Epididymitis following Cytoreductive Surgery with Intraperitoneal Oxaliplatin Chemotherapy: Two Case Reports.

Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy has emerged as an aggressive treatment option with intent to either cure or extend disease-free survival of selected patients with peritoneal carcinomatosis. However, postoperative complications are common. We describe the cases of 2 men who underwent CRS with hyperthermic intraperitoneal oxaliplatin and developed scrotal pain, which was consistent with noninfectious epididymitis.

Regulation of inflammatory chemokine receptors on blood T cells associated to the circulating versus liver chemokines in dengue fever.

Little is known about the role of chemokines/chemokines receptors on T cells in natural DENV infection. Patients from DENV-2 and -3- outbreaks were studied prospectively during the acute or convalescent phases. Expression of chemokine receptor and activation markers on lymphocyte subpopulations were determined by flow cytometry analysis, plasma chemokine ligands concentrations were measured by ELISA and quantification of CCL5/RANTES(+) cells in liver tissues from fatal dengue cases was performed by immunochemistry. In the acute DENV-infection, T-helper/T-cytotoxic type-1 cell (Th1/Tc1)-related CCR5 is significantly higher expressed on both CD4 and CD8 T cells. The Th1-related CXCR3 is up-regulated among CD4 T cells and Tc2-related CCR4 is up-regulated among CD8 T cells. In the convalescent phase, all chemokine receptor or chemokine ligand expression tends to reestablish control healthy levels. Increased CCL2/MCP-1 and CCL4/MIP-1ß but decreased CCL5/RANTES levels were observed in DENV-patients during acute infection. Moreover, we showed an increased CD107a expression on CCR5 or CXCR3-expressing T cells and higher expression of CD29, CD44(HIGH) and CD127(LOW) markers on CCR4-expressing CD8 T cells in DENV-patients when compared to controls. Finally, liver from dengue fatal patients showed increased number of cells expressing CCL5/RANTES in three out of four cases compared to three death from a non-dengue patient. In conclusion, both Th1-related CCR5 and CXCR3 among CD4 T cells have a potential ability to exert cytotoxicity function. Moreover, Tc1-related CCR5 and Tc2-related CCR4 among CD8 T cells have a potential ability to exert effector function and migration based on cell markers evaluated. The CCR5 expression would be promoting an enhanced T cell recruitment into liver, a hypothesis that is corroborated by the CCL5/RANTES increase detected in hepatic tissue from dengue fatal cases. The balance between protective and pathogenic immune response mediated by chemokines during dengue fever will be discussed.

Polineuroradiculopatia por citomegalovírus em paciente imunocompetente: relato de caso / Cytomegalovirus is polyradiculoneuropathy in an immunocompetent patient: case report

JUSTIFICATIVA E OBJETIVOS: A citomegalovirose é uma infecção causada pelo citomegalovírus (CMV) e, quando manifestada clinicamente, produz sintomas leves em indivíduos imunocompetentes.As complicações durante o curso da infecção estão geralmente relacionadas a situações de imunodeficiência. O objetivo deste estudo foi relatar um caso raro de polirradiculoneuropatia por CMV em adolescente previamente hígida sem relação com imunodeficiência. RELATO DO CASO: Paciente do sexo feminino, 13 anos, imunocompetente,apresentou quadro inicial de cefaleia, febre, mialgia e artralgia, evoluindo com queixa de mialgia cervical, parestesia de mãos e pés e fraqueza muscular que dificultava a deambulação. A eletroneuromiografia evidenciou sinais compatíveis com miopatia neurogênica, sugerindo um quadro de polirradiculoneuropatia desmielinizante.Foram realizadas sorologias para CMV, confirmando o diagnóstico etiológico. CONCLUSÃO: A polirradiculoneuropatia por CMV não associada à síndrome da imunodeficiência adquirida (SIDA) ou outras imunodeficiências é uma complicação esperada, porém rara da infecção por este vírus, não necessitando de nenhum tratamento específico à medida que o acometimento neurológico seja autolimitado. O acompanhamento clínico rigoroso se faz necessário, já que se trata de uma entidade de evolução imprevisível, dependente da resposta imunológica de cada hospedeiro.

BACKGROUND AND OBJECTIVES: Cytomegalovirus (CMV) infection is caused by CMV and when manifested clinically produces mild symptoms in immunocompetent individuals. Complications during the course of infection are usually related to situations of immunodeficiency. The aim of this study was to report a rare case of CMV polyradiculoneuropathy in previously healthy teen ager with no relation to immunodeficiency. CASE REPORT: Female patient, 13 years old, immunocompetent,presented the initial headache, fever, myalgia and arthralgia, myalgia progressing with complaints of neck, numbness of hands and feet,and muscle weakness that impair ambulation. Electromyography showed signs compatible with neurogenic myopathy, suggesting a picture of demyelinating polyradiculoneuropathy. CMV serology was performed, confirming the diagnosis. CONCLUSION: The cytomegalovirus' polyradiculoneuropathy not associated with acquired immunodeficiency syndrome (AIDS) or other immunodeficiency's is an expected complication but rare infection by this virus does not require any specific treatment as the neurological involvement is self-limited. The strict clinical monitoring is necessary, since it is an entity of unforeseeable change, dependent on the immune response of each host.