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4.
Sultan Qaboos Univ Med J ; 23(2): 256-258, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-37377818

RESUMO

Primary systemic vasculitis can present with a wide spectrum of manifestations ranging from systemic non-specific features such as fever, malaise, arthralgia and myalgia to specific organ damage. We describe two cases of cholesterol embolisation syndrome and Kaposi sarcoma mimicking primary systemic vasculitis, both of which were characterised by features such as livedo reticularis, blue toe syndrome, a brown purpuric skin rash and positive perinuclear anti-neutrophil cytoplasmic antibodies associated with Kaposi sarcoma. Establishing the right diagnosis was challenging and thus this report aimed to highlight the possible ways to distinguish them from primary systemic vasculitis.


Assuntos
Síndrome do Artelho Azul , Livedo Reticular , Sarcoma de Kaposi , Vasculite Sistêmica , Humanos , Síndrome do Artelho Azul/complicações , Sarcoma de Kaposi/diagnóstico , Sarcoma de Kaposi/complicações , Livedo Reticular/etiologia , Livedo Reticular/patologia , Vasculite Sistêmica/complicações
8.
Rev Med Interne ; 43(9): 562-565, 2022 Sep.
Artigo em Francês | MEDLINE | ID: mdl-35643784

RESUMO

INTRODUCTION: Cutaneous and vascular manifestations of cancer are numerous. Among paraneoplastic acral vascular syndrome, we report a case of blue toe syndrome as the first manifestation of a prostate cancer following with analysis of this syndrome according literature. OBSERVATION: A 56-year-old man, with Raynaud's phenomenon of the upper limbs for 2 to 3 years, had 4 blue toes of the left foot evolving for 18 months, without ulceration, the pulses being present. Vascular and cardiac explorations (ultrasound, angio-MRI) were normal. There was no biological or immunological abnormality except an elevated PSA level. Prostate biopsies confirmed diagnosis and abdomino-pelvic CT scan proved the bone and lymph node metastasis. CONCLUSION: The revelation of a prostate cancer with bone metastases by a blue toe syndrome is a rare situation. In a patient with a blue toe syndrome with no obvious clinical or biological abnormality, especially atheromatous, investigations should include a search for cancer, which can be revealed by blue toes.


Assuntos
Síndrome do Artelho Azul , Neoplasias Ósseas , Neoplasias da Próstata , Síndrome do Artelho Azul/diagnóstico , Síndrome do Artelho Azul/etiologia , Neoplasias Ósseas/complicações , Neoplasias Ósseas/diagnóstico , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/complicações , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/patologia , Tomografia Computadorizada por Raios X/efeitos adversos
10.
BMJ Case Rep ; 13(11)2020 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-33208309

RESUMO

Durvalumab is a selective, high-affinity human immunoglobulin monoclonal antibody in a class called check point inhibitors, that blocks PD-L1 on tumour cells. Despite clinical success in increasing progression-free survival rates in patients with stage III non-small-cell lung cancer, durvalumab has been associated with immune-related side effects such as pneumonitis and colitis. We present a case of an 84-year-old woman with acral vasculitis presenting as blue toe syndrome, associated with prolonged use of durvalumab. After 1 year of fortnightly durvalumab therapy postchemoradiation therapy, the patient came in with a left blue big toe, and later developed bilateral livedo racemosa. The diagnosis of durvalumab-associated vasculitis was made and treatment with prednisolone was started with clinical improvement.


Assuntos
Anticorpos Monoclonais/efeitos adversos , Antineoplásicos Imunológicos/efeitos adversos , Síndrome do Artelho Azul/induzido quimicamente , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Vasculite/induzido quimicamente , Idoso de 80 Anos ou mais , Anticorpos Monoclonais/uso terapêutico , Antineoplásicos Imunológicos/uso terapêutico , Síndrome do Artelho Azul/tratamento farmacológico , Síndrome do Artelho Azul/patologia , Carcinoma Pulmonar de Células não Pequenas/classificação , Feminino , Glucocorticoides/uso terapêutico , Humanos , Neoplasias Pulmonares/patologia , Prednisolona/uso terapêutico , Resultado do Tratamento , Vasculite/tratamento farmacológico
11.
J Am Podiatr Med Assoc ; 109(3): 235-240, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31268794

RESUMO

Antiphospholipid syndrome is an autoimmune disease characterized by vascular thrombosis involving both the arterial and venous systems that can lead to tissue ischemia or end-organ damage. Much of the literature describes various symptoms at initial presentation, but isolated tissue ischemia manifesting as a solitary blue toe is unusual. We discuss a case of a 23-year-old man who presented to the emergency department with a solitary blue fourth digit with minimal erythema and edema, who was suffering from exquisite pain. Following an extensive workup, the patient was diagnosed with antiphospholipid syndrome with thrombi of the vasculature in their lower extremity. With therapeutic anticoagulation, the patient's symptoms subsided and amputation of the digit was prevented.


