Debilidad e hipertrofia muscular como forma de presentación de un hipotiroidismo: síndrome de Hoffman / Muscle weakness and hypertrophy as a presentation form of hypothyroidism: Hoffman¿s syndrome

Las alteraciones musculares aparecen con relativa frecuencia en los pacientes con hipotiroidismo. El síndrome de Hoffman constituye una forma especial y poco común de miopatía hipotiroidea. Presentamos el caso de una varón con debilidad progresiva, hipertrofia muscular y elevación de los niveles de creatinfosfokinasa debido a un hipotiroidismo primario (AU)

Muscle involvement is common in patients with hypothyroidism.Hoffman’s syndrome is a rare form of hypothyroidmyopathy. We report the case of a man with progressive weakness,muscle hypertrophy and serum creatine kinase elevationdue to a primary hypothyroidism (AU)

[Visceral leishmaniasis and bronchial asthma: influence of steroid therapy in the development of the macrophage activation syndrome and relative adrenal insufficiency]. / Leishmaniasis visceral y asma bronquial: influencia del tratamiento esteroideo en el desarrollo del síndrome de activación macrofágica e insuficiencia suprarrenal relativa.

The risk of suffering opportunistics infections in the immunoincompetent patient is a fact perfectly established. An uncommon situation constitutes the bronchopaties, pathologies with a high prevalence among the general population that they require habitually, among other, steroid treatment. The immunosupression confers to the clinical evolution of the infections, as a consequence of the inadequate response to the physical stress, due to the inhibition of the hypothalamus-hypophysis axis being able to in particularly serious cases, to develop the denominated macrophage activation syndrome, a serious and uncommon syndrome that darkens the clinical prognosis in these patients. In presence of a feverish syndrome of uncertain origin in a patient in immunosuppressor treatment, although it is to low dose, it is necessary to carry out a exhaustive differential diagnosis, should consider, among them, the infection for Leishmania, a parasitosis whose incidence is increasing notably in the last years in the immunosuppressed population. We present the clinical case of a 63 year-old patient, immunoincompetent as a consequence of secondary chronic steroid therapy to asthmatic bronchopaty that experiences an uncommon form of visceral leishmaniasis in our area, consistent in multiorganic failure in the context of the development of a macrophage activation syndrome.

Rotura aórtica por úlcera ateromatosa penetrante / Aortic rupture due to penetrating atheromatous ulceration

La rotura aórtica es una complicación poco frecuente pero extremadamente grave. Entre sus posibles causas se encuentra la disección de aorta clásica, pero también la úlcera ateromatosa y el hematoma intramural aórtico. La úlcera ateromatosa penetrante de aorta se produce cuando se ulcera una placa ateromatosa en la pared aórtica, produciendo su ruptura transmural y un sangrado activo al mediastino o al hemitórax izquierdo o derecho. Es más frecuente en pacientes ancianos con hipertensión arterial (HTA) grave. La úlcera ateromatosa penetrante de aorta debe estar en el diagnóstico diferencial del dolor toraco-abdominal agudo, especialmente en pacientes ancianos con HTA grave (AU)