RESUMO
Behçet's disease is a vasculitis of unknown origine. Mucocutaneous manifestations are necessary for diagnosis. Ocular and neurological involvements can lead to severe impairment. Arterial involvement may be lethal. Treatment is only symptomatic using steroids, colchicine and antiaggregant therapy. Immunosuppressive drugs are generally given for severe manifestations resistant to conventional therapy. Alpha interferon and infliximab are interesting in case of failure or relapses despite treatment. As in all chronic diseases, education and good observance are needed to improve prognosis.
Assuntos
Síndrome de Behçet , Síndrome de Behçet/complicações , Síndrome de Behçet/diagnóstico , Síndrome de Behçet/tratamento farmacológico , HumanosRESUMO
Chondrocalcinosis, chronic pseudo-osteoarthritis arthropathy, and osteoporosis are classic osteoarticular complications of hemochromatosis (HC). Within HC, femoral head aseptic osteonecrosis (FHAO) is not notified in textbooks. We describe 3 cases of FHAO occurring in this setting in 3 patients homozygous for the C282Y mutation on HFE gene who had no other risk factors for FHAO. FHAO was diagnosed 9 years before (Case 1), concomitantly with (Case 3), or 9 years after HC (Case 2). In one case, FHAO occurred although phlebotomies were regularly carried out. There are scarce data available in the literature on HC and FHAO. Our observations suggest FHAO may be an indicator for HC, and iron balance should be determined before considering FHAO as idiopathic. Thus phlebotomy may not be protective against the occurrence of FHAO. Studies are needed to determine the prevalence of HC in consecutive patients with FHAO.
Assuntos
Necrose da Cabeça do Fêmur/complicações , Hemocromatose/complicações , Adulto , Feminino , Necrose da Cabeça do Fêmur/genética , Necrose da Cabeça do Fêmur/patologia , Predisposição Genética para Doença , Hemocromatose/genética , Hemocromatose/patologia , Proteína da Hemocromatose , Antígenos de Histocompatibilidade Classe I/genética , Homozigoto , Humanos , Imageamento por Ressonância Magnética , Masculino , Proteínas de Membrana/genética , Pessoa de Meia-Idade , MutaçãoRESUMO
INTRODUCTION: In patients with lupus, the most common acquired circulating anticoagulant is antiprothrombinase which is responsible for thrombosis. The presence of antibodies directed against factor VIII is rarely found in systemic lupus erythematosus. A case of acquired haemophilia in a patient with lupus is reported. CASE REPORT: A 30 year-old woman with systemic lupus erythematosus developed a right coxalgia and ecchymotic skin lesions which were prominent on the right arm and forearm. Laboratory values were as follows: positive antinuclear antibodies > 1: 2 560, anti-DNA antibodies (300 IU/ml), prolonged activated partial thromboplastin time, reduced factor VIII activity (1 p. 100) and the presence of antibodies against factor VIII. Magnetic nuclear resonance of the right hip confirmed the presence of an intramuscular hematoma. The patient was initially treated with intravenous pulse and oral corticosteroids, intravenous immunoglobulins and intravenous cyclophosphamide. Clinical and biological improvement was promptly obtained. DISCUSSION: In our patient with systemic lupus erythematosus, bleeding revealed acquired haemophilia with antibodies against factor VIII. It should be pointed out that the association between lupus and haemophilia is uncommon and that at present no standardized treatment can be recommended.
