Lupus eritematoso sistémico y púrpura trombótica trombocitopénica: un caso refractario sin actividad lúpica asociada / Systemic lupus erythematosus and thrombotic thrombocytopenia purpura: a refractory case without lupus activity

La asociación entre lupus eritematoso sistémico (LES) y púrpura trombótica trombocitopénica (PTT) es una situación descrita pero poco frecuente y suele ocurrir en casos con actividad lúpica y deterioro renal. Presentamos un caso de PTT con disminución de los niveles de ADAMST13 que ocurrió en una paciente afectada de LES pero sin actividad y sin afectación renal. Fue un caso que presentó dificultades diagnósticas iniciales y que, debido a su refractariedad, precisó recambios plasmáticos y tratamientos inmunosupresores, incluyendo rituximab (AU)

The association between systemic lupus erythematosus (SLE) and thrombotic thrombocytopenic purpura (TTP) has been infrequently reported. Usually, patients with TTP have more SLE activity and frequent renal involvement. Here we present a case of TTP associated to low-activity SLE. The absence of renal and major organ involvement increased the difficulty in making the initial diagnosis. ADAMTS13 activity in plasma in this patient was very low, as seen in other similar cases. The evolution of the patient was poor, needing plasma exchanges and immunosuppressive therapy, including the use of rituximab (AU)

Systemic lupus erythematosus and thrombotic thrombocytopenia purpura: a refractory case without lupus activity.

The association between systemic lupus erythematosus (SLE) and thrombotic thrombocytopenic purpura (TTP) has been infrequently reported. Usually, patients with TTP have more SLE activity and frequent renal involvement. Here we present a case of TTP associated to low-activity SLE. The absence of renal and major organ involvement increased the difficulty in making the initial diagnosis. ADAMTS13 activity in plasma in this patient was very low, as seen in other similar cases. The evolution of the patient was poor, needing plasma exchanges and immunosuppressive therapy, including the use of rituximab.

Reactive arthritis and other musculoskeletal sequelae following an outbreak of Salmonella hadar in Castellon, Spain.

OBJECTIVE: In 2005 a large outbreak of Salmonella hadar occurred in Spain following the consumption of commercial precooked roast chicken. We estimated the incidence and risk factors for reactive arthritis (ReA) and other musculoskeletal sequelae in the patients of this outbreak in 2 health departments of Castellon province. METHODS: A prospective cohort study of the patients and their families was carried out. Clinical infection with Salmonella was considered as the exposure factor. The cohort was studied for ReA symptoms using a telephone questionnaire. Telephone interviews or medical examinations of subjects with musculoskeletal symptoms were conducted by a rheumatologist. Robust Poisson regression models were used in the analysis. RESULTS: From the cohort of 262 people, 248 (94.7%) participated in the telephone survey, 155 with clinical salmonellosis (infected), 78 noninfected, and 15 with some symptoms but not clinical salmonellosis. One hundred one infected patients (65%) reported musculoskeletal symptoms, compared to 19 noninfected (24%) (adjusted relative risk = 2.60, 95% CI 1.73-3.90). Of the infected group, 16 ReA (incidence 10%, 95% CI 6.0-16.2), 7 enthesopathies, and 2 arthralgias were detected, and zero in the noninfected group. The risk factors for ReA were age, weight loss, and duration of diarrhea. Antibiotic treatment for the infection protected against symptoms of peripheral or axial arthritis (adjusted relative risk = 0.73, 95% CI 0.55-0.98). CONCLUSION: The incidence of ReA and musculoskeletal symptoms after the infection was high. The use of antibiotics for S. hadar infection offered some protection against musculoskeletal symptoms.

[Incidence of reactive arthritis and other musculoskeletal sequelae following a foodborne outbreak of Salmonella enteritidis phago type 14 b infection]. / Incidencia de artritis reactiva y síntomas osteoarticulares después de un brote de Salmonella enteritidis fagotipo 14 b.

