ABSTRACT
Tenofovir is a nucleotide analogue used for the treatment of chronic hepatitis B and HIV infection. The safety of tenofovir is high but it has been described that tenofovir produces tubular toxicity and Fanconi's syndrome in some HIV-infected patients. To our knowledge this is the first documented case of bone involvement in Fanconi's syndrome in a patient treated with tenofovir for chronic hepatitis B without HIV coinfection. Bone scintigraphy has proven to be very useful for the diagnosis of secondary osteomalacia. Normalization of the bone scan after the withdrawal of the drug and the decline in alkaline phosphatase and phosphate serum levels reinforce the cause-effect relationship.
Subject(s)
Adenine/analogs & derivatives , Bone and Bones/diagnostic imaging , Fanconi Syndrome/chemically induced , Organophosphonates/adverse effects , Osteomalacia/chemically induced , Osteomalacia/diagnostic imaging , Reverse Transcriptase Inhibitors/adverse effects , Adenine/adverse effects , Adenine/therapeutic use , Female , Hepatitis B, Chronic/drug therapy , Humans , Middle Aged , Organophosphonates/therapeutic use , Radionuclide Imaging , Reverse Transcriptase Inhibitors/therapeutic use , TenofovirABSTRACT
BACKGROUND: The aim of this study is to report two patients with osteitis in secondary syphilis. The increase in the number of cases of syphilis, linked to the changes in sexual behavior and to the increase of immigrants from areas of high prevalence of STD, as well as its relationship with HIV infection, makes important to clinicians become aware of unusual presentation of secondary syphilis. PATIENTS: We report two patients diagnosed of secondary syphilis, one of them with HIV infection. Both showed dermatological lesions in palms and soles, malaise and fever. Bone scintigraphy showed significant uptake in parietal and frontal bones in both patients. Clinical response was quickly achieved after penicillin treatment. CONCLUSIONS: In patients with secondary syphilis and osteoarticular symptoms luetic osteitis must be included in differential diagnosis. Bone scintigraphy should be the first diagnostic tool because it possibilities to perform a total body scan which allows localizing asymptomatic lesions. Moreover bone scan shows a high sensitivity.
Subject(s)
Frontal Bone/diagnostic imaging , Osteitis/etiology , Parietal Bone/diagnostic imaging , Syphilis/complications , Adult , HIV Infections/complications , Humans , Male , Middle Aged , Osteitis/diagnostic imaging , Radionuclide ImagingABSTRACT
Introducción: El objetivo del presente trabajo es presentar dos casos de osteítis en sífilis secundaria. El aumento de la incidencia de sífilis, debido a los cambios en los comportamientos sexuales y al aumento de los inmigrantes procedentes de áreas con elevada prevalencia de enfermedades de transmisión sexual (ETS), y su relación con el virus de la inmunodeficiencia humana (VIH), hace que sea importante familiarizarse con formas menos frecuentes de presentación de esta infección sistémica. Pacientes: Se presentan dos pacientes diagnosticados de sífilis secundaria, uno de ellos con infección por el VIH y el otro no. En el momento del diagnóstico ambos tenían lesiones cutáneas que afectaban palmas y plantas, síntomas generales y fiebre. La gammagrafía ósea demostró en ambos casos lesiones osteoblásticas múltiples en los huesos parietales y frontal. Los dos enfermos respondieron con mejoría clínica al tratamiento con penicilina. Conclusiones: En los pacientes con sífilis secundaria y sintomatología osteoarticular se debe hacer el diagnóstico diferencial de afectación ósea sifilítica. Recomendamos como técnica de elección la gammagrafía ósea debido a su gran sensibilidad y a la posibilidad de realizar rastreos corporales que permiten el diagnóstico de lesiones sintomáticas. (AU)
Subject(s)
Middle Aged , Adult , Male , Humans , Syphilis , HIV Infections , Parietal Bone , Osteitis , Frontal BoneSubject(s)
HIV Seropositivity/complications , Lung Neoplasms/diagnosis , Sarcoma, Kaposi/diagnosis , Antineoplastic Agents, Phytogenic/therapeutic use , Cough/etiology , Diagnosis, Differential , Fever/etiology , Follow-Up Studies , Humans , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/drug therapy , Male , Radiography, Thoracic , Radionuclide Imaging , Sarcoma, Kaposi/diagnostic imaging , Sarcoma, Kaposi/drug therapy , Time Factors , Vinblastine/therapeutic use , Vincristine/therapeutic useABSTRACT
OBJECTIVES: The purpose of this study was to investigate left ventricular wall motion changes during dobutamine-induced myocardial ischemia. BACKGROUND: Dobutamine is increasingly used as a stress test. It has been assumed that high doses of the drug induce the same changes in contractility as physical exercise. However, some data suggest that ischemic myocardium can respond to dobutamine with an increase in contractility. METHODS: Sixty-three postinfarction patients twice underwent the dobutamine test (up to 40 micrograms/kg per min) within 1 to 2 days. Thallium-201 single-photon emission computed tomography (SPECT) and gated equilibrium radionuclide ventriculography were performed on each patient at rest and with dobutamine. Both global and regional ejection fractions were quantified. Sixty patients underwent coronary cineangiography within 1 week. The presence of redistribution was correlated with global and regional ejection fraction changes and with coronary lesions. RESULTS: Redistribution was present in 45 patients, and no change or a decrease in global or regional ejection fraction was detected in 22. In the entire group of patients global ejection fraction increased from 46 +/- 12% to 56 +/- 14%. The six patients with triple-vessel disease had a flat (-0.2 +/- 5%) ejection fraction response to dobutamine, whereas the remaining patients had an increase of 11 +/- 7% (p = 0.003). The regional ejection fraction of the hypokinetic area increased from 27 +/- 10% to 41 +/- 19%, showing no change or a decrease in 13 patients. The 44 patients with peri-infarct redistribution had a significantly higher increase in regional ejection fraction than those without redistribution (16.4 +/- 10% vs. 4.7 +/- 17%, p = 0.003). In the patients with peri-infarct redistribution, an inverse linear correlation was found between redistribution score and dobutamine-induced regional ejection fraction change (r = -0.44, p = 0.004). CONCLUSIONS: Mild to moderate dobutamine-induced peri-infarct ischemia is compatible with an increase in contractility, whereas severe ischemia induces worsening of wall motion.
