RESUMO
VEXAS syndrome was described by the end of 2020 as an autoinflammatory disease caused by post-zygotic variants in the UBA1 gene. VEXAS syndrome occurs in adult males with recurrent fever, arthralgia/arthritis, ear/nose chondritis, neutrophilic dermatosis, lung inflammation, venous thrombosis, and different types of vasculitis. Common laboratory changes include raised acute phase reactants and macrocytic anemia. The coexistence of myelodysplasia is frequent, and bone marrow vacuolization of myeloid and erythroid precursors is characteristic. Glucocorticoids are effective at medium-high doses, but the remaining immunosuppressive drugs, either conventional or biological, have showed limited or absent efficacy. Azacitidine has been associated with a good response, especially in patients with accompanying myelodysplastic syndrome. Allogeneic hematopoietic stem cell transplantation appears to be the only curative therapy by now. VEXAS syndrome has become a paradigm shift in the diagnosis and treatment of autoinflammatory diseases and systemic vasculitis.
Assuntos
Doenças Hereditárias Autoinflamatórias , Vasculite Sistêmica , Vasculite , Adulto , Masculino , Humanos , Doenças Hereditárias Autoinflamatórias/diagnóstico , Inflamação/complicações , Vasculite/diagnóstico , Vasculite/genética , Vasculite/terapia , Vasculite Sistêmica/diagnóstico , Vasculite Sistêmica/genética , Vasculite Sistêmica/terapiaRESUMO
PURPOSE: To describe a case of outer retinitis with frosted branch angiitis associated with mumps infection treated with hyperbaric oxygen (HBO) therapy. METHODS: Observational case report. CASE REPORT: A four-year-old boy with bilateral blindness was diagnosed with necrotizing outer retinitis with frosted branch angiitis associated with serologically confirmed mumps virus infection. He was treated with HBO therapy. Visual acuity subsequently improved to 20/40 in the right eye and to 20/320 in the left eye. Sequential follow-up optical coherence tomography examinations showed progressive recovery of the outer retinal layers in the right eye. CONCLUSION: HBO therapy appears to be a feasible and safe treatment that might improve the anatomical and functional outcome in patients with mumps retinitis.
Assuntos
Oxigenoterapia Hiperbárica , Caxumba , Vasculite Retiniana , Retinite , Vasculite , Pré-Escolar , Humanos , Oxigenoterapia Hiperbárica/efeitos adversos , Masculino , Caxumba/complicações , Vasculite Retiniana/diagnóstico , Retinite/diagnóstico , Retinite/etiologia , Retinite/terapia , Tomografia de Coerência Óptica , Vasculite/diagnósticoRESUMO
BACKGROUND The discovery of antineutrophil cytoplasm antibody (ANCA) makes the early diagnosis of primary vasculitis possible, and also has important guiding significance for the diagnosis and treatment of secondary vasculitis. This study aimed to investigate the clinical significance of ANCA. MATERIAL AND METHODS ANCA was detected by indirect immunofluorescence assay (IIF), and anti-myeloperoxidase (MPO) antibody, and anti-proteinase 3 (PR3) antibody were detected by ELISA. The results were analyzed retrospectively. RESULTS Among 118 730 patients, a total of 5853 (4.93%) were positive for ANCA. In the positive cases, 3.98% were male and 6.33% were female, with significant differences (χ²=123.38, P<0.01). For ANCA, the department with the highest positive rate (15.06%) was the Department of Rheumatology, followed by 7.78% in the Department of Dermatology, 6.79% in the Department of Nephrology, and 5.72% in the Department of Traditional Chinese Medicine (TCM). Anti-PR3 and cANCA were highly specific in primary vasculitis (P<0.01). Anti-MPO and pANCA had high specificity for other autoimmune diseases (P<0.01). CONCLUSIONS ANCA has important guiding significance for vasculitis-related diseases. Therefore, it is important in the diagnosis and treatment of this disease and has value in clinical practice.
