Autoimmune hypothyroidism: might its presence be useful to support the diagnosis of sarcoidosis in a patient with acute symmetrical oligoarthritis?

Acute sarcoid arthritis may be present in isolation or as part of Löfgren's syndrome. Its true incidence is unclear since the diagnosis may be difficult when patients present with articular symptoms alone. The diagnosis of sarcoid arthritis is based upon suggestive clinical, imaging, synovial fluid findings, and in some cases upon synovial biopsy. The finding of sterile noncaseating granulomatous inflammation on biopsy is supportive, but it is not pathognomic of sarcoidosis. On the other hand, sarcoidosis has been associated with autoimmune diseases, especially with autoimmune thyroid disease. We believe that it might be of interest to evaluate thyroid function testing in patients with clinical features consistent with sarcoid arthritis, and the diagnosis of sarcoidosis should be considered in patients who present with symmetrical arthritis and thyroid autoimmune disease. We describe herein a patient with subclinical autoimmune hypothyroidism and an acute symmetrical oligoarthritis, with a clinical presentation and laboratory data consistent with acute sarcoid arthritis (Ref. 14).

[Spinal epidural abscess without spondylodiscitis. Description of four cases]. / Absceso epidural espinal sin espondilodiscitis. Descripción de cuatro casos.

We performed a retrospective study about patients diagnosed of spinal epidural abscess without concurrent spondylodiscitis, collected in the last five years in our hospital. We describe four patients, all of them males, with ages ranged from 59 to 67 years old. All patients presented fever, elevated phase reactants and spinal pain, with cord compression in three of them. Two patients had risk factors: diabetes mellitus and non-Hodgkin lymphoma. S. aureus was isolated in three patients, and S. agalactiae in the other one. The posterior epidural space was the most frequently affected, with variable location along the spinal cord. Three patients required surgical operation, and the other one was treated only with antibiotics. All patients demonstrated a complete clinical, analytical and radiological resolution.

[Primary biliary cirrhosis-autoimmune hepatitis overlap syndrome. Contribution of two new cases]. / Síndrome "overlap" hepatitis autoinmune-cirrosis biliar primaria. Aportación de dos nuevos casos.

The autoimmune hepatitis (AIH)-primary biliary cirrhosis (PBC) overlap syndrome is characterized for clinical, biochemical, immunological, and histological features overlapping those of AIH and PBC, whose pathogenesis and more appropriate treatment are unknown at present. We describe two new patients of this entity, which made debut with cholestasic acute hepatitis accompanied of hypergammaglobulinemia. In the first patient was demonstrated the presence of AMA, ASMA, and anti-LKM1 autoantibodies; and ANA in the second one. The histological findings showed changes suggestive of AIH and PBC. After the start of immunosuppressive treatment, associated to ursodeoxycholic acid in one patient, a successful outcome was observed.

Remission of HIV-associated myelopathy after highly active antiretroviral therapy.

HIV-associated myelopathy is the leading cause of spinal cord disease in HIV-infected patients. Typically, it affects individuals with low CD4 T cell counts, presenting with slowly progressive spastic paraparesis associated with dorsal column sensory loss as well as urinary disturbances. Other aetiologies must be first ruled out before establishing the diagnosis. We report here the case of a 37-year-old woman with advanced HIV disease, who developed HIV-associated myelopathy. The patient showed a gradual improvement after beginning with highly active antiretroviral therapy and, finally, she achieved a complete functional recovery. In addition, neuroimaging and neurophysiological tests normalized.