RESUMO
BACKGROUND: Sarcoidosis is a multiorgan-system granulomatous disease causing respiratory complaints in most patients. Eye involvement, most commonly granulomatous uveitis, is seen in 5% of black patients with sarcoidosis. Neurosarcoidosis is also rare, affecting 5% of patients with sarcoidosis. Thoracoscopic lymph node biopsy in pregnancy has never before been reported. CASE: An otherwise-healthy, 25-year-old woman, gravida 2, para 1001, presented at 25 weeks' gestation with a painful facial palsy and visual defects. Ophthalmologic examination revealed uveitis, and a chest radiograph revealed asymmetric hilar adenopathy. At 28 weeks' gestation, the patient underwent thoracoscopic lymph node biopsy, which confirmed the diagnosis of sarcoidosis. The symptoms were stabilized with therapeutic corticosteroids, and the patient delivered a healthy neonate at term. CONCLUSION: The diagnosis of sarcoidosis remains one of exclusion and requires a high index of suspicion. Tissue confirmation is often necessary, especially when patients have extrathoracic complaints. For patients without other lesions amenable to biopsy, thoracoscopic lymph node biopsy can be considered despite pregnancy.
Assuntos
Linfonodos/patologia , Doenças do Sistema Nervoso/diagnóstico , Complicações na Gravidez/diagnóstico , Sarcoidose/diagnóstico , Biópsia , Diagnóstico Diferencial , Paralisia Facial/etiologia , Feminino , Humanos , Doenças do Sistema Nervoso/patologia , Gravidez , Complicações na Gravidez/patologia , Sarcoidose/patologia , Toracoscopia , Uveíte/etiologiaRESUMO
We present a case of vertebral osteomyelitis with an adjacent abdominal aortic mycotic aneurysm caused by a highly penicillin-resistant Streptococcus pneumoniae strain. The occurrence of all three phenomena in a single patient has not been previously described. This presentation offers the opportunity to reflect on the increasing incidence of S. pneumoniae as a resistant pathogen, the treatment of highly penicillin-resistant S. pneumoniae, and the etiologic agents of both vertebral osteomyelitis and mycotic aneurysm.
Assuntos
Aneurisma Infectado/microbiologia , Vértebras Lombares , Osteomielite/microbiologia , Resistência às Penicilinas , Infecções Pneumocócicas/microbiologia , Streptococcus pneumoniae/efeitos dos fármacos , Aneurisma da Aorta Abdominal/microbiologia , Feminino , Humanos , Pessoa de Meia-Idade , Infecções Pneumocócicas/patologiaRESUMO
Yersinia enterocolitica can cause enteritis, right lower-quadrant pain mimicking appendicitis, reactive arthritis, and erythema nodosum. This organism is transmitted through food, animal contact, and contaminated blood products. Patients with iron excess are at a higher risk for serious infection. This article describes the history, microbiology, virulence factors, epidemiology, clinical manifestations, diagnosis, and therapy of Y. enterocolitica and Y. pseudotuberculosis. In addition, the immune response of those developing reactive arthritis following infection with Y. enterocolitica is discussed.
