Rabdomiólise em paciente com infecção por dengue: relato de caso / Rabdomyolysis in patient with dengue infection: case report / Rabdomiolisis en paciente con infección por dengue: reporte de un caso

A rabdomiólise como complicação da dengue é subnotificada e pouco descrita na literatura. O presente caso traz um alerta para recordar tal possibilidade, principalmente devido à alta incidência da dengue no Brasil e da importância do manejo inicial, que pode evitar um desfecho desfavorável. Este relato trata de um paciente de 54 anos que iniciou com quadro agudo de fraqueza, com dor intensa em membros inferiores, dor abdominal, náuseas, vômitos e anúria. Foi observada evidente disfunção renal aguda em urgência dialítica com acidose metabólica grave, além de hiperuricemia, hiponatremia, hipocalcemia e hipercalemia, com valores de creatinofosfoquinase (CPK) de 125.010 e de mioglobina, 318,28. O paciente necessitou de três sessões de hemodiálise e recebeu alta com recuperação da função renal. O resultado da sorologia IgM para dengue foi positivo após um mês e dez dias da admissão hospitalar.

Reports on rhabdomyolysis as a complication of dengue are scarce in the literature. This study warns about such a possibility, especially considering the high incidence of dengue in Brazil and the importance of early management to avoid an unfavorable outcome for the patient. The case consists of a 54-year-old patient admitted to the hospital with complains of acute weakness, severe lower limb pain, abdominal pain, nausea, vomiting, and anuria. Clinical evaluation indicated acute renal dysfunction in dialysis emergency with severe metabolic acidosis, as well as hyperuricemia, hyponatremia, hypocalcemia, and hyperkalemia, with creatine phosphokinase (CPK) values equal to 125.010 and myoglobin to 318.28. The patient was discharged with recovery of renal function after three hemodialysis sessions. Serology results were positive for dengue IgM one month and ten days after hospital admission.

La rabdomiólisis como complicación del dengue está poco implementada en la literatura y poco reportada, y este caso trae una advertencia para recordar esta posibilidad, principalmente por la alta incidencia del dengue en el país en el que vivimos y la importancia del manejo inicial, evitando un desfavorable resultado para el paciente. Se trata de un paciente de 54 años que inicia debilidad aguda, dolor severo en miembros inferiores, dolor abdominal, náuseas, vómitos y anuria. Se evidenció disfunción renal aguda en urgencia de diálisis con acidosis metabólica severa, además de hiperuricemia, hiponatremia, hipocalcemia e hiperpotasemia, con valores de creatinfosfoquinasa (CPK)de 125.010 y mioglobina de 318,28. El paciente requirió tres sesiones de hemodiálisis y fue dado de alta con recuperación de la función renal. El resultado de la serología IgM para el dengue fue positivoun mes y diez días después del ingreso hospitalario.

Monocyte subpopulations study in patients with plaque psoriasis.

Psoriasis is a chronic and systemic, immune-mediated, inflammatory disease, mainly manifested by skin and / or joints lesions, presenting with a wide degree of clinical severity, but generally with great impact on patients' quality of life. Despite advances in the understanding of its pathogenesis, especially regarding the participation of T-lymphocytes and the key role of TNF, the triggering factor of the disease at the molecular level remains unknown, as well as the function of other cell populations. By presenting antigens to T-lymphocytes, monocytes assume an important role in both innate and adaptive immune response. In the last two decades, by using flow cytometry with antibodies against CD14 (receptor for lipopolysaccharide) and CD16 (low affinity receptor for IgG), human blood monocytes were classified into three subpopulations: classical (CD14++CD16-), intermediate (CD14++CD16+), and non-classical (CD14+CD16++). Under normal conditions the population of classical monocytes corresponds to about 85%, while intermediate to 5.4%, and nonclassical to 9.2%. However, intermediate and nonclassical subsets are increased in various inflammatory situations, such as moderate to severe asthma, colorectal cancer, and rheumatoid arthritis. Despite psoriasis being considered a disease of inflammatory nature, scarce studies evaluating the frequency of subpopulations of monocytes in psoriatic patients are found on current medical literature, and they are restricted to peripheral blood analysis. This study aims to identify the frequency of monocyte subpopulations in blood levels as well as lesional skin of plaque psoriasis patients, and to evaluate their association to cytokines, and clinical disease severity.

