Tuberculosis: Cliché or Outsider?

Tuberculosis is an infectious disease with the potential for multisystemic dissemination, including the central nervous system (CNS). It is difficult to diagnose when the central nervous system is involved. Brain biopsy is the diagnostic method par excellence for diagnostic confirmation; however, as it is an invasive method and therefore not free from risks, before carrying it out, extra-CNS sites should be privileged, whenever available, through mycobacteriological culture. Here, we present a case of a 34-year-old female with chronic onset of neurologic semiology, whose diagnostic evolution culminated in the diagnosis of cerebral tuberculomas and miliary tuberculosis. Rapid commencement of antibacillaty therapy led to the resolution of the neurologic deficits. Although we face a cliché clinical presentation, in the sense that is very common, the authors consider it outsider because such a presentation is rarely seen in Portugal.

Lofgren Syndrome: Achieving an Accurate Diagnosis for Improved Patient Care.

Lofgren syndrome is a clinically distinct phenotype of sarcoidosis. It is characterized by the triad of bilateral hilar lymphadenopathy, arthritis (usually the ankles), and fever. We present the case of a 31-year-old male patient who presented with fever and edema in both lower limbs, with palpation of subcutaneous nodules. A chest contrast-enhanced computerized axial tomography (CECT) scan revealed perihilar and mediastinal lymphadenopathy. In making the diagnosis, tuberculosis and lymphoma were both ruled out. A mediastinoscopy confirmed Lofgren syndrome. In medicine, a good differential diagnosis is important, as it will help inform the best treatment for the patient.

Arrhythmogenic Cardiomyopathy as a Late Complication of COVID-19-Induced Myocarditis.

COVID-19 has become a global health problem. So far, more than 281 million COVID-19 cases have been confirmed. The vast majority of patients diagnosed with COVID-19 infection present only with respiratory signs and symptoms. A small amount of patients, however, show signs and symptoms of cardiovascular involvement like a myocardial injury. Myocarditis is one of the possible complications, and cases of clinically suspected myocarditis have been reported in the setting of COVID-19. Herein, we present a case of inflammatory cardiomyopathy, a different type of arrhythmogenic cardiomyopathy, in a 32-year-old man, 40 days after being diagnosed with COVID-19.

Primary Sternal Osteomyelitis Caused by Methicillin-Sensitive Staphylococcus aureus: A Diagnosis Rare in Healthy Adults.

Primary sternal osteomyelitis (PSO) is a rare clinical entity, and usually, it is associated with predisposing factors such as intravenous drug use, diabetes mellitus, or human deficiency virus infection. In an otherwise healthy adult, it becomes an even rarer entity. Early diagnosis and treatment minimize associated morbidity, like the need for surgical debridement, longer courses of medication, and length of in-hospital stay. We describe the case of a 54-year-old man without any predisposing risk factors for PSO, who presented with chest pain, erythema, tenderness, and warmth at the right parasternal region. A non-enhanced thoracic tomography showed a 33 mm suspicious pulmonary nodule and no signs of sternum abnormalities. To better evaluate this finding, a positron emission tomography with fluorine-18 fluorodeoxyglucose was performed, showing abnormal uptake of the radionuclide at the sternomanubrial synchondrosis and no abnormal uptake at the lung parenchyma. The presence of Staphylococcus aureus in blood cultures, in conjunction with these results, supported the diagnosis of PSO. The patient completed six weeks of microbiologically oriented antibacterial therapy with complete recovery.

Elementos estructurales del trauma psíquico en víctimas de sismos / Structural elements of psycohological trauma in victms of earthquakes

El estudio de las respuestas de la autoconciencia ante situaciones extremas podría abrir vías para detectar los elementos más vulnerables al impacto psíquico como también los más estables; la relación ante la traumatización psíquica y el desarrollo ontogénico; la predisposición de la conciencia para que se produzca el trauma; la correlación entre las tendencias entrópicas negativas en el sistema vivencial; las vías y medios para "eliminar en forma espontánea" el trauma psíquico; la forma más adeucada para movilizar los mecanismos sanógenos durante el tratamiento y otros aspectos de sumo interés no sólo para la psicoterapia sin también para la comprensión misma del hombre, aspectos a los cuales ni las investigaciones fisilógicas sobre el estrés y disestrés, ni las concepciones psiquiátricas tradicionales han podido dar una respuesta exhaustiva