RESUMO
OBJECTIVES: To report a case of intravascular lymphoma (IVL) in a Caucasian patient who presented with anasarca as his sole clinical sign. MATERIAL AND METHODS: A man presented with anasarca-type oedema and fatigue. After excluding heart failure, hepatic cirrhosis, nephrotic syndrome, hypothyroidism, AL-amyloidosis and adverse drug reaction which can all cause oedema, we turned our attention to capillary permeability disorders. RESULTS: Closer review of the bone marrow aspirate demonstrated haemophagocytic histiocytosis, while core, renal and duodenal biopsies showed a B-cell IVL. CONCLUSION: The differential diagnosis of anasarca, a relatively common clinical sign, should include IVL although the diagnosis may still be challenging. LEARNING POINTS: Anasarca-type oedema is an unusual initial presentation of intravascular lymphoma (IVL) and is normally attributed to capillary permeability disorders.Two clinical forms of IVL have been recognized: a Western form and an Asian variant which is characterized by haemophagocytosis.Patients of Caucasian origin who have the clinical features of the Asian variant of IVL make the diagnosis of this condition even more challenging.
RESUMO
Adult onset Still's disease (AOSD) is a well-recognized clinical disorder characterized by involvement of various organs, including liver. However, acute hepatitis or hepatic failure is extremely rare, and most of the reported cases occurred during treatment with hepatotoxic drugs. Anakinra is an interleukin-1 receptor antagonist (IL-1Ra). Experimental and clinical data support a central role for IL-1Ra in fulminant hepatic failure. We report the case of a patient with AOSD complicated with acute hepatitis during treatment with corticosteroids, which was dramatically improved with anakinra.
Assuntos
Antirreumáticos/uso terapêutico , Hepatite/tratamento farmacológico , Proteína Antagonista do Receptor de Interleucina 1/uso terapêutico , Doença de Still de Início Tardio/complicações , Anti-Inflamatórios/uso terapêutico , Hepatite/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prednisona/uso terapêutico , Doença de Still de Início Tardio/tratamento farmacológicoRESUMO
The combination of synovitis, acne, pustulosis, hyperostosis and aseptic osteitis is known as SAPHO syndrome. Osteitis involves the anterior chest, particularly the sternoclavicular and upper costosternal junctions. Diagnosis is difficult when there are no typical skin and bone lesions and differential diagnosis includes bacterial ostomyelitis, malignancy and Paget's disease. We present a case of SAPHO syndrome with aseptic femoral osteitis and symmetrical involvement of the lower costosternal junctions. The main advantage of recognition and diagnosis of SAPHO syndrome is the avoidance of unnecessary prolonged antibiotic treatment and repeated invasive procedures.
Assuntos
Síndrome de Hiperostose Adquirida/diagnóstico , Fêmur , Articulações Esternocostais , Síndrome de Hiperostose Adquirida/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Osteíte/etiologiaAssuntos
Acetamidas/uso terapêutico , Anti-Infecciosos/uso terapêutico , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/microbiologia , Oxazolidinonas/uso terapêutico , Staphylococcus epidermidis , Idoso , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/microbiologia , Humanos , Linezolida , MasculinoAssuntos
Vasculite por IgA/etiologia , Resistência a Meticilina , Infecções Estafilocócicas/complicações , Humanos , Vasculite por IgA/imunologia , Masculino , Pessoa de Meia-Idade , Receptores de Antígenos de Linfócitos T/análise , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/imunologia , Superantígenos/imunologiaRESUMO
The case is reported of non-bacterial thrombotic endocarditis (NBTE) in a patient with giant cell arteritis and prostate cancer, and the relevant literature reviewed. To the present authors' knowledge, this is the first case to be reported where NBTE coexists with both arteritis and cancer. NBTE is difficult to diagnose if the underlying disease is accompanied by fever. If a diagnosis of probable infective endocarditis is established, the cultures and serology are negative, and there is no response to antibiotic treatment, then NBTE should be considered.