de Causa Desconhecida/terapia , França/epidemiologia , Humanos , Infecções/complicações , Infecções/diagnóstico , Inflamação/complicações , Inflamação/diagnóstico , Anamnese , Neoplasias/complicações , Neoplasias/diagnóstico , Exame Físico , Prognóstico , Doenças Reumáticas/complicações , Doenças Reumáticas/diagnóstico , Fatores de Risco , Fatores de TempoRESUMO
The search of JAK2 V617F mutation is a useful tool for the diagnosis of myeloproliferative disorders (MPD). This case report highlights the potential usefulness of this testing in recurrent deep venous thrombosis (DVT) of lower limb. We report a 73-year-old man who presented with three spontaneous episodes of lower limb DVT. The third episode occured while he was receiving fluindione. MPD was suspected because of an increased hematocrit (55 %) and hemoglobin (17g/dl) level. Red cell blood volume was increased and a JAK2 V617F mutation was detected confirming the diagnosis of polycythemia vera. The usefulness of JAK2 mutation for the diagnosis of MPD has been widely demonstrated. Also, some studies confirmed its usefulness in apparently idiopathic abdominal venous thrombosis. This report highlights the possible interest of JAK2 mutation in unexplained recurrent lower limb DVT, especially when it occurs under anticoagulant therapy.
Assuntos
Janus Quinase 2/genética , Mutação , Trombose Venosa/genética , Idoso , Humanos , Masculino , RecidivaRESUMO
Esophageal adenocarcinoma and its precursor Barrett's esophagus are increasing in incidence in western populations. Gastroesophageal reflux and high body mass index (BMI) are known risk factors. Studies about Barrett's esophagus in obese patients have emphasised the role of central adiposity as a stronger risk factor than BMI in the development of specialized intestinal metaplasia and subsequently esophagus adenocarcinoma. The proinflammatory impact of adipocytokines of the abdominal fat associated with the metabolic syndrome is also relevant. Except cardiovascular diseases, type 2 diabetes and non alcoholic steatohepatitis, abdominal obesity and metabolic syndrome are responsible of an increase of prevalence of esophageal adenocarcinoma, but also other cancer sites. In this review, we study the up to date main epidemiologic and physiopathologic data concerning this association that could be important in future for a preventive action in obese patients, especially when metabolic syndrome is present.
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Refluxo Gastroesofágico/complicações , Obesidade/complicações , Adenocarcinoma/etiologia , Neoplasias Esofágicas/etiologia , Esofagite Péptica/etiologia , Refluxo Gastroesofágico/epidemiologia , Humanos , Obesidade/epidemiologiaRESUMO
G6PD deficiency is very frequent with almost 400 millions of patients worldwide in Asia, Africa and Mediterranean. G6PD deficiency is involved in mild or severe haemolysis and the precipitating factor is usually a drug. More than 100 drugs have been implicated and fluoroquinolones are one of the more classic. However, the literature review shows that only a few observations have been clearly documented.
Assuntos
Complicações do Diabetes/microbiologia , Infecções por Escherichia coli/tratamento farmacológico , Deficiência de Glucosefosfato Desidrogenase/complicações , Ofloxacino/uso terapêutico , Infecções Urinárias/tratamento farmacológico , Contraindicações , Complicações do Diabetes/tratamento farmacológico , Feminino , Humanos , Insulina/uso terapêutico , Pessoa de Meia-IdadeRESUMO
We report a historical case of hyperparathyroidism in a young patient hospitalized for an array of osteolytic foci and incomplete fracture associated with a swollen neck, revealing a very special form of a metastatic parathyroid carcinoma with unusual multiple locations and exceptional medullary flooding. Carcinoma of the parathyroid gland produces a malignant hypersecreting tumor particularly difficult to diagnose. Treatment of this rare tumor is primarily surgical. The preoperative syndrome is unusually severe primary hyperparathyroidism. Intraoperatively, the size of the tumor and its local extension to surrounding tissue are highly suggestive. Confirmation requires pathological analysis of the operative specimens and can be further supported by the clinical course of local recurrence or metastasic spread. Specific immunohistochemical techniques have recently been shown to be contributive. The diagnosis is strengthened in the presence of associated Schantz and Castelman criteria. Foci of local extension can be identified preoperatively with ultrasound, (99m)Tc-sestamibi scintigraphy and MRI of the neck and mediastinum. The prognosis depends mainly on the possibility of achieving complete resection at the initial surgery. In some cases, very aggressive complementary postoperative radiotherapy is likely to improve locoregional control of the tumor. Chemotherapy alone or in combination with radiation has not demonstrated its effectiveness. The disease course and control can be monitored by regular assay of serum calcium and the parathormone.
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Hiperparatireoidismo/patologia , Neoplasias das Paratireoides/patologia , Adulto , Feminino , Seguimentos , Humanos , Neoplasias das Paratireoides/diagnóstico por imagem , Neoplasias das Paratireoides/cirurgia , Cintilografia , Compostos Radiofarmacêuticos , Tecnécio Tc 99m Sestamibi , Resultado do TratamentoRESUMO
The association of microscopic colitis with celiac disease is rare. A case of microscopic colitis associated with celiac disease and following administration of venlafaxine in a 67-year-old patient is described. The pathophysiologic hypotheses of such an association are discussed.
