Epidural abscess due to Salmonella enteritidis in a patient with systemic lupus erythematosus.

Increased susceptibility to infection has long been observed among patients with systemic lupus erythematosus, and still represents a chief cause of morbidity and mortality in these patients. This is due in part to the severity of infection and to the difficulty of early diagnosis owing to the similarity between SLE flares and infection. Epidural infection is an uncommon condition, and a most rare condition caused by salmonella, which accounts for a broad spectrum of human illnesses from gastroenteritis and typhoid fever to the asymptomatic carrier state. We report the first case of epidural abscess caused by Salmonella enteritidis in a female with SLE with protean manifestations treated by intravenous antibiotics and surgery with full recovery of neurological symptoms, illustrating the importance of performing an early diagnosis and prompt treatment.

Rituximab in refractory autoimmune diseases: Brazilian experience with 29 patients (2002-2004).

OBJECTIVE: Rituximab, a monoclonal antibody against B-lymphocytes that express CD 20, is already available for the treatment of non-Hodgkin's lymphoma. Due to the increased relevance of B-cell regulation in the pathogenesis of autoimmune diseases, rituximab is being used in the treatment of patients whose condition is refractory to conventional therapy. METHODS: We retrospectively evaluated the short-term efficacy and tolerance of rituximab in patients with various autoimmune diseases who were treated at the Hospital Israelita Albert Einstein in the city of Sao Paulo. RESULTS: During the period 2002-2004, 29 patients with various autoimmune diseases were treated with rituximab 375 mg/m2 for 4 consecutive weeks, or two doses of 1 g 2 weeks apart. We observed remarkable short-term results in all cases, except for one patient with thrombocytopenic purpura. Of note, we describe the results in two patients with diseases not previously treated with rituximab (hypergammaglobulinemic purpura of Waldenstrom and eosinophilic fasciitis with hypergammaglobulinemia). Treatment was well tolerated, with no unexpected adverse events. We also observed a marked reduction in steroid dosage. CONCLUSION: Rituximab seems to be safe and effective in the treatment of patients with a variety of autoimmune diseases that are refractory to other modalities of treatment.

[Hormonal and biochemical parameters in postmenopausal osteoporosis]. / Parâmetros bioquímios e hormonais na osteoporose pós-menopausa.

In the recent years, many authors had studied the relationship between the calciotropic and gonadotropic hormones actions on postmenopausal bone loss, named calcium negative balance, with different results (Riggs et al 1983; Prince et al, 1995). We evaluated 187 female patients, aged 40 to 80 with the following distribution: 24 normals, 49 patients with osteopenia and 114 patients with osteoporosis, according to WHO classification. The aim of this study was to analyse the relationship between biochemical parameters (seric and urinary calcium), gonadotropic (seric FSH-foliculi stimulant-hormone and seric oestradiol) and calciotropic hormone (PTH) and postmenopausal bone loss. The results had shown the diminution on bone mineral density was related with elevated levels of FSH (p < 0.00001), lower levels of oestradiol (p < 0.00001) and, however, no differences on seric and urinary calcium (respectively, p > 0.70 and p > 0.52) or PTH (p > 0.70) were demonstrated.