RESUMO
Marchiafava-Bignami disease (MBD) is rare and often associated with chronic alcohol consumption; however, cases have been described in non-alcoholic patients with nutritional deficits. This disease manifests itself through an array of neurological signs and symptoms, from mild dysarthria or mild confusion to coma and death, and can present acutely, subacutely, or chronically, depending on their severity. The evolution of imaging technology makes magnetic resonance imaging (MRI) the gold standard for the diagnosis of this disease, although computed tomography (CT) scan is usually in the first line owing to its greater availability. The main feature for the diagnosis of MBD by brain MRI is the identification of areas of demyelination and necrosis of the corpus callosum. We report a 55-year-old male with subacute neurological deterioration whose MRI demonstrated atrophy and demyelination of the corpus callosum.
RESUMO
Coronavirus disease 2019 (COVID-19) is a pandemic that spread rapidly around the world, causing an enormous overload on the health systems of the different affected countries. Among the many different manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, an uncommon complication is the development of pneumomediastinum. In the clinical case presented, the patient was diagnosed with COVID-19 pneumonia and due to severe refractory hypoxemia, she was submitted to therapy with non-invasive ventilation (NIV). After initial stabilization and improvement, there was unexpected clinical deterioration and pneumomediastinum was diagnosed. The purpose of this report is to highlight the importance of considering pneumomediastinum as a complication of COVID-19 pneumonia in cases subjected to non-invasive ventilation.
RESUMO
A metastização ganglionar cervical por neoplasia da próstata é rara, sendo ainda menos frequente como manifestação inicial da doença. O presente estudo é um relato de um caso clínico de uma pessoa do sexo masculino, com 72 anos, que apresentava massa cervical esquerda, indolor, com 2 meses de evolução e dores ósseas lombar e torácica. A citologia aspirativa por agulha fina com estudo imuno-histoquímico revelou positividade para o antígeno prostático específico, concluindo se tratar de metástase ganglionar de carcinoma da próstata. Analiticamente, constatou-se que o valor do antígeno prostático específico foi maior que 1.000ng/mL, além da elevação da fosfatase alcalina. A cintilografia óssea de corpo inteiro revelou envolvimento ósseo secundário. Após o diagnóstico, o paciente iniciou hormonoterapia e recusou radioterapia com intuito paliativo. Oito meses após o diagnóstico, constatou-se a recorrência da doença, com elevação do valor do antígeno prostático específico novamente. Dessa forma, relata-se um caso de neoplasia da próstata com metastização óssea e ganglionar cervical esquerda em um indivíduo assintomático do ponto de vista urológico. Salienta-se que, no diagnóstico diferencial de adenopatias cervicais, deve-se considerar a neoplasia da próstata em pessoas do sexo masculino. (AU)
Cervical lymph nodes involvement is rare in prostate cancer and uncommon as an initial manifestation. This study is a clinical case report of a 72-year-old man who presented with a left cervical painless mass of 2-month progression, and bone pain on the lumbar and thoracic regions. Fine-needle aspiration cytology with immunohistochemistry staining was performed and revealed positivity for prostate-specific antigen consistent with prostate adenocarcinoma metastasis. Blood tests revealed a prostate-specific antigen of more than 1,000ng/mL, as well as high alkaline phosphatase. Whole-body bone scan showed secondary bone involvement. Following diagnosis, the patient started hormonal therapy and refused palliative radiotherapy. Eight months after diagnosis, recurrence was observed, with prostate-specific antigen elevation again. Thus, a clinical case of prostate cancer with bone and cervical lymph node metastasis in a patient with no urologic symptoms is reported. It should be noted that prostate cancer shall always be considered in the differential diagnosis of cervical lymphadenopathies in male patients. (AU)