BACKGROUND AND OBJECTIVE: We intended to estimate the prevalence of reactive arthritis (ReA) and other musculoskeletal sequelae after a foodborne outbreak of Salmonella enteritidis phago type 14 b in a banquet in Castellón in June 5th, 2004. PATIENTS AND METHOD: A prospective cohort study was carried out with 125 subjects (90.6%) out of the banquet participants. Sixty-two symptomatic infected cases occurred, 33 with positive cultures of S. enteritidis phago type 14 b, and 54 non-infected subjects. After 4 months of the outbreak, all 125 subjects were studied by means of a symptoms questionnaire of ReA based on Buxton et al, administered by telephone. Medical examination of subjects with musculoskeletal symptoms, 29 of 30, was done by a rheumatologist. Relative risk (RR) with 95% confidence interval (CI) was estimated by Poisson regression models. RESULTS: Any symptoms were reported by 32 (52%) of infected cases versus 13 (24%) of non-infected (RR adjusted = 2.49; 95% CI, 1.26-4.95); 20 (32%) infected cases reported muskuloskeletal symptoms compared to 4 (7%) non-infected (RR adjusted = 4.96; 95% CI, 1.64-15.04). The medical examination of the subjects with musculoskeletal symptoms revealed 3 infected cases with ReA (4.8%; 3/62). In addition, several reactive musculoskeletal sequelae associated with salmonellosis infection were found in 4 subjects (1 neck pain, 1 polyarthralgias, and 2 enthesopathy). CONCLUSIONS: The occurrence of ReA was lower than other studies but the incidence of musculoskeletal symptoms was increased. The infection by Salmonella supposes a risk for joint symptoms that could be important taking into account the high incidence of salmonellosis.

Incidencia de artritis reactiva y síntomas osteoarticulares después de un brote de Salmonella enteritidis fagotipo 14 b / Incidence of reactive arthritis and other musculoskeletal sequelae following a foodborne outbreak of Salmonella enteritidis phago type 14 b infection

Fundamento y objetivo: Estimar la incidencia de artritis reactiva (ARe) y otras secuelas osteoarticulares después de un brote de toxiinfección alimentaria causado por Salmonella enteritidis fagotipo 14 b en un banquete en Castellón el 5 de junio de 2004. Pacientes y método: Se efectuó un estudio de cohorte prospectivo con 125 personas (90,6% de los participantes al banquete). Hubo 62 casos clínicos o infectados, de los que 33 tenían un cultivo positivo a S. enteritidis fagotipo 14 b; 54 personas no resultaron infectadas. Cuatro meses después del brote, se llevó a cabo una encuesta telefónica en las 125 personas siguiendo el cuestionario de síntomas de ARe de Buxton et al1 mientras que un reumatólogo examinó a 29 de las 30 personas con síntomas osteoarticulares. Se estimó los riesgos relativos (RR) con un intervalo de confianza (IC) del 95% mediante modelos de regresión de Poisson. Resultados: Se detectó síntomas en 32 (52%) infectados frente a 13 (24%) de los no infectados (RR ajustado = 2,49; IC del 95%, 1,26-4,95); 20 (32%) de los infectados presentaron síntomas osteoarticulares frente a 4 (7%) de los no infectados (RR ajustado = 4,96; IC del 95%, 1,64-15,04). El examen médico de las personas con síntomas osteoarticulares halló 3 infectados con ARe (4,8%; 3/62). Además, se diagnosticó varias secuelas osteoarticulares reactivas asociadas a la salmonelosis en otros 4 infectados (1 cervicalgia, 1 poliartralgia y 2 entesopatías). Conclusiones: La incidencia de ARe fue más baja que en otros estudios pero la frecuencia de síntomas osteoarticulares fue alta. La infección por Salmonella supone un riesgo de síntomas osteoarticulares que pueden ser importantes considerando la elevada incidencia de la salmonelosis

Background and objective: We intended to estimate the prevalence of reactive arthritis (ReA) and other musculoskeletal sequelae after a foodborne outbreak of Salmonella enteritidis phago type 14 b in a banquet in Castellón in June 5th, 2004. Patients and method: A prospective cohort study was carried out with 125 subjects (90.6%) out of the banquet participants. Sixty-two symptomatic infected cases occurred, 33 with positive cultures of S. enteritidis phago type 14 b, and 54 non-infected subjects. After 4 months of the outbreak, all 125 subjects were studied by means of a symptoms questionnaire of ReA based on Buxton et al1, administered by telephone. Medical examination of subjects with musculoskeletal symptoms, 29 of 30, was done by a rheumatologist. Relative risk (RR) with 95% confidence interval (CI) was estimated by Poisson regression models. Results: Any symptoms were reported by 32 (52%) of infected cases versus 13 (24%) of non-infected (RR adjusted = 2.49; 95% CI, 1.26-4.95); 20 (32%) infected cases reported muskuloskeletal symptoms compared to 4 (7%) non-infected (RR adjusted = 4.96; 95% CI, 1.64-15.04). The medical examination of the subjects with musculoskeletal symptoms revealed 3 infected cases with ReA (4.8%; 3/62). In addition, several reactive musculoskeletal sequelae associated with salmonellosis infection were found in 4 subjects (1 neck pain, 1 polyarthralgias, and 2 enthesopathy). Conclusions: The occurrence of ReA was lower than other studies but the incidence of musculoskeletal symptoms was increased. The infection by Salmonella supposes a risk for joint symptoms that could be important taking into account the high incidence of salmonellosis