RESUMO
A case of progressive multifocal leukoencephalopathy (PML) is described in an HIV-negative patient with mixed connective-tissue disease (MCTD) on a minimally immunosuppressive treatment with hydroxychloroquine. The patient presented with right-sided weakness, episodes of disorientation and loss of short-term memory and of vision in her right eye. PML was diagnosed by JCV DNA on cerebrospinal fluid and radiological criteria. She was treated with off-label maraviroc and mirtazapine but died two months after hospital admission, despite a surprising decrease in the viral load of cerebrospinal fluid three weeks after starting therapy. Prompt diagnosis and antiviral treatment of PML even in low-risk patients are warranted. Future studies are required to define the therapeutic role of maraviroc (MVC) and mirtazapine in this setting.
Assuntos
Antagonistas dos Receptores CCR5/administração & dosagem , Leucoencefalopatia Multifocal Progressiva/tratamento farmacológico , Maraviroc/administração & dosagem , Mirtazapina/administração & dosagem , Quimioterapia Combinada , Feminino , Soronegatividade para HIV , Humanos , Pessoa de Meia-IdadeAssuntos
Pseudo-Obstrução Intestinal/etiologia , Encefalomiopatias Mitocondriais/diagnóstico , Encefalomiopatias Mitocondriais/fisiopatologia , Dor Abdominal/etiologia , Adulto , Fezes/microbiologia , Feminino , Humanos , Pseudo-Obstrução Intestinal/diagnóstico , Pseudo-Obstrução Intestinal/fisiopatologia , Síndromes de Malabsorção/etiologia , Distrofia Muscular Oculofaríngea , Oftalmoplegia/congênito , Tomografia Computadorizada por Raios X/métodos , Vômito/etiologia , Redução de PesoRESUMO
Malignant fibrous histiocytoma (MFH) is a pleomorphic sarcoma, occurring most frequently in the deep soft tissues of the extremities, and it is most frequently seen in elderly patients. A primary MFH of the diaphragm is very rare, and to the best of our knowledge, a multi-phased spiral CT appearance of this tumour has not been previously reported. In this report, we describe the clinical and multi-phase CT features of a primary MFH of the diaphragm.
