A case of hepatic and bone marrow sarcoidosis with progressive renal failure: diagnostic and therapeutic challenges.

Sarcoidosis is a systemic granulomatous disease, sometimes characterized by an extrapulmonary localization in 30 - 50% of cases. We describe a 60-year-old Italian man with an unexplained history of fatigue, ascitis and progressive renal function impairment. Diagnosis of hepatic and bone marrow sarcoidosis was established by histology, and fast improvement of renal function was obtained after starting  corticosteroid therapy. Atypical presentation and simultaneous involvement of liver, bone marrow and kidneys make diagnosis of extrapulmonary sarcoidosis still a diagnostic challenge. Delayed diagnosis could lead to serious organ damage like a progressive severe kidney failure.

Observaciones metodológicas en la realización de la historia clínica aplicadas a una enfermedad autoinmune: implicaciones para la enseñanza de la medicina / Methodological observations in the realization of the clinical history applied to an autoimmune disease: implications for the teaching of medicine

Prescribir el mejor tratamiento posible se relaciona estrechamente con las condiciones que presente el paciente al momento de la consulta, pero también, y de manera fundamental, con el recuento de su historial clínico. La información relativa a las enfermedades que ha tenido una persona a lo largo de su vida, así como los métodos utilizados para tratarlas, son sumamente relevantes, sobre todo si se atiende un padecimiento severo o crónico. Este artículo presenta el caso de un paciente de 62 años con asma intrínseca severa desde los 18 años de edad. Los estudios que se practicaron sugirieron la presencia de un factor reumatoide severo, que sirvió para diagnosticar un padecimiento autoinmune. La Homeopatía, como puede apreciarse a lo largo del trabajo, fue determinante para el control de la patología.

[Use of PCR for TB bacteria on BAL in early diagnosis of tubercular lobitis]. / PCR per BK su BAL nella diagnostica precoce di lobite tubercolare.

In June 2008 a 23-year-old immunocompetent came to our observation, without fever and with an occasional cough for 2 months, who showed two chest X-rays and a CT, performed respectively 60, 40 and 20 days earlier, that pointed to a small lobitis at the right lung base. The patient had already undergone several antibiotic therapies that had not changed the X-graphic framework. On presentation, routine blood tests and cultural examinations of sputum were carried out to detect common germs, fungi and TB bacteria (microscopic observation, cultivation and PCR), and a new antibiotic therapy (piperacillin/tazobactam) was started. Since the radiological picture appeared unchanged after 10 days of therapy and the examinations (microscopic observation and PCR) were negative, bronchoscopy with bacteriological evaluation of BAL was performed, which was positive to Mycobacterium tuberculosis, and then tubercular lobitis was diagnosed. Therefore a specific therapy - rifampin (RMP), isoniazid (INH), etambutol (EMB), pyrazinamid (PZA) - was started and changed after 10 days due to the growth of mycobacteria resistant to INH and EMB on examination of sputum. Consequently, the early use of PCR on BAL allows, in skilled hands, small aspecific lobitis to be diagnosed more rapidly than using cultural examination of sputum.

[Sexual exposure to HIV, sexual behaviour and use of pharmacological post-exposure prophylaxis (PEP)]. / Esposizione sessuale al virus HIV, comportamenti sessuali ed utilizzo della profilassi farmacologica post- esposizione (PEP).

In this study we examined the characteristics of 60 subjects (49 M and 11 F, average age 32.3) out of 195 post-exposure pharmacological prophylaxis (PEP) to HIV, taken in our hospital from 2001 to 2008. The above-mentioned subjects are sexually exposed (or presumably exposed) to HIV. We considered both their sexual intercourse behaviour and protective measures, and sought to infer some trends in sexual behaviour in Italy. All the subjects were monitored until 180 days after exposure, as established by the national guidelines. Only one of the 60 people presented a seroconversion (he dropped out after a 15-day follow-up and after an inadequate 19-day prophylaxis). Another subject, a homosexual male, never previously tested, resulted positive at time 0 both for HIV-Ab and syphilis tests (due to previous risk-sexual exposure), which caused the suspension of the prophylaxis. No HBV, HCV or syphilis seroconversion occurred. Two other homosexual males showed a previously latent positivity to syphilis tests at time 0.