Assuntos
Anticorpos Anticitoplasma de Neutrófilos/sangue , Vasculite/sangue , Adulto , China , Feminino , Técnica Indireta de Fluorescência para Anticorpo , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Centros de Atenção Terciária/estatística & dados numéricos , Vasculite/diagnóstico , Vasculite/imunologiaRESUMO
This project was developed to set up a nurse-led service based on the needs of patients diagnosed with 'red legs'. These patients are often wrongly admitted into hospital for treatment of cellulitis. Representatives from the specialties involved in caring for those individuals with red legs were invited to participate with patients to create a stakeholder group whose purpose was to develop integrated care pathways focused on referral criteria, diagnostics and treatment to inform a new nurse-led service. There was a commitment to utilising a number of facilitation techniques and practice-development methods in the progression of the project with the support of the Foundation of Nursing Studies. Much of the prescribed care can be carried out by the patients at home and only 25% patients have required a follow-up appointment within the new service. The service has now been fully commissioned and a secondment opportunity has been developed to lead the new service. Significant savings have been demonstrated and regular revision of the integrated care pathways with all groups, including the patients, will take place.
Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Dermatopatias/diagnóstico , Dermatopatias/enfermagem , Medicina Estatal/organização & administração , Celulite (Flegmão)/diagnóstico , Celulite (Flegmão)/enfermagem , Dermatite/diagnóstico , Dermatite/enfermagem , Diagnóstico Diferencial , Eczema/diagnóstico , Eczema/enfermagem , Edema/diagnóstico , Edema/enfermagem , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Úlcera da Perna/diagnóstico , Úlcera da Perna/enfermagem , Papel do Profissional de Enfermagem , Guias de Prática Clínica como Assunto , Desenvolvimento de Programas , Estudos Retrospectivos , Esclerodermia Localizada/diagnóstico , Esclerodermia Localizada/enfermagem , Reino Unido , Vasculite/diagnóstico , Vasculite/enfermagemRESUMO
A 58-year-old man presented for evaluation and treatment of non-tender, non-pruritic, annular patches on the right temple and frontal aspect of the scalp that reddened with exercise. A biopsy specimen showed a purpuric dermatitis with features of lymphocytic vasculitis; a diagnosis of exercise-induced progressive pigmentary purpura was made. Whereas progressive pigmentary purpura is purported to be caused by exercise, other similar appearing entities are associated with exercise, namely exercise-induced vasculitis (EIV). EIV may be considered as an acute microcirculatory deficiency and thermoregulation decompensation that occurs after episodes of exhaustive major muscular activity or after unusual or excessive exercise. The combination of age greater than 50 years, heat, and prolonged exercise are the most potent contributing factors. This is the first report of exercise-induced progressive pigmentary purpura.
Assuntos
Exercício Físico , Dermatoses Faciais/etiologia , Púrpura/etiologia , Dermatoses do Couro Cabeludo/etiologia , Diagnóstico Diferencial , Progressão da Doença , Dermatoses Faciais/diagnóstico , Dermatoses Faciais/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Púrpura/diagnóstico , Púrpura/patologia , Corrida , Dermatoses do Couro Cabeludo/diagnóstico , Dermatoses do Couro Cabeludo/patologia , Vasculite/diagnóstico , Veias/fisiopatologia , YogaRESUMO
A 55-year-old woman was referred because of diffuse pruritic erythematous lesions and an ischemic process of the third finger of her right hand. She was known to have anaemia secondary to hypermenorrhea. She presented six months before admission with a cutaneous infiltration on the left cubital cavity after a paravenous leakage of intravenous iron substitution. She then reported a progressive pruritic erythematous swelling of her left arm and lower extremities and trunk. Skin biopsy of a lesion on the right leg revealed a fibrillar, small-vessel vasculitis containing many eosinophils.Two months later she reported Raynaud symptoms in both hands, with a persistent violaceous coloration of the skin and cold sensation of her third digit of the right hand. A round 1.5 cm well-delimited swelling on the medial site of the left elbow was noted. The third digit of her right hand was cold and of violet colour. Eosinophilia (19 % of total leucocytes) was present. Doppler-duplex arterial examination of the upper extremities showed an occlusion of the cubital artery down to the palmar arcade on the right arm. Selective angiography of the right subclavian and brachial arteries showed diffuse alteration of the blood flow in the cubital artery and hand, with fine collateral circulation in the carpal region. Neither secondary causes of hypereosinophilia nor a myeloproliferative process was found. Considering the skin biopsy results and having excluded other causes of eosinophilia, we assumed the diagnosis of an eosinophilic vasculitis. Treatment with tacrolimus and high dose steroids was started, the latter tapered within 12 months and then stopped, but a dramatic flare-up of the vasculitis with Raynaud phenomenon occurred. A new immunosuppressive approach with steroids and methotrexate was then introduced. This case of aggressive eosinophilic vasculitis is difficult to classify into the usual forms of vasculitis and constitutes a therapeutic challenge given the resistance to current immunosuppressive regimens.
