Acute generalized exanthematous pustulosis due to dextromethorphan.

Acute generalized exanthematous pustulosis (AGEP) is a rare, severe, pustular, cutaneous reaction. We report a case in which a patient developed AGEP after the intake of 3 different antitussive agents containing dextromethorphan as the only ingredient in common.

Retinocoroiditis toxoplásmica: ¿recidiva o membrana neovascular coroidea? / Toxoplasmic retinochoroiditis: relapse vs choroidal neovascular membrane

Caso clínicoSe presentan cuatro casos de pacientes con deterioro de agudeza visual y lesiones retinocoroideas compatibles con toxoplasmosis ocular en los que el diagnóstico de retinocoroiditis toxoplásmica activa o membrana neovascular coroidea se basó en un cribaje diagnóstico específicamente diseñado para ello.DiscusiónEn el contexto de un cuadro clínico compatible, con cicatrices coriorretinianas sugestivas e inflamación escasa o ausente, las membranas coroideas neovasculares pueden simular cuadros de retinocoroiditis toxoplásmica activa y viceversa. Un exhaustivo estudio oftalmológico, serológico e inmunológico (del humor acuoso) puede facilitar el diagnóstico, permitiendo una adecuada toma de decisión terapéutica(AU)

Clinical caseWe report four patients with both decreased visual acuity and retinochoroidal lesions compatible with ocular toxoplasmosis in which a diagnosis of active toxoplasmic retinochoroiditis or choroidal neovascular membrane was made based on a specifically designed diagnostic screening.DiscussionIn the context of a compatible clinical picture, with retinochoroidal scars and low grade or absence of inflammation, choroidal neovascular membranes may mimic active toxoplasmic retinochoroiditis and vice-versa. A thorough ophthalmic, serological, and immunological examination (in ocular fluids) may help in the differential diagnosis allowing for proper therapeutic decision-making(AU)

[Toxoplasmic retinochoroiditis: relapse vs choroidal neovascular membrane]. / Retinocoroiditis toxoplásmica: ¿recidiva o membrana neovascular coroidea?

CLINICAL CASE: We report four patients with both decreased visual acuity and retinochoroidal lesions compatible with ocular toxoplasmosis in which a diagnosis of active toxoplasmic retinochoroiditis or choroidal neovascular membrane was made based on a specifically designed diagnostic screening. DISCUSSION: In the context of a compatible clinical picture, with retinochoroidal scars and low grade or absence of inflammation, choroidal neovascular membranes may mimic active toxoplasmic retinochoroiditis and vice-versa. A thorough ophthalmic, serological, and immunological examination (in ocular fluids) may help in the differential diagnosis allowing for proper therapeutic decision-making.

[Successful treatment of surgically induced necrotizing sclerokeratitis (SINS) with systemic immunosuppresive agents and amniotic membrane grafting]. / Tratamiento inmunosupresor sistémico y trasplante de membrana amniótica en escleritis necrotizante inducida por cirugía (ENIC).

CLINICAL CASE: We report the case of a 74-year-old female who developed a necrotizing sclerokeratitis affecting her left eye after uncomplicated cataract surgery. She had no previous history of systemic autoimmune disease. Histopathology of the lesion revealed necrotic granulomatosis with an increased number of plasma cells. DISCUSSION: Surgically induced necrotizing sclerokeratitis (SINS) is a serious entity which requires prompt and aggressive therapy to prevent its potential devastating ocular consequences. Conjunctival resection and amniotic membrane grafting may be necessary to temporarily interrupt local immunologic events in severe cases. However, associated systemic immunomodulatory therapy seems to be mandatory (Arch Soc Esp Oftalmol 2009; 84: 577-580).

Tratamiento inmunosupresor sistémico y trasplante de membrana amniótica en escleritis necrotizante inducida por cirugía (ENIC) / Succesful treatment of surgically induced necrotizing sclerokeratitis (SINS) with systemic immunosuppresive agents and amniotic membrane grafting

Caso clínico: Presentamos el caso de una mujer de74 años que desarrolló una escleroqueratitis necrotizanteen su ojo izquierdo tras cirugía de cataratano complicada. No tenía antecedentes de enfermedadautoinmune sistémica. El análisis histopatológicode la lesión mostró granulomatosis necrotizantecon abundantes células plasmáticas.Discusión: La escleroqueratitis necrotizante inducidapor cirugía (ENIC) es una grave afección querequiere tratamiento precoz y agresivo tratando deprevenir sus potencialmente devastadoras consecuencias.La resección conjuntival junto conimplante de membrana amniótica pueden ser necesariaspara interrumpir temporalmente el procesoinmunológico local. No obstante, es esencial asociarun tratamiento inmunosupresor sistémico(AU)

Clinical case: We report the case of a 74-year-oldfemale who developed a necrotizing sclerokeratitisaffecting her left eye after uncomplicated cataractsurgery. She had no previous history of systemicautoimmune disease. Histopathology of the lesionrevealed necrotic granulomatosis with an increasednumber of plasma cells.Discussion: Surgically induced necrotizing sclerokeratitis(SINS) is a serious entity which requiresprompt and aggressive therapy to prevent its potentialdevastating ocular consequences. Conjunctivalresection and amniotic membrane grafting may benecessary to temporarily interrupt local immunologicevents in severe cases. However, associated systemicimmunomodulatory therapy seems to be mandatory(AU)

[Paraneoplastic optic neuritis in an unknown small cell lung carcinoma defined by CRMP-5-IgG]. / Neuritis óptica paraneoplásica en carcinoma microcítico pulmonar desconocido definida por marcador CRMP-5-IgG.

