[Tumor-induced osteomalacia: rhinosinusal hemangiopericytoma]. / Osteomalacia inducida por tumor: hemangiopericitoma rinosinusal.

Tumor-induced osteomalacia is a rare disease of bone metabolism. The characteristic of this disease is an increase in phosphate excretion followed by hypophosphatemia, due to phosphaturic agents produced by different types of tumors. Tumor resection results in complete resolution of clinical, biochemical and radiological abnormalities. We present the case of a 61 year old man with signs, symptoms and laboratory findings consistent with oncogenic osteomalacia due to a rhino-sinusal mesenchymal tumor. The histological diagnosis showed a vascular neoplasm: hemangiopericytoma.

[Nutritional status, systemic inflammatory response syndrome and mortality in the elderly hospitalized patient]. / El estado nutricional, la respuesta inflamatoria sistémica y la mortalidad en el anciano internado.

In order to evaluate the relationship between systemic inflammatory response and mortality in the older hospitalized patient, we developed a prospective cohort study in which we evaluated a nutritional score (SGA), years of instruction, functional status, organic failure (Marshall), presence of sepsis, comorbidities (Charlson), cognitive state (MMSE), albumin, erythrocyte sedimentation rate and mortality. Fifty two patients were included, 19 men (36.5%) and 33 women (63.5%), mean age was 80 (Interquartile Range 12.5) years. 29 (55.8%) patients were well-nourished and 23 (44.2%) malnourished, 53.8% of patients developed sepsis at admission or during hospitalization. Total nosocomial mortality was 7.7 % (n = 4) and one-year mortality was 31.8% (n = 14). Comparative analyses showed older age (80 vs. 78; p = 0.012), less years of instruction (7 vs. 8; p = 0.027), lower MMST (14 vs. 27; p = 0.017), lower previous functional status (21 vs. 32; p < 0.0001), lower albumin (3 vs. 3.35; p = 0.014) and higher organic failure score at admission (3 vs. 1; p = 0.01) with more number of affected organs (2 vs. 1; p = 0.003) in malnourished patients compared to well nourished ones. Higher incidence of sepsis -at admission or during hospitalization- (73.9% vs. 37.9%; p = 0.01) and more severe stages of sepsis were also observed in malnourished patients. One-year mortality was significantly higher in malnourished (52.2% vs. 9.5%, log rank test = 0.002). In conclusion, malnourished patients presented greater systemic inflammatory response.

[Analysis of the first 100 patients with COVID-19 admitted to internal medicine wards at the Hospital de Clínicas José de San Martin, Buenos Aires University]. / Análisis de los primeros 100 pacientes internados por COVID-19 en el Hospital de Clínicas José de San Martín, Universidad de Buenos Aires.

This retrospective descriptive study analyzes the clinical and epidemiological characteristics, the disease evolution and its association with laboratory markers of poor prognosis of the first 100 patients with COVID-19 admitted to internal medicine wards at the Hospital de Clínicas José de San Martín, University of Buenos Aires. Thirty-one patients were nursing home residents, the most common clinical manifestations were fever, cough and odynophagia. Regarding comorbidities, obesity was the most frequent one and hypertension was the most prevalent in patients with pneumonia. The most important predictors of mortality were age and pneumonia. Patients older than 70 years had higher acute phase reactants showing an exaggerated inflammatory response. Mortality was high (13%), compared to most reports (5%), probably because of the advanced age of our population and the unfavorable clinical conditions they presented at admission.

Se analiza, en un estudio descriptivo retrospectivo, las características clínicas y epidemiológicas, la evolución de la enfermedad y su asociación con los marcadores del laboratorio de mal pronóstico, en los primeros 100 pacientes internados en clínica médica con COVID-19 en el Hospital de Clínicas José de San Martín de la Universidad de Buenos Aires. El 31% de los pacientes provenían de geriátricos, las manifestaciones clínicas más comunes fueron fiebre, tos y odinofagia. En relación a las comorbilidades, la obesidad fue la más frecuente y la hipertensión arterial la más prevalente en los pacientes con neumonía. La edad y la presencia de neumonía fueron los predictores más importantes de mortalidad. Los pacientes mayores de 70 años presentaron reactantes de fase aguda más elevados mostrando una respuesta inflamatoria exagerada. La mortalidad fue elevada (13%), en comparación con la mayoría de las comunicaciones (5%), probablemente como consecuencia de la edad avanzada de nuestra población y las condiciones clínicas desfavorables que presentaron a su ingreso.

