RESUMO
OBJECTIVES: To describe a case of joint infection by Aspergillus fumigatus in a unusual site (sacroiliac) and perform a systematic review of such cases described in the literature. METHODS: We performed a Medline search of the cases of fungal joint of Aspergillus fumigatus in the period ranging from 1970 to 2009. RESULTS: Following PRISMA Guidelines, 15 cases including ours were reported during this period. Stem cell and solid organ transplantation, hematologic malignancy, and intra-articular steroids injection were the medical conditions found in such patients. The knee followed by the shoulder were the joints more affected. In the cases where synovial fluid analyses were reported, elevated cell count numbers could be found with a predominance of polymorphonuclear neutrophils. CONCLUSIONS: Fungal joint arthritis is a rare clinical disease most frequently present in immuno-incompetent patients. Rheumatologists should be aware of this condition, where early diagnosis can be associated with good prognosis.
Assuntos
Artrite Infecciosa/patologia , Aspergilose/patologia , Aspergillus fumigatus/isolamento & purificação , Articulação Sacroilíaca/patologia , Antifúngicos/uso terapêutico , Artrite Infecciosa/microbiologia , Artrite Infecciosa/terapia , Aspergilose/complicações , Aspergilose/terapia , Aspergillus fumigatus/fisiologia , Caspofungina , Terapia Combinada , Drenagem , Equinocandinas/uso terapêutico , Feminino , Humanos , Hospedeiro Imunocomprometido , Lipopeptídeos , Pessoa de Meia-Idade , Pirimidinas/uso terapêutico , Articulação Sacroilíaca/microbiologia , Resultado do Tratamento , Triazóis/uso terapêutico , VoriconazolRESUMO
Autologous stem cell transplant is one of the therapies employed in the treatment of primary amyloidosis or AL. The authors report on a 46-year-old patient with bilateral periorbital hematomas, macroglossia who presented, during the investigation, IgG-Kappa paraprotein in serum. The diagnosis of primary amyloidosis or AL was confirmed and the treatment proposed consisted of high-dose melphalan as conditioning regimen before autologous stem cell transplant, which determined complete remission of the disease, along with the disappearance of clinical signs and absence of the monoclonal component.
Assuntos
Amiloidose , Transplante de Células-Tronco , Amiloidose/cirurgia , Humanos , Amiloidose de Cadeia Leve de Imunoglobulina , Masculino , Pessoa de Meia-Idade , Indução de RemissãoRESUMO
Transplante autólogo de células tronco é uma das formas de tratamento da amiloidose primária ou AL. Os autores relatam um paciente de 46 anos com hematomas periorbitais bilaterais, macroglossia, em quem, na investigação, se constatou a presença de paraproteínas IgG Kappa no soro. O diagnóstico de amiloidose primária ou AL foi confirmado, e o tratamento proposto com condicionamento com doses altas de Melfalan, seguido de transplante autólogo de células tronco, determinou a remissão completa da doença com desaparecimento de sinais clínicos e ausência do componente monoclonal.
Autologous stem cell transplant is one of the therapies employed in the treatment of primary amyloidosis or AL. The authors report on a 46-year-old patient with bilateral periorbital hematomas, macroglossia who presented, during the investigation, IgG-Kappa paraprotein in serum. The diagnosis of primary amyloidosis or AL was confirmed and the treatment proposed consisted of high-dose melphalan as conditioning regimen before autologous stem cell transplant, which determined complete remission of the disease, along with the disappearance of clinical signs and absence of the monoclonal component.