RESUMEN
INTRODUCTION: Kikuchi-Fujimoto disease (KFD) is a rare, benign, necrotizing lymphadenitis of unknown aetiology with good prognosis. It is characterized by cervical lymphadenopathy, nocturnal diaphoresis and fever. Surgical excision of the adenopathy, histopathological study and immunophenotyping are crucial for diagnosis. PATIENTS AND METHODS: This paper describes five patients with three different histological subtypes of KFD, including an atypical presentation masquerading as pyelonephritis and two other cases where physicians mistakenly started chemotherapy. In one other case cytomegalovirus was identified as the responsible aetiological agent, while in the remaining patient, KFD evolved into an autoimmune condition. DISCUSSION: KFD, although rare, may mimic infectious, autoimmune and neoplastic diseases. It also poses a risk for the subsequent development of an autoimmune disorder. LEARNING POINTS: Kikuchi-Fujimoto disease (KFD), although rare, should be included in the differential diagnosis of patients with cervical lymphadenopathy and fever of unknown origin.Early recognition of KFD may minimize the use of unnecessary aggressive examinations and therapies.The course of KFD in most patients is self-limiting, but there is a risk of progression to an autoimmune syndrome.
RESUMEN
INTRODUCTION: Carbon monoxide poisoning may occur in several contexts. MATERIAL AND METHODS: Retrospective of 37 carbon monoxide poisoning cases that underwent hyperbaric oxygen during wildfires in Funchal in August 2016. RESULTS: The studied sample included 37 patients, mean age of 38 years, 78% males. Ten were firefighters, four children and two pregnant victims. Neurological symptoms were the most reported. Median carboxyhemoglobin level was 3.7% (IQR 2.7). All received high-flow oxygen from admission to delivery of hyperbaric oxygen. Persistence of symptoms was the main indication for hyperbaric oxygen. Median time to hyperbaric oxygen was 4.8 hours (IQR 9.5), at 2.5 ATA for 90 minutes, without major complications. Discharge in less than 24 hours occurred in 92% of the cases. Thirty days follow-up: five patients presented clinical symptoms of late neurological syndrome; twelve patients were lost to follow-up. Carboxyhemoglobin levels on admission and mean time to hyperbaric oxygen were no different between those who did and did not develop the syndrome at 30 days (p = 0.44 and p = 0.58, respectively). DISCUSSION: Late neurological syndrome at 30 days occurred in 20% and no new cases were reported at 12 months. CONCLUSION: Use of hyperbaric oxygen appears to have reduced the incidence of the syndrome. This seems to be the first Portuguese series reporting use of hyperbaric oxygen in carbon monoxide poisoning due to wildfires. The authors intend to alert to the importance of referral of these patients because the indications and benefits of this treatment are well documented. This is especially important given the ever-growing issue of wildfires in Portugal.
Introdução: A intoxicação por monóxido de carbono pode ocorrer em diversos contextos. Material e Métodos: Retrospectiva de 37 casos de intoxicação por monóxido de carbono submetidos a oxigenoterapia hiperbárica nos fogos do Funchal de agosto de 2016. Resultados: Foram analisados 37 doentes, com média de 38 anos e 78% do sexo masculino; o universo de casos analisados incluiu 10 bombeiros, quatro crianças e duas grávidas; 80% reportaram sintomas neurológicos. O nível mediano de carboxihemoglobina foi de 3,7%. Todos receberam oxigénio alto débito até iniciarem oxigenoterapia hiperbárica. A persistência de sintomas foi a principal indicação para oxigenoterapia hiperbárica. O tempo mediano para oxigenoterapia hiperbárica foi 4,8 horas, a 2,5 ATA durante 90 minutos, sem intercorrências relevantes. O tempo até alta foi inferior a 24 horas em 92% dos casos. Follow-up 30 dias: cinco doentes apresentavam sinais clínicos de síndrome neurológico tardio; doze foram perdidos no follow-up. Os níveis de carboxihemoglobina durante a admissão e tempo médio até oxigenoterapia hiperbárica não diferiram entre os doentes que desenvolveram a síndrome a 30 dias e os restantes (p = 0,44 e p = 0,58, respetivamente). Discussão: A ocorrência de síndrome neurológico tardio a 30 dias ocorreu em 20% dos doentes, não se tendo verificado novos casos ao fim de 12 meses. Conclusão: A oxigenoterapia hiperbárica parece ter permitido reduzir a incidência de síndrome neurológico tardio. Esta é a primeira série de casos portuguesa que reporta exclusivamente a utilização de oxigenoterapia hiperbárica na intoxicação por monóxido de carbono por fogos florestais. Os autores pretendem alertar para importância destes doentes, cuja indicação terapêutica e benefício clínico deste tratamento está bem documentada, sobretudo atendendo à crescente problemática dos incêndios florestais em Portugal.