[Bartonella endocarditis associated with glomerulonephritis and neuroretinitis]. / Endocarditis por Bartonella asociada a glomerulonefritis y neurorretinitis.

Blood-culture negative endocarditis is a diagnostic challenge. Both Bartonella and Coxiella can cause it with similar clinical presentations mimicking a systemic vasculitis. The identification of the etiologic agent is essential because they differ in treatment type and duration. We present a case of blood-culture negative endocarditis caused by Bartonella henselae, associated with glomerulonephritis and neuroretinitis, with negative blood culture, positive anti-neutrophil cytoplasmic and antiproteinase 3 antibodies. The serology was positive for Bartonella with crossreactivity to Coxiella burnetti. The etiological diagnosis was achieved by polymerase chain reaction amplification and sequencing of a ribC gene fragment. The patient received antibiotic and immunosuppressive treatment followed by replacement of the aortic valve with favorable medium-term evolution.

La endocarditis bacteriana con hemocultivo negativo constituye un dilema diagnóstico. Tanto Bartonella como Coxiella pueden causarla, con presentaciones clínicas similares que pueden simular una vasculitis sistémica no infecciosa. Sin embargo, difieren en el tipo y la duración del tratamiento, por lo que es fundamental identificar el agente etiológico. Presentamos un caso de endocarditis por Bartonella henselae asociada a glomerulonefritis y neurorretinitis, con hemocultivo negativo, anticuerpos anticitoplasma de neutrófilos y antiproteinasa 3 positivos, y serología positiva para Bartonella con reacción cruzada para Coxiella burnetti. El diagnóstico etiológico fue confirmado a posteriori mediante amplificación y secuenciación parcial del gen ribC a partir de tejido de la válvula cardíaca. El paciente recibió tratamiento antibiótico e inmunosupresor seguido de recambio valvular aórtico y presentó evolución favorable.

[Brown tumor as the initial manifestation of primary hyperparathyroidism]. / Tumor pardo como manifestación inicial de hiperparatiroidismo primario.

Brown tumor is a localized form of osteitis fibrosa cystica, being part of the hyperparathyroid bone disease. It rarely is the first manifestation of hyperparathyroidism, since nowadays, the diagnosis is made at an asymptomatic or minimally symptomatic stage. We present a case of a left superior maxillar brown tumor as the first manifestation of primary hyperparathyroidism due to a parathyroid adenoma. A parathyroidectomy was performed, and there was a regression of the bone lesion, without the need of performing other local surgical procedures.

[Young woman with hyperthyroidism associated with severe tricuspid regurgitation]. / Mujer joven con hipertiroidismo asociado a insuficiencia tricuspídea grave.

Cardiovascular manifestations of hyperthyroidism are frequent and sometimes are relevant in the clinical picture. Usually an hyperdynamic circulatory state hallmarks the disease with low peripheral resistance, increased intravascular volume and cardiac output. However, right chamber dilatation with tricuspid valve regurgitation and cardiac failure are unusual. We present the case of a young woman with Graves-Basedow disease without cardiovascular history who complained about palpitations, peripheral edemas, weight loss and fever. The clinical findings were tachycardia with irregular pulse, right heart failure and regurgitant tricuspid murmur that increased with inspiration. The chest radiograph and the echocardiogram showed right ventricular dilatation and severe tricuspid regurgitation without pulmonary hypertension. The treatment with propranolol, corticosteroids and diuretics was successful. The patient was asymptomatic with sinus rhythm. We discuss the effects of thyroidal hormones on the cardiovascular system and postulate pathophysiologic mechanisms of heart failure in hyperthyroidism.

Endocarditis por bartonella asociada a glomerulonefritis y neurorretinitis / Bartonella endocarditis associated with glomerulonephritis and neuroretinitis

La endocarditis bacteriana con hemocultivo negativo constituye un dilema diagnóstico. Tanto Bartonella como Coxiella pueden causarla, con presentaciones clínicas similares que pueden simular una vasculitis sistémica no infecciosa. Sin embargo, difieren en el tipo y la duración del tratamiento, por lo que es fundamental identificar el agente etiológico. Presentamos un caso de endocarditis por Bartonella henselae asociada a glomerulonefritis y neurorretinitis, con hemocultivo negativo, anticuerpos anticitoplasma de neutrófilos y antiproteinasa 3 positivos, y serología positiva para Bartonella con reacción cruzada para Coxiella burnetti. El diagnóstico etiológico fue confirmado a posteriori mediante amplificación y secuenciación parcial del gen ribC a partir de tejido de la válvula cardíaca. El paciente recibió tratamiento antibiótico e inmunosupresor seguido de recambio valvular aórtico y presentó evolución favorable.

