RESUMEN
The relationship between primary hematologic disease and rheumatologic manifestations is well known, especially acute lymphocytic leukemia, lymphomas, plasma cell dyscrasias and myelodysplastic syndrome (MDS). Currently, more has been described about autoimmune manifestations in chronic myelomonocytic leukemia (CMML). Many different clinical scenarios may lead a patient with MDS/CMML initially to seek a rheumatological unit. Autoimmune features such as polymyalgia rheumatic symptoms, myositis, neutrophilic dermatosis, cutaneous vasculitis and positive antinuclear antibodies (ANA) are some examples of clinical presentation of MDS/CMML. Moreover, peripheral cytopenias are a common initial presentation both for systemic lupus erythematous (SLE) and MDS/CMML. The aim of this study was to describe a case of an elderly woman with thrombocytopenia and positivity of antibodies to anti-extractable nuclear antigens (anti-ENA) as initial manifestation of CMML mimicking SLE, and to present some clues that encourage the clinician to perform a bone marrow study in such a clinical scenario.
Asunto(s)
Anticuerpos Antinucleares/sangre , Leucemia Mielomonocítica Crónica/sangre , Lupus Eritematoso Sistémico/sangre , Trombocitopenia/sangre , Anciano de 80 o más Años , Antimetabolitos Antineoplásicos/uso terapéutico , Azacitidina/uso terapéutico , Biomarcadores/sangre , Examen de la Médula Ósea , Diagnóstico Diferencial , Femenino , Hemólisis , Humanos , Leucemia Mielomonocítica Crónica/diagnóstico , Leucemia Mielomonocítica Crónica/tratamiento farmacológico , Leucemia Mielomonocítica Crónica/inmunología , Lupus Eritematoso Sistémico/diagnóstico , Lupus Eritematoso Sistémico/inmunología , Valor Predictivo de las Pruebas , Trombocitopenia/diagnóstico , Trombocitopenia/inmunologíaRESUMEN
27 preschool children were observed naturally during classroom activities. Observations of behaviors of Social Interaction, Spatial Localization, and Posture categories were made under music (folk or rock and roll) and no music conditions. Music selections favored child-to-child social interaction.