Case for diagnosis. Cutaneous small vessel vasculitis (anti-proteinase 3 positive), fever, hemoptysis, and lung cavitation in an adult.

Small vessel vasculitis with anti-proteinase antibodies 3 is an atypical clinical presentation of tuberculosis. The authors present the case of a 47-year-old male patient, with palpable purpura and palmoplantar hemorrhagic blisters, with subsequent dissemination. He presented severe pulmonary symptoms with cavitation, fever, hemoptysis, and high levels of anti-proteinase 3. Histopathological assessment of the skin revealed small vessel vasculitis; pulmonary histopathology showed granulomas with caseation. Bronchoalveolar lavage was positive for alcohol-acid-fast bacilli. In countries with a high prevalence of tuberculosis, the presence of autoantibodies in a patient with vasculitis, fever, and pulmonary cavitation requires investigation of infectious causes.

Escorbuto em paciente bariátrica com cardiopatia grave. Relato de caso / Scurvy in patient bariatric with severe heart disease. Case report

Contexto: Escorbuto tem sido identificado, modernamente, com certa frequência devido ao aumento de fatores de riscos como neoplasias, bypass gástrico, quadros infecciosos, uso crônico de diuréticos, doenças neuropsiquiátricas, alcoolismo, dieta inadequada e progressivo envelhecimento populacional, com mais idosos morando sozinhos. Relato de caso: Apresentamos o caso de paciente pós-bariátrica, sexo feminino, 43 anos, cardiopata grave sob longa internação em uso de altas doses de diuréticos e drogas vasoativas, que desenvolveu púrpuras e equimoses espontâneas nos membros inferiores e no abdome. O tratamento com vitamina C endovenosa levou à melhora clínica das lesões e da condição hemodinâmica em três semanas. Discussão: O escorbuto se manifesta de forma insidiosa e pouco específica em pacientes com comorbidades crônicas. Alterações hemorrágicas (petéquias, equimoses, sangramento gengival), edema articular, fadiga, anorexia, anemia, xerose, e susceptibilidade a infecções, devem levar à suspeita clínica em pacientes de risco. Conclusão: Os clínicos devem estar atentos ao diagnóstico do escorbuto moderno, especialmente, em pacientes bariátricos.

Case for diagnosis. Noninfectious suppurative panniculitis induced by mesotherapy with deoxycholate.

A 28-year-old white female patient presented with multiple erythematous-to-violaceous, painful, suppurative nodules on the buttocks and thighs that appeared after two weeks of mesotherapy with deoxycholate, caffeine, sunflower liposomes, and sinetrol for localized fat. She was treated for atypical mycobacteriosis, but with no satisfactory response after antibiotic therapy. Bacterial, mycobacterial, and fungal culture were all negative. Histopathologic examination of the biopsy showed noninfectious suppurative panniculitis. It resolved after treatment with methotrexate, prednisone, and hydroxychloroquine. This report highlights the rarity of this complication, the importance of its early recognition, and differentiation with atypical fast growing mycobacterioses.

Case for diagnosis. Noninfectious suppurative panniculitis induced by mesotherapy with deoxycholate

Abstract A 28-year-old white female patient presented with multiple erythematous-to-violaceous, painful, suppurative nodules on the buttocks and thighs that appeared after two weeks of mesotherapy with deoxycholate, caffeine, sunflower liposomes, and sinetrol for localized fat. She was treated for atypical mycobacteriosis, but with no satisfactory response after antibiotic therapy. Bacterial, mycobacterial, and fungal culture were all negative. Histopathologic examination of the biopsy showed noninfectious suppurative panniculitis. It resolved after treatment with methotrexate, prednisone, and hydroxychloroquine. This report highlights the rarity of this complication, the importance of its early recognition, and differentiation with atypical fast growing mycobacterioses.

ANALYSIS OF RISK FACTORS AND POSTOPERATIVE COMPLICATIONS IN PATIENTS WITH CROHN'S DISEASE.