Is there any association between Hashimoto's thyroiditis and thyroid cancer? A retrospective data analysis.

OBJECTIVE: To evaluate the association between Hashimoto's thyroiditis (HT) and papillary thyroid carcinoma (PTC). MATERIALS AND METHODS: The patients were evaluated by ultrasonography-guided fine needle aspiration cytology. Typical cytopathological aspects and/or classical histopathological findings were taken into consideration in the diagnosis of HT, and only histopathological results were considered in the diagnosis of PTC. RESULTS: Among 1,049 patients with multi- or uninodular goiter (903 women and 146 men), 173 (16.5%) had cytopathological features of thyroiditis. Thirty-three (67.4%) out of the 49 operated patients had PTC, 9 (27.3%) of them with histopathological features of HT. Five (31.3%) out of the 16 patients with non-malignant disease also had HT. In the groups with HT, PTC, and PCT+HT, the female prevalence rate was 100%, 91.6%, and 77.8%, respectively. Mean age was 41.5, 43.3, and 48.5 years, respectively. No association was observed between the two diseases in the present study where HT occurred in 31.1% of the benign cases and in 27.3% of malignant cases (p = 0.8). CONCLUSION: In spite of the absence of association between HT and PCT, the possibility of malignancy in HT should always be considered because of the coexistence of the two diseases already reported in the literature.

OBJETIVO: Avaliar a associação entre tireoidite de Hashimoto (TH) e carcinoma papilífero da tireoide (CPT). MATERIAIS E MÉTODOS: Pacientes foram avaliados por punção aspirativa guiada pela ultrassonografia. Para TH consideraram-se aspectos característicos da citopatologia e/ou achados histopatológicos clássicos. O diagnóstico de CPT foi considerado apenas pela histopatologia. RESULTADOS: De 1.049 pacientes portadores de bócios uni-multinodulares (903 femininos e 146 masculinos), 173 (16,5%) tinham quadro citopatológico de tireoidite. Dos 49 pacientes operados, 33 (67,4%) revelaram CPT, dos quais 9 (27,3%) tinham a glândula com quadro histopatológico de TH. Dos 16 pacientes sem malignidade, 5 (31,3%) exibiam também TH. Nos grupos TH, CPT e CPT+TH, a proporção de acometimento do gênero feminino foi, respectivamente, 100%, 91,6% e 77,8%. A distribuição da média da idade (anos) nos três grupos foi 41,5, 43,3 e 48,5. Não houve associação entre as duas doenças, neste estudo, em que a TH esteve presente em 31,3% dos casos benignos e em 27,3% dos casos malignos (p = 0,8). CONCLUSÃO: Não houve associação entre TH e CPT, mas a possibilidade de malignidade em TH deve ser sempre lembrada em razão da concomitância das duas doenças, já revelada na literatura.

Is there any association between Hashimoto’s thyroiditis and thyroid cancer? A retrospective data analysis / Existe associação entre tireoidite de Hashimoto e câncer de tireoide? Análise retrospectiva de dados

Abstract Objective: To evaluate the association between Hashimoto's thyroiditis (HT) and papillary thyroid carcinoma (PTC). Materials and Methods: The patients were evaluated by ultrasonography-guided fine needle aspiration cytology. Typical cytopathological aspects and/or classical histopathological findings were taken into consideration in the diagnosis of HT, and only histopathological results were considered in the diagnosis of PTC. Results: Among 1,049 patients with multi- or uninodular goiter (903 women and 146 men), 173 (16.5%) had cytopathological features of thyroiditis. Thirty-three (67.4%) out of the 49 operated patients had PTC, 9 (27.3%) of them with histopathological features of HT. Five (31.3%) out of the 16 patients with non-malignant disease also had HT. In the groups with HT, PTC, and PCT+HT, the female prevalence rate was 100%, 91.6%, and 77.8%, respectively. Mean age was 41.5, 43.3, and 48.5 years, respectively. No association was observed between the two diseases in the present study where HT occurred in 31.1% of the benign cases and in 27.3% of malignant cases (p = 0.8). Conclusion: In spite of the absence of association between HT and PCT, the possibility of malignancy in HT should always be considered because of the coexistence of the two diseases already reported in the literature. .

