[Reactive hemophagocytic syndrome: analysis of a series of 7 cases]. / Síndrome hemofagocítico reactivo: análisis de una serie de siete casos.

We report a series of seven patients with reactive hemophagocytic syndrome, which was quite characteristic of its etiological spectrum. Infections were the leading cause, among them a case associated with HIV and another one with Salmonella enteritidis (a hitherto unreported association). The clinical findings consisted of fever, hepatomegaly, splenomegaly, lymphadenopathy, rash and pancytopenia. The diagnosis was carried out by bone marrow aspiration-biopsy except in two patients who were diagnosed at autopsy. The difficulty of the differentiation from malignant histiocytosis is discussed: one case of hemophagocytic syndrome due to diphenylhydantoin toxicity (the second reported one in the literature) was histologically undistinguishable from it. We think that, in any etiology, hemophagocytic syndrome is a reactive syndrome with variable intensity. The need for extensive microbiological investigation even in cases of histiocytosis of neoplastic appearance is emphasized.

Phenytoin-induced hemocytophagic histiocytosis indistinguishable from malignant histiocytosis.

We have reported a case of phenytoin-induced hemocytophagic histiocytosis indistinguishable on clinical and histopathologic grounds from malignant histiocytosis. We emphasize the need to investigate for microbiologic causes and drug ingestion, even if the diagnosis of malignant histiocytosis is plausible. We think that reactive and malignant histiocytosis are not really two distinct entities with different etiologies, but a continuum of host responses to several insults with different degrees of aggressiveness depending on the host immune status.

[Multicenter study of tuberculosis in clinical autopsies in Andalucia, in the 1973-1988 period]. / Estudio multicéntrico de la tuberculosis en autopsias clínicas en Andalucía, en el período 1973-88.

We revised 6,863 protocols of clinical autopsies in four hospitals of the Andalusian Health Service, from 1973 to 1988, out of which 2,814 were valid, and finding 81 active tuberculosis cases (TBC) (2.87%), in 53 males and 28 females, with mean age of 54.41 years. Milliar forms (44 cases) predominated over non-milliar (37), with a premortem diagnosis in 32 cases. TBC was considered as the principal disease in 65.43%, it directed contributed to death in 59.26% of cases, and was associated to other diseases in 79.01% of cases. The most frequent localizations were lung (80.25%), lymph nodes (43.20%) and liver (37.04%). We compared two similar periods of time: 1978-80 and 1986-88, observing an increase in TBC in the latter, 14:22, which can be attributed to HIV infection, since 6 of the 22 cases were associated to this pathology.