Assuntos
Eosinofilia/diagnóstico , Isquemia/etiologia , Tromboembolia/etiologia , Extremidade Superior/irrigação sanguínea , Vasculite/diagnóstico , Biópsia , Resistência a Medicamentos , Quimioterapia Combinada , Eosinofilia/complicações , Eosinofilia/tratamento farmacológico , Feminino , Humanos , Imunossupressores/administração & dosagem , Isquemia/diagnóstico , Isquemia/terapia , Pessoa de Meia-Idade , Oscilometria , Recidiva , Pele/patologia , Tromboembolia/diagnóstico , Tromboembolia/terapia , Resultado do Tratamento , Ultrassonografia Doppler Dupla , Vasculite/complicações , Vasculite/tratamento farmacológicoRESUMO
BACKGROUND: Plaque vulnerability to rupture has emerged as a critical correlate to risk of adverse coronary events but there is as yet no clinical method to assess plaque stability in vivo. In the search to identify biomarkers of vulnerable plaques an association has been found between macrophages and plaque stability--the density and pattern of macrophage localization in lesions is indicative of probability to rupture. In very unstable plaques, macrophages are found in high densities and concentrated in the plaque shoulders. Therefore, the ability to map macrophages in plaques could allow noninvasive assessment of plaque stability. We use a multimodality imaging approach to noninvasively map the distribution of macrophages in vivo. The use of multiple modalities allows us to combine the complementary strengths of each modality to better visualize features of interest. Our combined use of Positron Emission Tomography and Magnetic Resonance Imaging (PET/MRI) allows high sensitivity PET screening to identify putative lesions in a whole body view, and high resolution MRI for detailed mapping of biomarker expression in the lesions. METHODOLOGY/PRINCIPAL FINDINGS: Macromolecular and nanoparticle contrast agents targeted to macrophages were developed and tested in three different mouse and rat models of atherosclerosis in which inflamed vascular plaques form spontaneously and/or are induced by injury. For multimodal detection, the probes were designed to contain gadolinium (T1 MRI) or iron oxide (T2 MRI), and Cu-64 (PET). PET imaging was utilized to identify regions of macrophage accumulation; these regions were further probed by MRI to visualize macrophage distribution at high resolution. In both PET and MR images the probes enhanced contrast at sites of vascular inflammation, but not in normal vessel walls. MRI was able to identify discrete sites of inflammation that were blurred together at the low resolution of PET. Macrophage content in the lesions was confirmed by histology. CONCLUSIONS/SIGNIFICANCE: The multimodal imaging approach allowed high-sensitivity and high-resolution mapping of biomarker distribution and may lead to a clinical method to predict plaque probability to rupture.
Assuntos
Vasculite/diagnóstico , Animais , Apolipoproteínas E/genética , Apolipoproteínas E/fisiologia , Imageamento por Ressonância Magnética , Camundongos , Camundongos Knockout , Tomografia por Emissão de Pósitrons , Ratos , Ratos Sprague-Dawley , Vasculite/diagnóstico por imagemRESUMO
Dejerine-Roussy syndrome, also known as the thalamic pain syndrome is a condition in which the body becomes hypersensitive to pain as a result of damage to the thalamus, a part of the brain that affects sensation. Association of this syndrome with HIV is rare with few case reports described in adults. We report a 10 year old male child who was HIV positive and had developed this syndrome due to cytomegalovirus vasculitis.