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Antidepressivos de Segunda Geração/efeitos adversos , Doença Celíaca/induzido quimicamente , Doença Celíaca/complicações , Colite Microscópica/induzido quimicamente , Colite Microscópica/complicações , Cicloexanóis/efeitos adversos , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversos , Idoso , Biópsia , Colite Microscópica/diagnóstico , Colite Microscópica/patologia , Colo/patologia , Colonoscopia , Transtorno Depressivo/tratamento farmacológico , Humanos , Masculino , Cloridrato de VenlafaxinaRESUMO
Sporadic colonic juvenile polyps are uncommon in adults. We report three cases for which clinical manifestations were presence of occult blood in the stool, rectal bleeding or chronic diarrhea. Two of these polyps occurred in the caecum which is an uncommon localisation. Endoscopic characteristics of these polyps were indistinguishable from adenomas. Endoscopic resection was complicated in one case by bleeding.
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Pólipos do Colo/diagnóstico , Adulto , Idoso , Pólipos do Colo/cirurgia , Diarreia/etiologia , Endoscopia Gastrointestinal , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Sangue Oculto , RetoRESUMO
OBJECTIVE: To report the mechanism of diarrhoea in patients with subacute colonic pseudo-obstruction, profuse secretory diarrhoea and hypokalemia. PATIENTS: Five consecutive patients who developed colonic pseudo-obstruction, profuse watery diarrhoea and severe hypokalemia. Investigations excluded mechanical intestinal obstruction. Usual cause of diarrhoea were ruled out. Abdominal distension and diarrhoea improved simultaneously in all cases after colonoscopic decompression or intravenous neostigmine. RESULTS: Faecal ionograms showed a low osmotic gap and high faecal potassium concentration explaining the hypokalemia: 100 to 180 mEq/kg (usually inferior than 50 mEq/l in case of secretory diarrhoea) and low faecal sodium concentrations. Potassium salts were the only factor identified as the driving osmotic force for the diarrhoea. CONCLUSION: Secretory diarrhoea is classically due to chloride active secretion with passive sodium secretion or to inhibition of sodium absorption. In five cases of Ogilvie's syndrome we evidenced an original mechanism of secretory diarrhoea due to active potassium secretion responsible of a profound hypokalemia. This novel type of diarrhoea may be a hallmark of colonic pseudo-obstruction due to colonic distension.
Assuntos
Pseudo-Obstrução do Colo/complicações , Pseudo-Obstrução do Colo/metabolismo , Diarreia/metabolismo , Fezes/química , Hipopotassemia/etiologia , Potássio/análise , Potássio/metabolismo , Idoso , Idoso de 80 Anos ou mais , Humanos , MasculinoRESUMO
We report a case of acute renal insufficiency in a 77 year-old patient who took flurbiprofen as antiplatelet therapy. This is an important observation because it illustrates the potential risk of acute renal insufficiency, when using flurbiprofen before invasive medical examination or surgery in patients receiving long-term treatment with angiotensin converting enzyme inhibitors or angiotensin II inhibitors. This risk is probably underestimated in usual clinical practice.
Assuntos
Injúria Renal Aguda/induzido quimicamente , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Flurbiprofeno/efeitos adversos , Idoso , Anti-Inflamatórios não Esteroides/efeitos adversos , Anti-Hipertensivos/efeitos adversos , Diabetes Mellitus Tipo 2/complicações , Retinopatia Diabética , Humanos , Masculino , Inibidores da Agregação Plaquetária/efeitos adversos , Ramipril/efeitos adversosRESUMO
PURPOSE: Our aim is to describe the skeletal manifestations of Behcet's disease (BD) among young adults in a military population. METHODS: We conducted a retrospective study of 176 patients with BD who were followed between 1980 and 2005. All the patients fulfilled the international study group on Behcet's disease diagnostic criteria. RESULTS: Rheumatic manifestations were noticed in 79 out of 176 patients (45%), ranking second after the skin and mucosal manifestations of the disease. Articular manifestations were the first disease manifestation in 16.5% of the patients. Inflammatory arthralgias were the most common manifestation and observed in 81%, interesting mainly the large lower limb joints. Disease course was acute in most of the patients. Arthritis was less common: oligoarthritis (7.5%), monoarthritis (6.5%) and polyarthritis (5%). Axial involvement was also noted: spine pain in 29%, isolated sacroiliitis in 7.5%, and definite ankylosing spondylitis in 5%. CONCLUSION: Joint involvement is common in BD and could be the first manifestation of the disease. Most of the patients present with inflammatory arthralgias of the large lower limb joints. Disease course is usually favourable, spontaneously or with treatment. However, in our study population, skeletal manifestations were responsible for significant disability.
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Síndrome de Behçet/fisiopatologia , Adulto , Artralgia/fisiopatologia , Artrite/fisiopatologia , Feminino , Seguimentos , Humanos , Extremidade Inferior/fisiopatologia , Masculino , Estudos Retrospectivos , Articulação Sacroilíaca/fisiopatologia , Coluna Vertebral/fisiopatologia , Espondilite Anquilosante/fisiopatologiaRESUMO
INTRODUCTION: Hypercalcemia is a rare complication of non-Hodgkin lymphoma. Usually, hypercalcemia occurs late in the disease course, except for high-grade lymphoma. Most often hypercalcemia is related to excessive level of circulating PTH-rP or sometimes, 1,25(OH)2D3. Concomitant high plasmatic concentration of PTH-rP and 1,25(OH)2D3 is uncommon. EXEGESIS: We report the case of a 82-year-old man who presented with abdominal pain and weight loss, leading to the diagnosis of diffuse large-B-cell lymphoma (high-grade lymphoma) associated with symptomatic hypercalcemia (3.21mmol/l). PTH-rP and 1,25(OH)2D3 plasmatic levels were high. Calcium concentration was normalized with glucocorticoids and sequential chemotherapy. CONCLUSION: This case report confirms that hypercalcemia, as consequence of excessive plasmatic level of PTH-rP secreted by tumoral cells, can occur early in the course of high-grade lymphoma. Glucocorticoids and chemotherapy are the best treatment options.