[Extrapulmonary tuberculosis. An unusual case]. / Tubercolosi extrapolmonare. Un caso inusuale.

Skeletal tuberculosis with extravertebral location is rare. We report a case of tuberculous osteomyelitis simultaneously affecting two right ribs and the left ulna. We emphasize the diagnostic problems (failure or delay in diagnosis) in extrapulmonary tuberculosis interesting uncommon sites and having relatively indolent presenting symptoms.

Heparin-induced thrombocytopenia with arterial thrombosis: an unusual case.

A case of heparin-induced thrombocytopenia with thrombosis (HITT) is described. The patient, treated for several days with porcine Ca-heparin at a dosage of 10,000 IU/day, presented severe thrombocytopenia (Plt 36 x 10(9)/L), intermittent right leg ischemia, and a positive heparin-induced platelet aggregation assay. We promptly discontinued heparin and started picotamide, an antiplatelet drug. Rapid clinical improvement was observed in a few days. We stress the unusual features of the reported case (HITT during prophylactic therapy with low doses of porcine heparin; intermittent thrombosis), and we suggest picotamide represents a rational therapy for HITT on the basis of clinical and pathogenetic considerations.

[Angioimmunoblastic lymphadenopathy with dysproteinemia: personal experience with 3 cases and review of the literature]. / Linfoadenopatia angioimmunoblastica con disprotidemia: esperienza personale su tre casi e revisione della letteratura.

OBJECTIVE: We report personal experience on 3 cases of angioimmunoblastic lymphadenopathy with dysproteinemia (AILD). We stress the prognostic and therapeutic aspects of this rare disease, that remain still unclear in recent literature. DESIGN: We performed a retrospective study on 3 cases of AILD, with a mean follow-up of 32.6 months (range 30-36). SETTING: Internal Medicine Unit. PATIENTS: We observed three patients, 2 males and 1 female, with a mean age of 65 years (range 51-72), with AILD confirmed by histopathological exams and evidence of unfavorable prognostic features at the time of diagnosis. INTERVENTIONS: 2 patients received polychemotherapy with cyclophosphamide+prednisone; cyclophosphamide + vincristine + prednisone. One patient was treated with low doses of prednisone (25 mg/day). MEASUREMENTS: We evaluated the degree of response (absent, partial, complete) an the time of survival (< 18 months or > 24 months). RESULTS: Response to therapy was partial in all patients; 1 patient underwent a severe bone marrow depression. All patients were alive for more than 24 months. CONCLUSIONS: The clinical course was independent of therapy (intensive or symptomatic) and prognostic criteria in all 3 patients. At present AILD is considered as a potentially malignant disease. Polychemotherapy must be used as a first choice treatment.