Blood-culture negative endocarditis is a diagnostic challenge. Both Bartonella and Coxiella can cause it with similar clinical presentations mimicking a systemic vasculitis. The identification of the etiologic agent is essential because they differ in treatment type and duration. We present a case of blood-culture negative endocarditis caused by Bartonella henselae, associated with glomerulonephritis and neuroretinitis, with negative blood culture, positive anti-neutrophil cytoplasmic and antiproteinase 3 antibodies. The serology was positive for Bartonella with cross-reactivity to Coxiella burnetti. The etiological diagnosis was achieved by polymerase chain reaction amplification and sequencing of a ribC gene fragment. The patient received antibiotic and immunosuppressive treatment followed by replacement of the aortic valve with favorable medium-term evolution.

Análisis de los primeros 100 pacientes internados por COVID-19 en el Hospital de Clínicas José de San Martín, Universidad de Buenos Aires / Analysis of the first 100 patients with COVID-19 admitted to internal medicine wards at the Hospital de Clínicas José de San Martin, Buenos Aires University

Resumen Se analiza, en un estudio descriptivo retrospectivo, las características clínicas y epidemiológicas, la evolución de la enfermedad y su asociación con los marcadores del laboratorio de mal pronóstico, en los primeros 100 pacientes internados en clínica médica con COVID-19 en el Hospital de Clínicas José de San Martín de la Universidad de Buenos Aires. El 31% de los pacientes provenían de geriátricos, las manifestaciones clínicas más comunes fueron fiebre, tos y odinofagia. En relación a las comorbilidades, la obesidad fue la más frecuente y la hipertensión arterial la más prevalente en los pacientes con neumonía. La edad y la presencia de neumonía fueron los predictores más importantes de mortalidad. Los pacientes mayores de 70 años presentaron reactantes de fase aguda más elevados mostrando una respuesta inflamatoria exagerada. La mortalidad fue elevada (13%), en comparación con la mayoría de las comunicaciones (5%), probablemente como consecuencia de la edad avanzada de nuestra población y las condiciones clínicas desfavorables que presentaron a su ingreso.

Abstract This retrospective descriptive study analyzes the clinical and epidemiological characteristics, the disease evolution and its association with laboratory markers of poor prognosis of the first 100 patients with COVID-19 admitted to internal medicine wards at the Hospital de Clínicas José de San Martín, University of Buenos Aires. Thirty-one patients were nursing home residents, the most common clinical manifestations were fever, cough and odynophagia. Regarding comorbidities, obesity was the most frequent one and hypertension was the most prevalent in patients with pneumonia. The most important predictors of mortality were age and pneumonia. Patients older than 70 years had higher acute phase reactants showing an exaggerated inflammatory response. Mortality was high (13%), compared to most reports (5%), probably because of the advanced age of our population and the unfavorable clinical conditions they presented at admission.

Osteomalacia inducida por tumor: hemangiopericitoma rinosinusal / Tumor-induced osteomalacia: rhinosinusal hemangiopericytoma

La osteomalacia inducida por tumor es una rara enfermedad del metabolismo óseo caracterizada por el aumento en la excreción de fosfato a nivel renal seguido de hipofosfatemia. Es causada por agentes fosfatúricos producidos por determinados tumores. La resección total del tumor resulta en la completa reversión de las anormalidades bioquímicas, la desaparición de las manifestaciones clínicas y los hallazgos en los estudios por imágenes. Presentamos el caso de un varón de 61 años con cuadro clínico y laboratorio compatibles con osteomalacia oncogénica inducida por tumor mesenquimático de localización rinosinusal. En nuestro caso el diagnóstico histológico correspondió a una neoplasia de tipo vascular: hemangiopericitoma.

Tumor-induced osteomalacia is a rare disease of bone metabolism. The characteristic of this disease is an increase in phosphate excretion followed by hypophosphatemia, due to phosphaturic agents produced by different types of tumors. Tumor resection results in complete resolution of clinical, biochemical and radiological abnormalities. We present the case of a 61 year old man with signs, symptoms and laboratory findings consistent with oncogenic osteomalacia due to a rhino-sinusal mesenchymal tumor. The histological diagnosis showed a vascular neoplasm: hemangiopericytoma.