RESUMO
Panton-Valentine leucocidin is a major virulence factor produced by some strains of Staphylococcus aureus (SA-PVL). The best-described invasive infection is a necrotizing haemorrhagic pneumonia. Pleural effusion is not uncommon but is always associated with a parenchymal lesion. Here, we report a case of haemorrhagic pleurisy attributable to isolated SA-PVL.
Assuntos
Toxinas Bacterianas/metabolismo , Exotoxinas/metabolismo , Hemorragia/diagnóstico , Leucocidinas/metabolismo , Pleurisia/diagnóstico , Infecções Respiratórias/diagnóstico , Infecções Estafilocócicas/diagnóstico , Staphylococcus aureus/isolamento & purificação , Adulto , Toxinas Bacterianas/toxicidade , Diagnóstico Diferencial , Exotoxinas/toxicidade , Feminino , Hemorragia/complicações , Hemorragia/microbiologia , Humanos , Leucocidinas/toxicidade , Pleurisia/complicações , Pleurisia/microbiologia , Pneumonia Estafilocócica/diagnóstico , Radiografia Torácica , Infecções Respiratórias/complicações , Infecções Respiratórias/microbiologia , Infecções Estafilocócicas/complicações , Staphylococcus aureus/metabolismo , Adulto JovemRESUMO
INTRODUCTION: In systemic lupus erythematosus, hemostasis disorders are mainly thrombotic, but more rarely hemorrhagic. CASE REPORT: A 25-year-old man presented with a macrophagic activation syndrome revealing a systemic lupus erythematosus, secondarily complicated by a hemorrhagic syndrome ; biological investigations revealed an increase thrombin time and an activated partial thromboplastin time, normalized by protamin neutralization in vitro, thus confirming the presence of a heparin-like anticoagulant. The hemostasis balance normalized after the specific treatment of lupus. CONCLUSION: This rare anomaly of hemostasis balance has been described in blood cancers and solid cancers. This is the first description of a case associated with an autoimmune connective tissue disorder such as lupus. After one year of follow-up, no diagnosis of blood or solid cancer was made.
Assuntos
Anticoagulantes/efeitos adversos , Autoanticorpos/efeitos adversos , Transtornos Hemorrágicos/diagnóstico , Lúpus Eritematoso Sistêmico/diagnóstico , Síndrome de Ativação Macrofágica/diagnóstico , Adulto , Anticoagulantes/sangue , Autoanticorpos/sangue , Diagnóstico Diferencial , Fator VIII/imunologia , Transtornos Hemorrágicos/sangue , Transtornos Hemorrágicos/etiologia , Heparina/análogos & derivados , Heparina/sangue , Humanos , Lúpus Eritematoso Sistêmico/sangue , Lúpus Eritematoso Sistêmico/complicações , Síndrome de Ativação Macrofágica/sangue , Síndrome de Ativação Macrofágica/complicações , MasculinoRESUMO
INTRODUCTION: Nocardiosis are uncommon. The diagnosis may be difficult, with significant morbidity and mortality, often occurring on frail patients. Few data are available in France. METHODS: A retrospective single center study was conducted from 2002 to 2014 and included all patients with at least one positive microbiological sample for Nocardia with a follow-up in our hospital. RESULTS: Nineteen patients, including 15 men, were included with a mean age of 58 years (25-85). Seventeen had a risk factor (lung diseases [13], corticosteroids [12], solid neoplasia [2], HIV infection [2], diabetes mellitus [3], kidney transplant [2], lymphopenia [1]). Infections' locations were: pulmonary (12), brain (3), skin (2), lymph node (1) and corneal (1). The slow growth leads to a median of 35 days for a positive result (3-95). Nine species were identified. Fifteen patients (79%) received one or more lines of antibiotics including: cotrimoxazole (9), amoxicillin (7) cefotaxime/ceftriaxone (7) imipenem (3), or amikacin (3). The average duration of antibiotic therapy was 207 days. Four patients did not receive antibiotics due to a late result or a bacterial co-infection masking nocardiosis. Five patients died (26%) including 2 with cerebral nocardiosis. Six patients were cured, 4 suffered a relapse, 4 had an unknown evolution, and 1 was still treated. CONCLUSION: Our study shows that nocardiosis is a disease difficult to treat. A better understanding of this type of infection is necessary.
Assuntos
Nocardiose , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Coinfecção , Feminino , França/epidemiologia , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Hospedeiro Imunocomprometido , Pneumopatias/complicações , Pneumopatias/tratamento farmacológico , Pneumopatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Nocardia/isolamento & purificação , Nocardiose/diagnóstico , Nocardiose/tratamento farmacológico , Nocardiose/epidemiologia , Nocardiose/microbiologia , Estudos Retrospectivos , Fatores de RiscoRESUMO
INTRODUCTION: The Doege-Potter syndrome is a rare paraneoplastic syndrome, first described by Doege and Potter in 1930, that usually involves solid fibrous pleural tumours. Hypoglycaemia is a rare complication of these tumours, due to secretion of insulin-like growth factors, and it can be the presenting symptom. The incidence of malignancy is low, about 12-15 %. CASE REPORT: An 81-year-old Caucasian man, operated on 20 years previously for a benign pleural fibroma, presented with several episodes of loss of consciousness due to profound hypoglycaemia and a history of increasing dyspnea. The chest X-ray revealed an intrathoracic mass. Following excision histological examination confirmed recurrence with malignant transformation to a high-grade sarcoma. CONCLUSION: The Doege-Potter syndrome is a rare condition but it should be suspected in episodes of hypoglycaemia associated with a history of dyspnea. These patients should be followed up postoperatively because of the risk of tumour recurrence.