RESUMEN
Lupus nephritis is one of the most serious and frequent manifestations of systemic lupus erythematosus. It usually presents in the first years of the disease, which suspicion should be raised in cases of elevated serum creatinine, presence of proteinuria above 500 mg/day or active urinary sediment, in the absence of other apparent causes such as urinary tract infection and use of nephrotoxic drugs. In most cases, it affects the glomerulus, and its presentation is rare in the form of isolated tubulo-interstitial disease. In this report, we describe a case of lupus nephritis diagnosed after 2 years of illness, in the form of atypical isolated tubular disease, characterized by massive deposits in the tubular basement membrane. Clinically, there were altered renal function, subnephrotic proteinuria, and evolution to a complete clinical response after immunosuppressive treatment.
RESUMEN
Fever of undetermined origin (FUO) is a challenging entity with a striking presence in hospitals around the world and can be associated with a myriad of differential diagnoses. It is defined as axillary temperature ≥ 37.8 ° C on several occasions, lasting ≥ three weeks, in the absence of diagnosis after three days of hospital investigation or three outpatient visits. The main etiologies are: infectious, neoplastic, and rheumatic. The diagnosis is based on the detailed clinical history and physical examination of these patients, in order to direct the specific complementary tests to be performed in each case. Empirical therapy is not recommended (with few exceptions) in patients with prolonged fever, as it may disguise and delay the diagnosis and conduct to treat the specific etiology. The prognosis encompasses mortality of 12% - 35%, varying according to the underlying etiology. In this sense, the objective of this study is to review the main topics about fever of undetermined origin, bringing historical and scientific aspects, national and international.
Asunto(s)
Fiebre de Origen Desconocido/diagnóstico , Fiebre de Origen Desconocido/etiología , Diagnóstico Diferencial , Humanos , Examen Físico , PronósticoRESUMEN
Fever of undetermined origin (FUO) is a challenging entity with a striking presence in hospitals around the world. It is defined as temperature ≥ 37.8 ° C on several occasions, lasting ≥ three weeks, in the absence of diagnosis after three days of hospital investigation or 3 outpatient visits. The main etiologies are infectious, neoplastic, and non-infectious inflammatory diseases. The diagnosis is based on the detailed clinical history and physical examination of these patients, in order to direct the specific complementary tests to be performed in each case. The initial diagnostic approach of the FUO patient should include non-specific complementary exams. Empirical therapy is not recommended (with few exceptions) in patients with prolonged fever, as it may disguise and delay the diagnosis and conduct to treat the specific etiology. The prognosis encompasses mortality of 12-35%, varying according to the baseline etiology.
Asunto(s)
Fiebre de Origen Desconocido/diagnóstico , Fiebre de Origen Desconocido/etiología , Infección Hospitalaria , Femenino , Humanos , Infecciones/complicaciones , Inflamación/complicaciones , Masculino , Neoplasias/complicaciones , NeutropeniaRESUMEN
RESUMO: Lúpus eritematoso sistêmico é uma doença de origem autoimune que apresenta um amplo espectro de manifestações clínicas causadas pelo estado inflamatório crônico. A associação com a síndrome do anticorpo antifosfolípide ocorre em aproximadamente 36% dos pacientes lúpicos. Nesses pacientes, a doença de base e o uso crônico de corticosteroides contribuem para aterosclerose acelerada, uma complicação que agrega risco cardiovascular. Relatamos um caso de acidente vascular encefálico em paciente de 25 anos portadora de lúpus eritematoso sistêmico e síndrome do anticorpo antifosfolípide. (AU)
ABSTRACT: Systemic lupus erythematosus is an autoimmune disease that presents a wide spectrum of clinical manifestations caused by the chronic inflammatory state. Association with antiphospholipid antibody syndrome occurs in approximately 36% of lupus patients. In these patients, the underlying disease and the chronic use of corticosteroids contribute to accelerated atherosclerosis, a complication that adds increased cardiovascular risk. We report a case of stroke in a 25-year-old patient with systemic lupus erythematosus and antiphospholipid antibody syndrome. (AU)
Asunto(s)
Humanos , Femenino , Adulto , Síndrome Antifosfolípido , Accidente Cerebrovascular , Factores de Riesgo de Enfermedad Cardiaca , Lupus Eritematoso SistémicoRESUMEN
Introdução: Granulomatose com poliangiite (GPA) é uma vasculite granulomatosa necrosante pauci-imune que afeta predominantemente pequenos vasos. É uma doença rara, de etiologia multifatorial, e constitui importante diagnóstico diferencial das síndromes pulmão-rim. Objetivo: atualizar os principais tópicos acerca da granulomatose com poliangiite, além de trazer perspectivas futuras e avanços no manejo clínico dessa vasculite. Metodologia: revisão de literatura realizada em 2018 a partir das publicações dos últimos 5 anos nas base de dados do PubMed Central® e da SciELO®. Resultados: 29 referências bibliográficas selecionadas, das quais: 16 revisões de leteratura; 2 revisões sistemáticas; 1 estudo transversal; 2 estudos caso-controle; 6 coortes; 2 consensos atualizados (1 brasileiro de 2017 e 1 internacional de 2017). Conclusão: a granulomatose com poliangiite é uma entidade de elevada morbimortalidade, e teve seu algoritmo de tratamento recentemente atualizado, conforme abordado nesta revisão. Novos estudos ainda em estão em andamento para avaliar a eficácia e segurança de novas abordagens terapêuticas.
