RESUMO
Tumor necrosis factor antagonists (anti-TNF) are increasingly prescribed as maintenance therapy for a variety of autoimmune conditions. Therefore, frequent monitoring and awareness of side effects are of the utmost importance. Adalimumab is known to cause peripheral eosinophilia, but there are few reports of more severe adverse events. Loeffler's endocarditis is a rare and fatal disease characterized by eosinophilic infiltration of the endomyocardium leading to fibrosis and restrictive cardiomyopathy. Herein we describe a 72 year old female on adalimumab therapy for two years for rheumatoid arthritis presenting with Loeffler's endocarditis. This case represents a rare case of Loeffler's endocarditis diagnosed rapidly and without myocardial biopsy. Early intervention is crucial in the prevention of permanent fibrosis and mortality in Loeffler's endocarditis. This case demonstrates the need for close monitoring and early recognition in patients on anti-TNF therapy. Abbreviations: tumor necrosis factor (TNF), hypereosinophilic syndrome (HES).
RESUMO
Aspirin remains one of the most common agents involved in both accidental and intentional overdose. The availability of enhanced elimination and early hemodialysis has been known to reduce the number of deaths from salicylate poisoning. We present the case of an intentional aspirin overdose with enteric-coated preparation that had continuously rising salicylate levels despite treatment with bicarbonate drip, continuous dialysis and activated charcoal.
RESUMO
Intramuscular progesterone has been reported to be infrequently associated with acute eosinophilic pneumonia in patients who have recently undergone in vitro fertilization. A 27-year-old female at 5 weeks gestation after in vitro fertilization presented with cough, fever, dyspnea, bilateral infiltrates, and eosinophilia. All infectious, neoplastic, and autoimmune evaluations were negative. She gradually improved with supportive care. This case demonstrates that progesterone in sesame seed oil may be an inciting agent for eosinophilic pneumonia and that removal of this agent may be sufficient for recovery in mild cases.
RESUMO
Chronic obstructive pulmonary disease (COPD) is one of the leading causes of disability and death worldwide. COPD exacerbation is usually treated with antibiotics, systemic corticosteroids, and inhaled bronchodilators. We present a case of recurrent COPD exacerbation that was treated repeatedly with standard therapy. Dynamic expiratory computed tomography of the chest was done, which revealed concomitant tracheomalacia. COPD and tracheomalacia may coexist during recurrent exacerbations of COPD, and delayed diagnosis can be associated with severe comorbidities. Ordering the appropriate imaging may aid in the correct diagnosis and facilitate appropriate management.