BACKGROUND: The post-operative complications rate is greater in patients with Crohn's disease than in other abdominal surgeries due to other benign conditions. Prevention and management of such complications are important factors in the care of these patients. OBJECTIVE: The objectives of this research are to analyze the rate of postoperative complications and the major risk factors in patients with Crohn's disease. METHODS: A descriptive and retrospective study based on analysis of medical records of patients with Crohn's disease undergoing ileal and/or colonic resection, which analyzed the main surgical complications and their major risk factors. RESULTS: Forty-four surgical procedures and thirty-seven patients were analyzed. Most were female (56.7%). Postoperative complications were observed in 18 (40.9%) surgeries. The disease duration (P=0.04), the penetrating behavior (P=0.013), the time between diagnosis and the first surgery (P=0.04), malnutrition with low body mass index (BMI), duration of surgery (P=0.016), and the size of the removed specimen (P=0.014) were associated with higher rates of complications. The use of drugs blocking tumor necrosis factor up to eight weeks before surgery was not significantly associated with higher complications rates or increased need for reoperation. CONCLUSION: The complication rate observed in this study is similar to published data. The duration of the disease, the penetrating behavior, the size of the removed specimen, the duration of the surgery, and BMI are important risk factors for perioperative complications in Crohn's disease.

Análise dos fatores de risco e complicações pós-operatórias em pacientes portadores de doença de Crohn / Analysis of risk factors and postoperative complications in patients with crohn's disease

ABSTRACT BACKGROUND: The post-operative complications rate is greater in patients with Crohn's disease than in other abdominal surgeries due to other benign conditions. Prevention and management of such complications are important factors in the care of these patients. OBJECTIVE: The objectives of this research are to analyze the rate of postoperative complications and the major risk factors in patients with Crohn's disease. METHODS: A descriptive and retrospective study based on analysis of medical records of patients with Crohn's disease undergoing ileal and/or colonic resection, which analyzed the main surgical complications and their major risk factors. RESULTS: Forty-four surgical procedures and thirty-seven patients were analyzed. Most were female (56.7%). Postoperative complications were observed in 18 (40.9%) surgeries. The disease duration (P=0.04), the penetrating behavior (P=0.013), the time between diagnosis and the first surgery (P=0.04), malnutrition with low body mass index (BMI), duration of surgery (P=0.016), and the size of the removed specimen (P=0.014) were associated with higher rates of complications. The use of drugs blocking tumor necrosis factor up to eight weeks before surgery was not significantly associated with higher complications rates or increased need for reoperation. CONCLUSION: The complication rate observed in this study is similar to published data. The duration of the disease, the penetrating behavior, the size of the removed specimen, the duration of the surgery, and BMI are important risk factors for perioperative complications in Crohn's disease.

RESUMO CONTEXTO: O índice de complicações pós-operatórias é maior em pacientes com doença de Crohn do que em outras cirurgias abdominais decorrentes de outras afecções benignas. A prevenção e o manejo de tais complicações constituem importante fator no tratamento desses pacientes. OBJETIVO: Os objetivos deste trabalho são analisar a taxa de complicações pós-operatórias e os principais fatores de risco em pacientes portadores de doença de Crohn. MÉTODOS: Estudo descritivo e retrospectivo, baseado na análise dos prontuários dos pacientes com doença de Crohn submetidos a ressecções ileais e/ou colônicas, analisando as principais complicações cirúrgicas e os principais fatores de risco relacionados as mesmas. RESULTADOS: Foram analisados 44 procedimentos cirúrgicos em 37 pacientes. A maioria dos pacientes era do sexo feminino (56,7%). Complicações pós-operatórias foram observadas em 18 (40,9%) cirurgias. A duração da doença (P=0,04), o comportamento penetrante (P=0,013), o tempo entre o diagnóstico e a primeira cirurgia (P=0,04), a desnutrição com baixo índice de massa corpórea (IMC), o tempo de duração da cirurgia (P=0,016), e o tamanho do espécime retirado (P=0,014) estiveram associados a maiores taxas de complicações. O uso de fármacos bloqueadores do fator de necrose tumoral até oito semanas antes da cirurgia não foi significativamente associado a maiores taxas de complicações ou a maior necessidade de reoperação. CONCLUSÃO: A taxa de complicações observadas neste trabalho é semelhante aos dados da literatura. A duração da doença, o comportamento penetrante, o tamanho do espécime retirado, o tempo de duração da cirurgia e o IMC são importantes fatores de risco para complicações peri-operatórias em doença de Crohn.