Assuntos
Infecções por Citomegalovirus/complicações , Infecções por HIV/complicações , Doenças Talâmicas , Vasculite/complicações , Criança , Citomegalovirus/isolamento & purificação , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/tratamento farmacológico , Infecções por Citomegalovirus/virologia , Ganciclovir/uso terapêutico , Cefaleia/fisiopatologia , Cefaleia/virologia , Humanos , Masculino , Doenças Talâmicas/diagnóstico , Doenças Talâmicas/etiologia , Tálamo/fisiopatologia , Vasculite/diagnóstico , Vasculite/tratamento farmacológico , Vasculite/virologiaRESUMO
Granuloma faciale (GF) is a rare cutaneous disorder categorized as a localized form of small vessel vasculitis. Clinically, it manifests as single or multiple, well-demarcated, red-brown plaques, papules and nodules, nearly always confined to the face. Herein, we report a 39-year-old man with multiple red-brown, infiltrated plaques on his face and extrafacial lesions on the back, shoulders, and both arms. Skin biopsy revealed typical histopathological findings of GF. The patient failed to respond to pulsed dye laser, but intralesional triamcinolone combined with cryotherapy led to an acceptable response.
Assuntos
Dermatoses Faciais/patologia , Granuloma/patologia , Vasculite/patologia , Adulto , Anti-Inflamatórios/uso terapêutico , Crioterapia , Eritema/diagnóstico , Eritema/patologia , Eritema/terapia , Dermatoses Faciais/diagnóstico , Granuloma/diagnóstico , Granuloma/terapia , Humanos , Lasers de Corante , Masculino , Fototerapia , Resultado do Tratamento , Triancinolona/uso terapêutico , Vasculite/diagnóstico , Vasculite/terapiaRESUMO
La utilización de los tratamientos biológicos en el campo de la Dermatología ha sido reciente y se ha centrado prioritariamente en el tratamiento de la psoriasis. Etanercept ha demostrado su eficacia y seguridad en este campo, si bien es cierto que, por su mecanismo de acción y por su perfil de seguridad, se ha utilizado en numerosas patologías diferentes a la psoriasis con resultados variables. Presentamos un caso de acrodermatitis de Hallopeau tratada con etanercept con buenos resultados. Dadas las características de cronicidad, progresividad y en general mala respuesta a los tratamientos convencionales, el empleo de etanercept supone una ayuda en las posibilidades terapéuticas de la acrodermatitis de Hallopeau. Se revisan además otras posibles indicaciones de etanercept en procesos diferentes a la psoriasis (AU)
The use of biological treatments in the field of Dermatology has been recent and priority focus has been given to the treatment of psoriasis. Etanercept has demonstrated its efficacy and safety in this field although it is true that it has been used in many different diseases other than psoriasis with variable results due to its action mechanism and safety profile. We present a case of Hallopeaus Acrodermatitis treated with etanercept with good results. Given the characteristics of chronicity, progressiveness and, in general, poor response to conventional treatments, the use of etanercept is of help in the therapeutic possibilities of Hallopeaus Acrodermatitis. In addition, other possible indications of etanercept in conditions other than Psoriasis are reviewed (AU)
Assuntos
Humanos , Masculino , Terapia Biológica/instrumentação , Terapia Biológica/métodos , Terapia Biológica , Psoríase/complicações , Psoríase/diagnóstico , Acrodermatite/diagnóstico , Acrodermatite/patologia , Acrodermatite/terapia , Esclerodermia Localizada/diagnóstico , Esclerodermia Localizada/terapia , Dermatomiosite/diagnóstico , Dermatomiosite/terapia , Vasculite/diagnóstico , Vasculite/terapiaRESUMO
Treatment for ANCA-associated vasculitides is now well defined, but must be adjusted for each patient according to the type of vasculitis, its precise form (e.g., limited versus systemic Wegener's granulomatosis) and severity, and patients' characteristics, such as age and renal function. The therapeutic decision must also take into account the risk of adverse events inherent to each treatment. The efficacy of adequate induction treatment has been demonstrated: more than 80% of patients now achieve remission. Relapse rates nonetheless remain high, especially in Wegener's granulomatosis. Patients with microscopic polyangiitis or Churg-Strauss