Encefalitis autoinmune por anticuerpos contra el receptor GABA-A: caso clínico / Autoimmune encephalitis induced by antibodies against GABA-A receptor

Among autoimmune encephalitides, a prevalent group are those associated with antibodies against the N-Methyl-D-aspartate receptor, which present with behavior abnormalities, psychosis, seizures and abnormal movements. A new variant, mediated by antibodies against the GABA-A receptor, was recen­tly described. We report a 66-years-old female with this form of encephalitis whose main manifestation was the presence of severe seizures leading to status epilepticus. The patient had a good response to immunomodulatory therapy with intravenous methylprednisolone, azathioprine and anticonvulsants. The laboratory tests initially detected anti-thyroid peroxidase antibodies which lead to the misdiagnosis of Hashimoto Encephalitis, which was ruled out after the detection of antibodies against GABA-A receptor. No malignancy was detected.

Tratamiento de la tiroiditis de Riedel con triamcinolona / Treatment of Riedel's thyroiditis with triamcinolone

Se presenta el primer paciente con una tiroiditis de Riedel que se le aplica un tratamiento alternativo con triamcinolona creado por el profesor Juan Gualberto Vivó Núñez. Es el caso de una mujer de 48 años de edad, que acude al cuerpo de guardia por aumento de volumen de la región anterior del cuello y referir ligera disfagia. Tiene antecedente inicialmente de hipertiroidismo, a los 9 años comenzó con hipotiroidismo y hace aproximadamente un año se le diagnosticó una tiroiditis de Hashimoto, con seguimiento por endocrinología. La ecografía del tiroides muestra un aumento marcado de la glándula tiroidea y las imágenes de la biopsia por aspiración con aguja fina (BAAF) son compatibles con una tiroiditis de Hashimoto. Con estos resultados se decide intervenirla quirúrgicamente eliminando así los signos compresivos. La biopsia postoperatoria describe una tiroiditis de Riedel. Por el gran tamaño de los lóbulos tiroideos, se le infiltra triamcinolona 1/2 cc en cada lóbulo, una vez al mes durante cuatro meses; logrando reducir aproximadamente el 50 por ciento de los lóbulos tiroideos. Por lo que se puede apreciar los resultados obtenidos con el uso de la triamcinolona(AU)

The first case of Riedel's thyroiditis treated with triamcinolone, a method created by Professor Juan Gualberto Vivo Nunez, was presented. The patient was a 48 years-old woman who went to the emergency service because she presented increased volume of the anterior region of the neck and slight dysphagia. She had a history of hyperthyroidism, at 9 years of age began hypothyroidism and one year before going to emergency room, she was diagnosed with Hashimoto thyroiditis and followed-up in the endocrinology service. Thyroid echography showed marked increase of thyroid gland and the images from fine needle aspiration biopsy were compatible with the existence of Hashimoto thyroiditis. The results backed up the decision of operating her to eliminate the compressive signs. Postoperative biopsy described Riedel's thyroiditis. Since the thyroid lobes were big, it was decided to apply triamcinolone at a dose of ½ cc to each lobe once a month for 4 months. This treatment managed to reduce roughly 50 percent of thyroid lobes. This showed the good results obtained with the use of triamcinolone(AU)