Social anxiety symptoms in alcohol-dependent outpatients: prevalence, severity and predictors / Sintomas de ansiedade social em alcoolistas em tratamento ambulatorial: prevalência, gravidade e preditores

ABSTRACT Objectives High rates of comorbidity between social anxiety disorder (SAD) and alcohol use disorders have been reported, but the predictors of this comorbidity are poorly known and most studies involve primary SAD samples. The aims were to estimate the prevalence and severity of SAD symptoms among alcohol-dependent patients and to investigate sociodemographic and clinical factors associated with SAD comorbidity, including suicidal behaviors. Methods A cross-sectional study with 53 adults who were in treatment for alcohol dependence at a Brazilian public university outpatient service. Assessment instruments Social Phobia Inventory (SPIN), Short Alcohol Dependence Data and Beck Depression Inventory. Bivariate analyses between the categorical outcome (Probable SAD: SPIN ≥ 19) and explanatory variables were conducted. Correlates of SPIN total and subscales scores (dimensional outcomes) were also investigated. Results The diagnosis and treatment of alcohol dependence occurred, on average, 30 years after the onset of alcohol use and 39.6% of the 53 patients (37 men and 16 women) reported alleviation of social anxiety symptoms with alcohol use. Twenty-four (45.3%) patients presented probable SAD. These patients differed from non-SAD alcohol-dependent individuals by having lower income and higher frequency of depression, suicidal ideation, suicide plans and attempts. The SPIN subscales mostly associated with suicidal behaviors were social inadequacy and social inferiority. Conclusions SAD symptoms are common among help-seeking alcohol-dependent individuals and should be directly investigated and treated, since depression and suicidality are associated with this comorbidity. Prospective studies are needed to assess the impact of SAD treatment on the clinical course of alcohol dependence.

RESUMO Objetivos Altas taxas de comorbidade têm sido descritas entre o transtorno de ansiedade social (TAS) e os transtornos por uso de álcool, mas os preditores dessa comorbidade são pouco conhecidos, e a maioria dos estudos envolve pacientes com diagnóstico primário de TAS. Os objetivos foram estimar a prevalência e a gravidade de sintomas de TAS em pacientes dependentes de álcool e investigar fatores sociodemográficos e clínicos associados à comorbidade com TAS, incluindo risco de suicídio. Métodos Estudo transversal com 53 adultos em tratamento ambulatorial para dependência de álcool num hospital público universitário brasileiro. Instrumentos de avaliação: Social Phobia Inventory (SPIN), Short Alcohol Dependence Data e Beck Depression Inventory. Foram conduzidas análises bivariadas entre o desfecho categorial (provável TAS: SPIN ≥ 19) e as variáveis explanatórias. Correlatos dos escores total e das subescalas da SPIN (desfechos dimensionais) também foram investigados. Resultados O diagnóstico e o tratamento da dependência de álcool ocorreram em média 30 anos após o início do uso de álcool, e 39,6% dos 53 pacientes (37 homens e 16 mulheres) relataram alívio dos sintomas de ansiedade social com o uso de álcool. Vinte e quatro (45,3%) pacientes apresentaram provável TAS. Esses pacientes diferiram dos alcoolistas sem TAS, por terem menor renda, maior frequência de depressão, ideação suicida, planos e tentativas de suicídio. As subescalas da SPIN que mais se associaram com comportamentos suicidas foram inadequação social e inferioridade social. Conclusões Sintomas de TAS são comuns em alcoolistas em tratamento e devem ser diretamente investigados e tratados, já que depressão e suicidalidade associam-se com essa comorbidade. Estudos prospectivos são necessários para investigar o impacto do tratamento do TAS no curso clínico da dependência de álcool.