syndrome with no poor prognostic factors can be treated with corticosteroids alone, with immunosuppressants added only in case of treatment failure. Patients with Wegener's granulomatosis or microscopic polyangiitis or Churg-Strauss syndrome and one or more poor prognostic factors must receive a combination of corticosteroids and immunosuppressants, mainly intravenous pulsed cyclophosphamide. Plasma exchange is indicated as an adjuvant therapy for patients with severe renal involvement. Once remission is achieved, maintenance therapy can replace cyclophosphamide by a less toxic immunosuppressive drug, such as azathioprine or methotrexate. For these latter patients, the optimal duration of induction therapy remains to be determined, but should not be shorter than 18 months. Conversely, there is no need to prescribe high-dose corticosteroids for months. Prednisone must be started at 1 mg/kg/d then rapidly tapered so that patients are not receiving more than 15 mg/d after 3-4 months of therapy. Biological therapies also appear to have a place in the therapeutic armamentarium for ANCA-associated systemic vasculitides, at least for patients whose disease is refractory to conventional therapy. However, the precise indications for anti-TNFalpha or anti-CD20 monoclonal antibodies and their optimal regimens (doses and durations) have not yet been defined. Anti-IL5, interferon-alpha and anti-IgE monoclonal antibodies might also be useful for Churg-Strauss syndrome. These biologics must be prescribed extremely cautiously and only in trial settings, especially in view of the adverse effects, few but severe, recently been reported with them.
Assuntos
Anticorpos Anticitoplasma de Neutrófilos , Síndrome de Churg-Strauss/tratamento farmacológico , Granulomatose com Poliangiite/tratamento farmacológico , Vasculite/tratamento farmacológico , Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Murinos , Azatioprina/administração & dosagem , Azatioprina/uso terapêutico , Terapia Biológica , Síndrome de Churg-Strauss/diagnóstico , Ensaios Clínicos como Assunto , Ciclofosfamida/administração & dosagem , Ciclofosfamida/uso terapêutico , Granulomatose com Poliangiite/diagnóstico , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/administração & dosagem , Fatores Imunológicos/uso terapêutico , Imunossupressores/administração & dosagem , Imunossupressores/uso terapêutico , Infliximab , Interleucina-5/antagonistas & inibidores , Metotrexato/administração & dosagem , Metotrexato/uso terapêutico , Troca Plasmática , Prednisona/administração & dosagem , Prednisona/uso terapêutico , Prognóstico , Estudos Prospectivos , Indução de Remissão , Rituximab , Fatores de Tempo , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Vasculite/diagnósticoRESUMO
Microscopic polyangiitis was initially considered a "microscopic" form of polyarteritis nodosa and was not definitively distinguished from it until the Chapel Hill nomenclature (1994). Microscopic polyangiitis is a systemic necrotizing vasculitis of small vessels. Its typical clinical manifestations are rapidly progressive glomerulonephritis and alveolar hemorrhage. Other possible symptoms resemble those encountered in polyarteritis nodosa. Microscopic polyangiitis belongs to the group of ANCA-associated vasculitides, and 75-80% of patients have pANCA to myeloperoxidase (MPO). Anti-MPO ANCA pathogenicity has been established in animal models, and a recent report describes transplacental transfer of these antibodies in humans, resulting in pulmonary hemorrhage and renal involvement in the newborn. Patients with no poor prognostic factors, as defined by a five-factor score, can be treated with corticosteroids alone, with immunosuppressants added only in case of treatment failure. Patients with one or more poor prognostic factors must receive a combination of corticosteroids and immunosuppressants, mainly intravenous pulsed cyclophosphamide, with plasma exchange as an adjuvant therapy for those with severe renal involvement. Once remission is achieved, maintenance therapy can replace cyclophosphamide by azathioprine or methotrexate. Biological therapies are under evaluation. The remission rate is above 80% with these regimens, and the relapse rate is around 30% at 5 years, lower than for Wegener's granulomatosis.