Assuntos
Anticoagulantes/uso terapêutico , Síndrome Antifosfolipídica/diagnóstico , Síndrome do Artelho Azul/etiologia , Anticorpos Antifosfolipídeos/sangue , Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/tratamento farmacológico , Angiografia por Tomografia Computadorizada , Diagnóstico Diferencial , Enoxaparina/uso terapêutico , Pé/irrigação sanguínea , Pé/diagnóstico por imagem , Humanos , Masculino , Dor/etiologia , Artérias da Tíbia/diagnóstico por imagem , Dedos do Pé/irrigação sanguínea , Varfarina/uso terapêutico , Adulto Jovem
12.
Rev Port Cir Cardiotorac Vasc ; 25(1-2): 77-82, 2018.
Artigo em Português | MEDLINE | ID: mdl-30317716

RESUMO

Atheroembolism is a rare multisystemic disorder that is characterized by release of cholesterol crystals and particles from atheromatous plaques, which can occlude distal vessels and induce an inflammatory response. Most affected individuals are males, older than 60 years of age, with advanced atherosclerotic disease. The abdominal aorta is the most common origin of cholesterol emboli, being the peripheral arteries a rarer source. Cholesterol embolization syndrome is often associated with invasive vascular procedures, although, more rarely, it may occur spontaneously. In this paper, the authors present three cases of spontaneous atheroembolism with cutaneous manifestations and their clinical management. Being an underdiagnosed pathology, knowledge about its clinical manifestations is essential in order to allow an early diagnosis and treatment, to ensure a better prognosis for the patient.


O ateroembolismo é uma doença multissistémica rara caraterizada pela libertação de cristais de colesterol e partículas de placas ateroscleróticas, que podem ocluir vasos sanguíneos periféricos e induzir uma resposta inflamatória. A maioria dos indivíduos afetados é do sexo masculino, com idade superior a 60 anos e doença aterosclerótica avançada. A origem mais frequente de embolização de colesterol é a aorta abdominal, sendo as artérias periféricas uma fonte mais rara. A síndrome de embolização por colesterol surge frequentemente associada a procedimentos vasculares invasivos, embora, mais raramente, possa ocorrer de forma espontânea. Neste artigo os autores apresentam três casos clínicos de ateroembolismo espontâneo com envolvimento cutâneo e respetiva abordagem clínica. Sendo uma patologia subdiagnosticada, torna-se fundamental o conhecimento acerca das suas manifestações clínicas, para permitir um diagnóstico e tratamento precoces de forma a garantir um melhor prognóstico para o doente.


Assuntos
Doenças da Aorta/complicações , Aterosclerose/complicações , Embolia de Colesterol/etiologia , Aorta Abdominal , Síndrome do Artelho Azul/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Dermatopatias/etiologia
13.
Medicina (B Aires) ; 78(5): 368-371, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-30285931

RESUMO

Pheochromocytomas are tumors that arise from chromaffin cells of the sympathetic nervous system and act by synthesizing and releasing catecholamines. They usually occur between the fourth and fifth decade of life and have a very wide clinical presentation. They occur only in 0.1-0.2% of the hypertensive population and represent a treatable and curable cause of arterial hypertension, as well as other symptoms derived from the uncontrolled secretion of catecholamines. Peripheral arterial ischemia secondary to massive amines release by a pheochromocytoma is a very uncommon condition. Here we report a case of pheochromocytoma manifested as blue finger syndrome in a patient with palpable distal pulses and history of poor blood pressure control despite treatment with two drugs.


Assuntos
Neoplasias das Glândulas Suprarrenais/complicações , Síndrome do Artelho Azul/etiologia , Feocromocitoma/complicações , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/patologia , Síndrome do Artelho Azul/patologia , Angiografia por Tomografia Computadorizada/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Necrose , Feocromocitoma/diagnóstico por imagem , Feocromocitoma/patologia
16.
BMJ Case Rep ; 20182018 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-29305361

RESUMO

We describe an unusual case of blue toe syndrome as the primary and solitary manifestation of systemic sclerosis. The possible cause was long-term occupational exposure in construction work. Blue toe syndrome is a small vessel disease, characterised by the sudden development of painful, blue discolouration in one or more toes. The most common aetiology is atheroembolic disease; however, it can also appear in several conditions ranging from hypercoagulability disorders to underlying systemic diseases such as vasculitis or autoimmune diseases. Here, we describe the case of a 57-year-old man who presented with blue toe syndrome without underlying atheroembolic disease. He was found to have positive anticentromere antibodies, which indicated that systemic sclerosis was the likely primary underlying cause. An extensive systemic evaluation and a thorough physical examination revealed no other symptoms associated with systemic sclerosis. He was prescribed nifedipin and rosuvastatin, and showed complete resolution of symptoms after 3 months.