Introduction: Granulomatosis with polyangiitis (GPA) is a pauci-immune necrotizing granulomatous vasculitis that affects predominantly small vessels. It is a rare disease with a multifactorial etiology and an important differential diagnosis of Pulmonary-renal syndromes. Objective: to update the main topics about granulomatosis with polyangiitis, in addition to bringing future perspectives and advances in the clinical management of this vasculitis. Methodology: literature review conducted in 2018 from the publications of the last 5 years in PubMed Central® and SciELO® databases. Results: 29 selected bibliographical references, of which: 16 literature reviews; 2 systematic reviews; 1 cross-sectional study; 2 case-control studies; 6 cohorts; 2 updated consensuses (1 Brazilian, 2017 and 1 international, 2017). Conclusion: granulomatosis with polyangiitis is an entity with high morbidity and mortality, and its treatment algorithm has recently been updated, as discussed in this review. Further studies are underway to evaluate the efficacy and safety of novel therapeutic approaches.
Asunto(s)
Granulomatosis con Poliangitis/diagnóstico , Granulomatosis con Poliangitis/terapia , Anticuerpos Anticitoplasma de Neutrófilos , Vasculitis Asociada a Anticuerpos Citoplasmáticos AntineutrófilosRESUMEN
SUMMARY Fever of undetermined origin (FUO) is a challenging entity with a striking presence in hospitals around the world and can be associated with a myriad of differential diagnoses. It is defined as axillary temperature ≥ 37.8 ° C on several occasions, lasting ≥ three weeks, in the absence of diagnosis after three days of hospital investigation or three outpatient visits. The main etiologies are: infectious, neoplastic, and rheumatic. The diagnosis is based on the detailed clinical history and physical examination of these patients, in order to direct the specific complementary tests to be performed in each case. Empirical therapy is not recommended (with few exceptions) in patients with prolonged fever, as it may disguise and delay the diagnosis and conduct to treat the specific etiology. The prognosis encompasses mortality of 12% - 35%, varying according to the underlying etiology. In this sense, the objective of this study is to review the main topics about fever of undetermined origin, bringing historical and scientific aspects, national and international.
RESUMO Febre de origem indeterminada (FOI) é uma entidade desafiadora com presença marcante nos hospitais de todo o mundo, à qual uma miríade de diagnósticos diferenciais podem estar associados. É definida como temperatura axilar ≥37,8 0 C em várias ocasiões, com duração ≥ três semanas, na ausência de diagnóstico após três dias de investigação hospitalar ou três consultas ambulatoriais. As principais etiologias são de ordem infecciosa, neoplásica e reumatológica. O diagnóstico é baseado na história clínica e no exame físico minuciosos desses pacientes, com a finalidade de direcionar os exames complementares específicos a serem realizados em cada caso. A terapia empírica não é recomendada (com poucas exceções) em pacientes com febre prolongada, uma vez que ela pode camuflar e retardar o diagnóstico e a conduta para tratar a etiologia específica. O prognóstico engloba uma mortalidade de 12-35%, variando de acordo com a etiologia de base. O objetivo deste estudo é revisar os principais tópicos acerca da febre de origem indeterminada, trazendo aspectos históricos e científicos, nacionais e internacionais.
Asunto(s)
Humanos , Fiebre de Origen Desconocido/diagnóstico , Fiebre de Origen Desconocido/etiología , Examen Físico , Pronóstico , Diagnóstico DiferencialRESUMEN
SUMMARY Fever of undetermined origin (FUO) is a challenging entity with a striking presence in hospitals around the world. It is defined as temperature ≥ 37.8 ° C on several occasions, lasting ≥ three weeks, in the absence of diagnosis after three days of hospital investigation or 3 outpatient visits. The main etiologies are infectious, neoplastic, and non-infectious inflammatory diseases. The diagnosis is based on the detailed clinical history and physical examination of these patients, in order to direct the specific complementary tests to be performed in each case. The initial diagnostic approach of the FUO patient should include non-specific complementary exams. Empirical therapy is not recommended (with few exceptions) in patients with prolonged fever, as it may disguise and delay the diagnosis and conduct to treat the specific etiology. The prognosis encompasses mortality of 12-35%, varying according to the baseline etiology.
RESUMO Febre de origem indeterminada (FOI) é uma entidade desafiadora com presença marcante nos hospitais de todo o mundo. É definida como temperatura ≥37,8 ° C em várias ocasiões, com duração ≥3 semanas, na ausência de diagnóstico após três dias de investigação hospitalar ou três consultas ambulatoriais. As principais etiologias são de ordem infecciosa, neoplásica e doenças inflamatórias não infecciosas. O diagnóstico é baseado na história clínica e no exame físico minuciosos desses pacientes, com a finalidade de direcionar os exames complementares específicos a serem realizados em cada caso. A abordagem diagnóstica inicial do paciente com FOI deve incluir exames complementares inespecíficos. A terapia empírica não é recomendada (com poucas exceções) em pacientes com febre prolongada, uma vez que ela pode camuflar e retardar o diagnóstico e a conduta para tratar a etiologia específica. O prognóstico engloba uma mortalidade de 12-35%, variando de acordo com a etiologia de base.