Assuntos
Anticorpos Anticitoplasma de Neutrófilos , Vasculite , Corticosteroides/uso terapêutico , Fatores Etários , Azatioprina/administração & dosagem , Azatioprina/uso terapêutico , Terapia Biológica , Ensaios Clínicos como Assunto , Ciclofosfamida/administração & dosagem , Ciclofosfamida/uso terapêutico , Diagnóstico Diferencial , Quimioterapia Combinada , Feminino , Seguimentos , Glomerulonefrite/etiologia , Humanos , Imunossupressores/uso terapêutico , Recém-Nascido , Pneumopatias/etiologia , Masculino , Metotrexato/administração & dosagem , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Troca Plasmática , Poliarterite Nodosa/diagnóstico , Prognóstico , Recidiva , Indução de Remissão , Dermatopatias/etiologia , Fatores de Tempo , Vasculite/complicações , Vasculite/diagnóstico , Vasculite/tratamento farmacológico , Vasculite/epidemiologia , Vasculite/etiologia , Vasculite/imunologia , Vasculite/mortalidadeRESUMO
INTRODUCTION: An alveolar haemorrhage occurs in 12 to 29% during microscopic polyangeitis and can reveal this disease. EXEGESIS: We report the case of a fifteen years old female patient with a microscopic polyangeitis which was diagnosed during the investigation of a chronic anemia with chronic asymptomatic alveolar haemorrhage and extracapillary glomerulonephritis with antineutrophil cytoplasmic antibodies positive (anti-myeloperoxydase antibodies). The good tolerance of alveolar haemorrhage is usual for children, particularly in idiopathic pulmonary haemorrhage but is exeptionnal for adults. According to some studies, thirty percent of idiopathic pulmonary haemorrhage goes to auto-immune disease. CONCLUSION: This observation shows that complementary pulmonary investigations are necessary in chronic anemia when gynaecologic and digestive investigations are negative and that auto-immune investigations are judicious in the survey of idiopathic pulmonary haemorrhage.
Assuntos
Anemia Ferropriva/diagnóstico , Hemorragia/diagnóstico , Pneumopatias/diagnóstico , Alvéolos Pulmonares/irrigação sanguínea , Vasculite/diagnóstico , Vasculite/etiologia , Adolescente , Biópsia , Diagnóstico Diferencial , Feminino , Humanos , Rim/patologiaRESUMO
Livedoid vasculitis is a chronic disease characterized by recurrent painful irregularly shaped ulcers, which heal with scars, most commonly located on feet or lower extremities. This condition is often resistant to the therapy. We report four cases with refractory livedoid vasculitis that responded to systemic psoralens and ultraviolet A radiation therapy.
Assuntos
Terapia PUVA , Vasculite/diagnóstico , Vasculite/tratamento farmacológico , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Extremidade Inferior , Pessoa de Meia-Idade , Vasculite/patologiaRESUMO
Clinical manifestations of vasculitis, as a complication of rheumatoid arthritis (RA), can be postulated as a consequence of immune response abnormalities and endothelial cell dysfunction. In this study we searched for the relationship between the extent of vascular involvement and either serum sICAM-1 or selenium concentrations. We also explored the possible interaction of serum selenium with sICAM-1 to provide a greater understanding of their role in rheumatoid vasculitis (RV). For the study, we measured the serum titers of sICAM-1 using an ELISA assay and the serum selenium concentrations using the ETAAS method in 37 women suffering from RA and 18 normal women serving as controls. All the RA patients were evaluated by extensive clinical, laboratory and capillaroscopic studies. In all patients with extra-articular manifestations, severe or moderate changes in nailfold capillaroscopy were found. Serum sICAM-1 titers in RA patients with mild vasculitis on nailfold capillaroscopy did not differ significantly from those of the healthy subjects, whereas a higher sICAM-1 level seemed to reflect the more intensive vascular changes in capillaroscopy. These data suggest that sICAM-1 serum levels may reflect the extent of the microvascular involvement in RA patients. Compared with controls, all the RA patients had markedly lower serum selenium concentrations, irrespective of the degree of the capillaroscopic vascular changes. A significant inverse correlation between sICAM-1 and selenium was found in the controls (r = -0.54; P<0.02). By contrast, no correlation was noted in RA patients (r=0.10, P not significant). This suggests that the sICAM-1 shedding in RV does not appear to be influenced by selenium, presumably owing to its low serum concentration.
