Anicteric leptospirosis with pneumonitis, pericarditis and acalculous cholecystitis.

We report the case of a 19-year-old male patient admitted to hospital with fever, asthenia, vomiting, abdominal and chest pains, cough with yellowish sputum, and hypotension. Laboratory tests showed leukocytosis and high creatine phosphokinase levels, without hyperbilirubinaemia or renal failure. The tomographic images of the chest and abdomen showed a right basal pneumonia and acalculous cholecystitis. The electrocardiograms revealed significant characteristics of acute pericarditis. Specific serology for leptospirosis done in the second and third weeks of disease showed positive results. The use of ceftriaxone 1g intravenously, twice a day for 7 days, resulted in an overall clinic improvement. The role of the suspicion index for diagnosis of leptospirosis is emphasized in anicteric patients, as well as the unsuspected possibility of pulmonary, pericardial and gallbladder involvement.

Doença de Behçet, anticorpos anticardiolipina, forame oval patente e síndrome de Sweet ? uma associação incomum / Behçet?s disease, anticardiolipin antibodies, patent foramen ovale, and Sweet syndrome ? an uncommon association

Doença de Behçet é condição inflamatória e autoimune infrequente, caracterizada por úlceras orais recorrentes e dois ou mais dos seguintesachados ? úlceras genitais, alterações oculares, lesões cutâneas e teste de patergia positivo. A ocorrência de vasculites e de anticorpos antifosfolípides pode contribuir para o aparecimento de tromboembolismos na doença de Behçet. Mulher de 49 anos, com doença de Behçet associada com diagnóstico prévio de síndrome de anticorpos antifosfolípides, apresentou erupção cutânea consistente com a síndrome de Sweet em um local de punção venosa. Foi introduzida prednisona 20mg/dia ao tratamento com warfarina 5 mg/dia que já utilizava, e a resposta satisfatória foi rápida. Pesquisa de sangue oculto foi positiva nas fezes, com concentração de antígeno carcinoembrionário discretamente elevada, e a colonoscopia revelou pólipos no cólon e no sigmoide. O câncerde cólon é descrito em portadores de doença de Behçet com lesões intestinais. Forame oval patente com shunt esquerdo-direito foi achado incidental no presente caso, e essa anomalia propicia embolias paradoxais em pacientes com estados hipercoaguláveis. A associação de doença de Behçet com síndrome de Sweet é raramente descrita e, embora sem o necessário esclarecimento, alguns autores admitem a possibilidade de mecanismo etiopatogênico comum a essas entidades.

Behçet?s disease is an inflammatory and autoimmune condition, characterized by recurrent oral ulcers and, at least, two of the following findings ? genital ulcers, ocular changes, cutaneous lesions, and positivetest for pathergy. The occurrence of vasculitis and antiphospholipid antibodies may contribute to thromboembolisms in Behçet?s disease. A 49-yearold woman with Behçet?s disease associated with a previous diagnosis of antiphospholipid antibodies syndrome presented with an abrupt cutaneous eruption consistent with the Sweet syndrome at the site of venipuncture. Prednisone 20 mg/day was introduced to the treatment with warfarin 5 mg/day that she was undergoing, resulting in a rapid favorable response. Fecal occult blood test was positive, and the level ofcarcinoembryonic antigen was mildly elevated, and the colonoscopy evaluation revealed colon and sigmoid polyps. Colon cancer may develop in patients with intestinal lesions of Behçet?s disease. Patent foramen ovale with left to right shunt was an incidental finding in the present case study, and this anomaly predisposes to paradoxal embolism in patients with thrombophilic conditions. Association between Behçet?s disease andSweet syndrome has been rarely described and, although without the necessary clarification, some authors believe in a possible common etiopathogenic mechanism.

Mujer con artritis reumatoidea, nódulos pulmonares cavitarios y úlcera de piel / A woman with rheumatoid arthritis,cavitary pulmonary nodules and skin ulcer

Rheumatoid arthritis (RA) more often affect women, but extra-articular manifestations ­ cardiac, cutaneous, gastrointestinal, nervous, ocular, pulmonary and renal, are predominant in men [1­7]. These changes are found in approximately 40-50% of active chronic disease [1, 5, 6, 8]. Skin nodules occur in up to 20% of cases, mainly if rheumatoid factor is positive [1-3, 5], and are related to small vessel vasculitis, similarly to digital changes and ulcers of extremities. Pulmonary nodules are associated with positive rheumatoid factor and anti-cyclic citrulinated peptide antibody; and can evolve with necrosis and central cavitations [1-3, 5-7]. The woman herein reported had longstanding seropositive RA with cavitary pulmonary nodules and indolent cutaneous ulcer in the left elbow

La artritis reumatoide (AR) afecta con mayor frecuencia a las mujeres, pero es extraarticular. manifestaciones cardíacas, cutáneas, gastrointestinales, nerviosas, oculares, Pulmonar y renal, son predominantes en los hombres [1­7]. Estos cambios se encuentran en aproximadamente el 40-50% de las enfermedades crónicas activas [1, 5, 6, 8]. Los nódulos cutáneos se producen en hasta el 20% de los casos, principalmente si el factor reumatoide es positivo [1-3, 5], y están relacionados con vasculitis de pequeños vasos, de forma similar a la digital Cambios y úlceras de extremidades. Los nódulos pulmonares están asociados. con factor reumatoide positivo y péptido citrulinado anticíclico anticuerpo; y puede evolucionar con necrosis y cavitaciones centrales [1-3, 5-7]. La mujer aquí reportada tenía una AR seropositiva de larga data con Nódulos pulmonares cavitarios y úlcera cutánea indolente en el codo izquierdo.