A case of febrile infection-related epilepsy syndrome (FIRES) in young adult: still a diagnostic and therapeutic challenge.

A new onset of status epilepticus in a previously healthy adult preceded by a recent minor febrile infection represents a diagnostic and therapeutic challenge in clinical practice. Considering the broad spectrum of epileptic encephalopathies caused by autoimmune mechanisms, differential diagnosis for new-onset refractory status epilepticus (NORSE) should include febrile infection-related epilepsy syndrome (FIRES), in order to not underestimate the underlying etiological condition triggering epilepsy in non-epileptic patients (Hon et al. in Recent Pat Inflamm Allergy Drug Discov 12:128-135, 2018). We report a case of acute encephalopathy with refractory seizures after a febrile illness (FIRES) in a young adult with complete remission of symptoms as well as dramatic improvement of EEG abnormalities following intravenous immunoglobulin and proper antiepileptic medications. We conducted an extensive workup including lumbar puncture, blood tests, EEG serial monitoring, MRI brain, total body CT scan, and PET brain with FDG to shed light on the etiology of the disease.

Dioctofimatose renal bilateral e disseminada em cão / Bilateral and disseminated renal dioctophimatosis in dog

Este trabalho descreve dioctofimatose renal bilateral e disseminada em canino no município de Pelotas, na região sul do Rio Grande do Sul. Uma cadela sem raça definida, de dois anos de idade e semi-domiciliada foi submetida a exame ultrassonográfico observando-se alterações sugestivas de parasitismo por Dioctophyme renale. O animal veio à morte antes de ser conduzido para nefrectomia e remoção dos parasitas. Foi encaminhado para necropsia no Laboratório Regional de Diagnóstico da Faculdade de Veterinária da UFPel. Macroscopicamente, ao corte do rim direito observou-se atrofia do parênquima com formações císticas e exsudato serosanguinolento com quatro exemplares fêmeas de D. renale. A cápsula renal media 0,4cm de espessura, e apresentava placas multifocais esbranquiçadas, irregulares e de consistência dura, medindo até 2cm de diâmetro. Na pelve do rim esquerdo, havia um parasita macho de 22cm. A bexiga possuía conteúdo escurecido e pastoso. Ainda, livre na cavidade abdominal, próximo ao rim direito havia outro parasita macho de 30cm. No fígado havia região cicatricial no lobo em contato com o parasita. No tórax identificou-se livre na cavidade e formando impressão sob a gordura pericárdica, um parasita macho de D. renale, medindo 20cm. Histologicamente, além de lesões características da enfermidade, observou-se metaplasia óssea na capsula renal direita.(AU)

This paper describes a bilateral and disseminated renal dioctophymiasis in a canine in the municipality of Pelotas, southern region of Rio Grande do Sul, in Brazil. The two-year-old female dog with no defined race was semi-domiciled and was submitted to ultrasound examination presenting alterations suggestive of parasitism by Dioctophyme renale. The patient died before being led for nephrectomy and removal of the parasites. It was referred for necropsy at the Regional Diagnostic Laboratory of the UFPel Veterinary School. Macroscopically, at the cut of the right kidney, atrophy of the parenchyma with cystic formations and serosanguinous exudate with four female specimens of D. renale were observed. The renal capsule was 0.4cm thick and had irregular, hard, multifocal regions measuring up to 2cm in diameter. In the pelvis of the left kidney, there was a 22cm long male parasite. The bladder had darkened and pasty contents. Also, free in the abdominal cavity, near to the right kidney there was another male parasite of 30cm. In the liver there was a cicatricial region in the lobe in contact with the parasite. In the thorax, a male parasite of D. renale measuring 20cm, was identified free in the cavity and forming an impression under the pericardial fat. Histologically, in addition to the characteristic lesions of the disease, bone metaplasia was observed in the right renal capsule.(AU)