Assuntos
Síndrome do Artelho Azul/etiologia , Escleroderma Sistêmico/complicações , Humanos , Masculino , Pessoa de Meia-Idade
17.
Rev Med Interne ; 39(2): 127-129, 2018 Feb.
Artigo em Francês | MEDLINE | ID: mdl-29288001

RESUMO

INTRODUCTION: Arterial and venous thromboses occur in almost one in five patients with POEMS syndrome and usually in macrocirculation. CASE REPORT: We report a 67-year-old male with a POEMS syndrome who presented initially with a blue toe syndrome. He complained of Raynaud's syndrome and left foot paresthesia. Physical examination showed gynecomastia, lymphadenopathies and skin lesions. Cardiovascular investigations excluded atrial fibrillation, unstable atherosclerotic lesions and vascular calcifications. Imaging studies showed diffuse osteosclerotic lesions. Monoclonal protein with lambda light chain was discovered and serum level of VEGF was increased at 2900pg/ml. CONCLUSION: This is to our knowledge the first case of thrombotic microangiopathy in POEMS syndrome without embolic cause or calciphylaxis.


Assuntos
Síndrome do Artelho Azul/etiologia , Síndrome POEMS/complicações , Idoso , Antineoplásicos Alquilantes/uso terapêutico , Síndrome do Artelho Azul/diagnóstico , Síndrome do Artelho Azul/tratamento farmacológico , Dexametasona/uso terapêutico , Glucocorticoides/uso terapêutico , Humanos , Masculino , Melfalan/uso terapêutico , Síndrome POEMS/diagnóstico , Síndrome POEMS/tratamento farmacológico , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Fator A de Crescimento do Endotélio Vascular/sangue
20.
Folia Med (Plovdiv) ; 58(2): 77-88, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27552783

RESUMO

Micro- and macrovascular pathology is a frequent finding in a number of common rheumatic diseases. Secondary Raynaud's phenomenon (RP) is among the most common symptoms in systemic sclerosis and several other systemic autoimmune diseases including a broad differential diagnosis. It should be also differential from other peripheral vascular syndromes such as embolism, thrombosis, etc., some of which lead to clinical manifestation of the blue toe syndrome. The current review discusses the instrumental methods for vascular assessments. Nailfold capillaroscopy is the only method among the imaging techniques that can be used for morphological assessment of the nutritive capillaries in the nailfold area. Laser-Doppler flowmetry and laser-Doppler imaging are methods for functional assessment of microcirculation, while thermography and plethysmography reflect both blood flow in peripheral arteries and microcirculation. Doppler ultrasound and angiography visualize peripheral arteries. The choice of the appropriate instrumental method is guided by the clinical presentation. The main role of capillaroscopy is to provide differential diagnosis between primary and secondary RP. In rheumatology, capillaroscopic changes in systemic sclerosis have been recently defined as diagnostic. The appearance of abnormal capillaroscopic pattern inherits high positive predictive value for the development of a connective tissue disease that is higher than the predictive value of antinuclear antibodies. In cases of abrupt onset of peripheral ischaemia, clinical signs of critical ischaemia, unilateral or lower limb involvement, Doppler ultrasound and angiography are indicated. The most common causes for such clinical picture that may be referred to rheumatologic consultation are the antiphospholipid syndrome, mimickers of vasculitides such as atherosclerosis with cholesterol emboli, and neoplasms.


Assuntos
Síndrome Antifosfolipídica/diagnóstico por imagem , Doença Arterial Periférica/diagnóstico por imagem , Doenças Vasculares Periféricas/diagnóstico por imagem , Escleroderma Sistêmico/diagnóstico por imagem , Vasculite/diagnóstico por imagem , Angiografia , Síndrome do Artelho Azul/diagnóstico por imagem , Doenças do Tecido Conjuntivo/diagnóstico por imagem , Humanos , Fluxometria por Laser-Doppler , Angioscopia Microscópica , Pletismografia , Doença de Raynaud/diagnóstico por imagem , Reumatologia , Termografia , Ultrassonografia Doppler
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