Assuntos
Artrite Reumatoide/complicações , Artrite Reumatoide/diagnóstico , Molécula 1 de Adesão Intercelular/metabolismo , Selênio/metabolismo , Vasculite/complicações , Vasculite/diagnóstico , Adulto , Idoso , Biomarcadores/análise , Estudos de Casos e Controles , Estudos de Coortes , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Molécula 1 de Adesão Intercelular/análise , Masculino , Pessoa de Meia-Idade , Probabilidade , Prognóstico , Valores de Referência , Selênio/análise , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Solubilidade , Estatísticas não ParamétricasRESUMO
An 91 years old woman was hospitalized because of lethargy, shortness of breath and diffuse subcutaneous hemorrhage of legs. Clinical features were consistent with the diagnosis of vasculitis with systemic involvement. However dermatologic characteristics of the legs, in association with malnutrition, suggested vitamin C deficiency which was confirmed by laboratory test. Ascorbic acid supplement dramatically improved her clinical symptoms. This case remarks how scurvy may mimmick a systemic vasculitis.
Assuntos
Escorbuto/diagnóstico , Vasculite/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Deficiência de Ácido Ascórbico/complicações , Diagnóstico Diferencial , Feminino , Humanos , Escorbuto/etiologiaAssuntos
Terapia de Imunossupressão/métodos , Imunossupressores/uso terapêutico , Dermatopatias Vasculares/tratamento farmacológico , Vasculite/tratamento farmacológico , Animais , Terapias Complementares/métodos , Feminino , Humanos , Masculino , Prognóstico , Dermatopatias Vasculares/diagnóstico , Resultado do Tratamento , Vasculite/diagnósticoRESUMO
Se analiza el papel preponderante que juega en la medicina actual la valoración del lecho microcirculatorio en varias patologías. Se hace un repaso de los métodos de diágnostico disponibles. Se presenta una clasificación clínica de Acrosíndromes. (AU)
Assuntos
Humanos , Microcirculação/patologia , Hemorreologia/métodos , Diagnóstico Clínico , Gasometria/métodos , Vasculite/classificação , Vasculite/diagnóstico , Vasculite/terapia , Doença de Raynaud/diagnóstico , Doença de Raynaud/terapia , Dermatopatias Vasculares , Cianose/classificação , Eritema Endurado , Eritema Nodoso , Tromboangiite Obliterante/terapia , Angiopatias Diabéticas/fisiopatologia , Pé DiabéticoAssuntos
Humanos , Sinais e Sintomas , Vasculite/diagnóstico , Anticorpos Anticitoplasma de Neutrófilos , Artralgia/etiologia , Diagnóstico Clínico , Arterite de Células Gigantes/diagnóstico , Granulomatose Linfomatoide/diagnóstico , Poliarterite Nodosa/diagnóstico , Arterite de Takayasu/diagnóstico , Vasculite/classificação , Vasculite/etiologiaRESUMO
Se analiza el papel preponderante que juega en la medicina actual la valoración del lecho microcirculatorio en varias patologías. Se hace un repaso de los métodos de diágnostico disponibles. Se presenta una clasificación clínica de Acrosíndromes.