CASE REPORT: The case of a 64-year-old patient with bilateral, progressive and painless diminution of visual acuity is presented. Ophthalmologic evaluation revealed optic neuritis and vitreous cells in both eyes, at different stages. Suspecting a paraneoplastic optic neuritis, the study of antibodies was requested. This showed positivity to the marker CRMP-5-IgG. After mediastinoscopy, a small cell lung carcinoma was diagnosed. DISCUSSION: Autoantibody CRMP-5-IgG defines a paraneoplastic entity of combined optic neuritis and vitreous inflammatory cells. The serological positivity avoids the vitreous biopsy and expedites the search for cancer. In our case, it allowed the diagnosis a previously unidentified tumor.

Niveles normales de interleucinas 6 y 8 en suero y orina de niños sanos asintomáticos / Normal levels of interleukin 6 and 8 in serum and urine in asymptomatic healthy children

Introducción: La infección urinaria es una patología muy frecuente en niños, y su diagnóstico y tratamiento precoces dependen de la sospecha clínica y la aplicación de parámetros analíticos. Algunas citocinas han despertado un gran interés en este terreno. Objetivo: Conocer los niveles de las interleucinas (IL) 6 y 8 en sangre y orina en niños sanos, y establecer el rango de normalidad de nuestro laboratorio. Material y métodos: Estudio observacional transversal, descriptivo y analítico, en niños sanos sin infección urinaria. Se analizan las variables sexo, edad, niño mayor o menor de 1 año, y nivel de IL 6 y 8 en sangre y orina (mediante ELISA). Se calcula la estadística básica de las variables cuantitativas. La comparación entre muestras independientes se llevó a cabo con el test U de Mann-Whitney, y la correlación entre las mismas con el test de Pearson. Se consideró un error alfa del 5% (SPSS 9.0). El límite superior de normalidad de las IL se estableció en la media más 2 desviaciones estándar (95% de la población). Resultados: Estudiamos 52 niños (40 varones, 76,92%) con una edad media de 51,31 + 47,98 meses (1-149 meses), sin diferencias en su distribución por sexo y grupos de edad inferior o superior a un año. Los niveles medios de IL (e intervalo de confianza IC: 95%), y el límite superior de la normalidad, fueron respectivamente, para IL-6 suero: 0,49 (IC: 0-1,05), y 3,95 pg/mL; IL-6 orina: 0,17 (IC: 0-0,51), 1,83 pg/mL; IL-8 suero: 136,66 (IC: 0,74-272,58), 974,58 pg/mL; IL-8 orina: 47,23 (14,71-79,75), 242,39 pg/mL. No hubo diferencias entre ambos sexos ni grupos de edad, salvo niveles medios de IL-8 urinaria más elevados en menores de 1 año, con una correlación negativa entre dicha variable y edad (p<0,05). Asimismo, existe una correlación positiva y muy significativa de IL-6 y 8 en orina (p<0,001) y de IL-8 entre suero y orina (p<0,01). Conclusiones: En niños sanos, no se observaron diferencias según sexos en los niveles de IL-6 y 8, pero la producción de IL-8 en orina es mayor en niños más pequeños. Adiferencia de la IL-6, se detectan niveles significativos de IL-8 en suero y orina de niños sanos, cuestionando su validez en el diagnóstico de infección. Finalmente, existe en condiciones normales una excelente correlación entre IL-6 y 8 en orina

Objective: To determine the interleukins (IL) 6 and 8 levels in serum and urine in the healthy pediatric population, and to establish our laboratory reference values, whit the purpose of subsequently to apply this determination to diagnosis of urinary tract infection. Material and methods: Observational, transversal, descriptive and analytical study, in healthy children without urinary tract infection. We analyse the following variables: sex, age, to be oldest or youngest than 1 year, and IL-6 and IL-8 levels in serum and urine (ELISA). We evaluate the basic statistics for quantitative variables. It compare the independent samples by means of Mann-Whitney U test, and its correlation with the Pearson test. We consider an alpha-error of 5% (SPSS 9.0). The upper limit of normality was established in two standard deviation more than the mean (95% of population). Results:We have studied 52 children (40 males, 76.92%). The mean of age was 51.31 + 47.98 months (1-149 months), and it didn’t have differences according to sex, or to be oldest and youngest than 1 year of age. The mean values of IL (and confidence interval IC: 95%), and the upper limit of normality, respectively were for serum IL-6: 0.49 (IC: 0-1,05), and 3.95 pg/mL; urine IL-6: 0,17 (IC: 0-0,51), 1,83 pg/mL; serum IL-8: 136,66 (IC: 0,74-272,58), 974,58 pg/mL; and urine IL-8: 47,23 (14,71-79,75), 242,39 pg/mL. It didn’t have differences neither between both sex nor age groups, except urine IL-8 mean levels greater in youngest of 1 year of age, with a negative correlation between this variable and age (p<0,05). Moreover, it exist a positive and very significant correlation of urine IL-6 and 8 (p<0,001), and serum and urine IL-8 (p<0,01). Conclusions: In healthy pediatric population, it didn’t observe differences according to sex in IL-6 and IL-8 levels, but the urine IL-8 production is greater in more little children. It observe significant serum and urine IL-8 levels in healthy children, making questionable its validity in urinary tract infection diagnosis. Finally, it exist an excellent correlation between urinary IL-6 and IL-8 in normal conditions