A case of Chagas' disease panniculitis after kidney transplantation.

Chagas' disease carries high morbidity and mortality due to acute parasitemia or cardiac, digestive, cutaneous or neurologic chronic lesions. Latin American countries have the majority of infected or at risk people. Transplanted patients using immunosuppressive agents may develop severe and even fatal forms of the disease. The available treatment causes frequent severe side-effects. A 59 years-old woman with end stage renal disease and positive serology for Chagas` disease, but without any clinical manifestation of this pathology, underwent kidney transplantation from a cadaveric donor and displayed three months later a thigh panniculitis from which a biopsy unveiled amastigote forms of Trypanosoma cruzi. The skin lesions disappeared following treatment with benzonidazole, but the drug was discontinued due to severe pancytopenia. Along with this, infection with E. faecalis and cytomegalovirus were treated with vancomicin and ganciclovir. The patient kept very well afterwards, with no new skin lesions and with good graft function. One year and three months after the transplant, she had an emergency surgery for an aortic dissecting aneurysm. Irreversible shock and death occurred in the immediate post-surgical period. It was not possible to establish or to rule out a relationship between the trypanosomiasis and the aortic lesions. Chagas` disease must be remembered in differential diagnosis of several clinical situations in transplant patients, mainly in endemic areas. The treatment can yeld good clinical response, but serious side-effects from the drugs may ensue. More effective and better tolerated options are in need for treatment or prophylaxis.

Paniculite chagásica pós-transplante renal: relato de caso / A case of Chagas' disease panniculitis after kidney transplantation

Resumo A doença de Chagas acarreta grande morbimortalidade, por parasitemia aguda ou por lesões cardíacas, digestivas, cutâneas ou neurológicas crônicas. Os países latino-americanos apresentam a maioria das pessoas infectadas ou em risco. Pacientes transplantados em uso de imunossupressores podem desenvolver formas graves da doença, muitas vezes fatais. As drogas disponíveis para o tratamento causam frequentemente efeitos colaterais graves. Uma paciente de 59 anos, com insuficiência renal crônica avançada e sorologia positiva para doença de Chagas, mas sem qualquer manifestação clínica dessa patologia, recebeu transplante renal de doador cadáver e apresentou três meses depois paniculite na coxa, tendo a biópsia das lesões mostrado formas amastigotas de Trypanosoma cruzi. Foi tratada com benzonidazol, observando-se o desaparecimento das lesões, mas a droga teve que ser suspensa por pancitopenia grave. Simultaneamente, apresentou infecção por E. faecalis e por citomegalovírus, tratadas com vancomicina e ganciclovir. Manteve-se depois muito bem clinicamente, sem novas lesões cutâneas e com boa função do enxerto. Um ano e três meses após o transplante, foi submetida à cirurgia de urgência por aneurisma dissecante da aorta. Evoluiu com choque irreversível e óbito no pós-operatório imediato. Não foi possível estabelecer ou afastar alguma relação entre as lesões aórticas e a tripanossomíase. A doença de Chagas deve ser lembrada no diagnóstico diferencial de várias situações clínicas em pacientes transplantados, principalmente em zonas endêmicas. Pode haver resposta clínica à medicação, mas são possíveis para-efeitos graves com as drogas utilizadas. O tratamento ou a profilaxia ainda aguardam por opções mais efetivas e melhor toleradas.

Abstract Chagas' disease carries high morbidity and mortality due to acute parasitemia or cardiac, digestive, cutaneous or neurologic chronic lesions. Latin American countries have the majority of infected or at risk people. Transplanted patients using immunosuppressive agents may develop severe and even fatal forms of the disease. The available treatment causes frequent severe side-effects. A 59 years-old woman with end stage renal disease and positive serology for Chagas` disease, but without any clinical manifestation of this pathology, underwent kidney transplantation from a cadaveric donor and displayed three months later a thigh panniculitis from which a biopsy unveiled amastigote forms of Trypanosoma cruzi. The skin lesions disappeared following treatment with benzonidazole, but the drug was discontinued due to severe pancytopenia. Along with this, infection with E. faecalis and cytomegalovirus were treated with vancomicin and ganciclovir. The patient kept very well afterwards, with no new skin lesions and with good graft function. One year and three months after the transplant, she had an emergency surgery for an aortic dissecting aneurysm. Irreversible shock and death occurred in the immediate post-surgical period. It was not possible to establish or to rule out a relationship between the trypanosomiasis and the aortic lesions. Chagas` disease must be remembered in differential diagnosis of several clinical situations in transplant patients, mainly in endemic areas. The treatment can yeld good clinical response, but serious side-effects from the drugs may ensue. More effective and better tolerated options are in need for treatment or prophylaxis.

Diphenyl ditelluride intoxication triggers histological changes in liver, kidney, and lung of mice.

Tellurium compounds may be cytotoxic to different cells types. Thus, this work evaluated the effect of diphenyl ditelluride ((PhTe)2), an organotellurium commonly used in organic synthesis, on the morphology of liver, kidney, and lung. Adult mice were acutely (a subcutaneous single dose: 250 µmol/kg) or subchronically (one daily subcutaneous dose: 10 or 50 µmol/kg for 7 and 14 days) exposed to (PhTe)2. Afterwards, the histological analyses of liver, kidney, and lungs were performed. Liver histology revealed that the hepatocytes of mice subchronically exposed to (PhTe)2 presented cytoplasmic vacuolization, hydropic degeneration, and hyperchromatic nuclei. Subchronic exposure to 50 µmol/kg (PhTe)2 also caused hepatic necrosis. Microvesicular and macrovesicular steatosis were identified in liver of mice acutely exposed to (PhTe)2. Acute and subchronic intoxication with (PhTe)2 induced changes on epithelial cells of renal tubules, namely, loss of brush border and cytoplasmatic vacuolization. Atrophy and hypertrophy, cast proteinaceous formation, and acute tubular necrosis were also identified in renal tissue. Mice subchronically exposed to 50 µmol/kg (PhTe)2 developed intra-alveolar edema and alveolar wall congestion in some areas of lungs. Acute exposure to (PhTe)2 did not cause histological changes in lungs. Our data show that (PhTe)2 may be considered a histotoxic agent for liver, kidney, and lung.

Pneumonia recorrente com uma causa rara: carcinoma mucoepidermóide / Mucoepidermoid carcinoma: a rare cause of recurrent pneumonia

A pneumonia recorrente caracteriza-se por episódios repetitivos de infecção e radiologicamente por infiltrados recorrentes em um único ou em múltiplos lobos pulmonares. São causas da doença localizada: obstrução intraluminal das vias aéreas, compressão extrínseca e alterações estruturais. O padrão, a freqüência e a gravidade das infecções, associados a uma revisão completa de todos os radiogramas de tórax, guiam a avaliação diagnóstica. Relata-se um caso de pneumonia recorrente devida à obstrução endobrônquica por carcinoma mucoepidermóide.

Recurrent pneumonia is characterized by frequent infection and infiltrates in one or more lung lobes. The localized form of the disease is caused by intraluminal obstruction, extrinsic compression or structural abnormalities. The pattern, frequency and severity of the infections, together with a thorough review of all chest X-rays, inform the diagnosis. Herein, we report a case of recurrent pneumonia due to endobronchial obstruction by mucoepidermoid carcinoma.