Resumo Objetivo: Avaliar a associação entre tireoidite de Hashimoto (TH) e carcinoma papilífero da tireoide (CPT). Materiais e Métodos: Pacientes foram avaliados por punção aspirativa guiada pela ultrassonografia. Para TH consideraram-se aspectos característicos da citopatologia e/ou achados histopatológicos clássicos. O diagnóstico de CPT foi considerado apenas pela histopatologia. Resultados: De 1.049 pacientes portadores de bócios uni-multinodulares (903 femininos e 146 masculinos), 173 (16,5%) tinham quadro citopatológico de tireoidite. Dos 49 pacientes operados, 33 (67,4%) revelaram CPT, dos quais 9 (27,3%) tinham a glândula com quadro histopatológico de TH. Dos 16 pacientes sem malignidade, 5 (31,3%) exibiam também TH. Nos grupos TH, CPT e CPT+TH, a proporção de acometimento do gênero feminino foi, respectivamente, 100%, 91,6% e 77,8%. A distribuição da média da idade (anos) nos três grupos foi 41,5, 43,3 e 48,5. Não houve associação entre as duas doenças, neste estudo, em que a TH esteve presente em 31,3% dos casos benignos e em 27,3% dos casos malignos (p = 0,8). Conclusão: Não houve associação entre TH e CPT, mas a possibilidade de malignidade em TH deve ser sempre lembrada em razão da concomitância das duas doenças, já revelada na literatura. .

Psoriasis: classical and emerging comorbidities.

Psoriasis is a chronic inflammatory systemic disease. Evidence shows an association of psoriasis with arthritis, depression, inflammatory bowel disease and cardiovascular diseases. Recently, several other comorbid conditions have been proposed as related to the chronic inflammatory status of psoriasis. The understanding of these conditions and their treatments will certainly lead to better management of the disease. The present article aims to synthesize the knowledge in the literature about the classical and emerging comorbidities related to psoriasis.

Psoriasis: classical and emerging comorbidities

Psoriasis is a chronic inflammatory systemic disease. Evidence shows an association of psoriasis with arthritis, depression, inflammatory bowel disease and cardiovascular diseases. Recently, several other comorbid conditions have been proposed as related to the chronic inflammatory status of psoriasis. The understanding of these conditions and their treatments will certainly lead to better management of the disease. The present article aims to synthesize the knowledge in the literature about the classical and emerging comorbidities related to psoriasis.

T-cell-predominant lymphoid hyperplasia in a tattoo

Cutaneous lymphoid hyperplasia (CLH) can be idiopathic or secondary to external stimuli, and is considered rare in tattoos. The infiltrate can be predominantly of B or T-cells, the latter being seldom reported in tattoos. We present a case of a predominantly T CLH, secondary to the black pigment of tattooing in a 35-year-old patient, with a dense infiltrate of small, medium and scarce large T-cells. Analysis of the rearrangement of T-cells receptor revealed a polyclonal proliferation. Since the infiltrate of CLH can simulate a T lymphoma, it is important to show that lesions from tattoos can have a predominance of T-cells.

T-cell-predominant lymphoid hyperplasia in a tattoo.

Cutaneous lymphoid hyperplasia (CLH) can be idiopathic or secondary to external stimuli, and is considered rare in tattoos. The infiltrate can be predominantly of B or T-cells, the latter being seldom reported in tattoos. We present a case of a predominantly T CLH, secondary to the black pigment of tattooing in a 35-year-old patient, with a dense infiltrate of small, medium and scarce large T-cells. Analysis of the rearrangement of T-cells receptor revealed a polyclonal proliferation. Since the infiltrate of CLH can simulate a T lymphoma, it is important to show that lesions from tattoos can have a predominance of T-cells.

Anti-TNFα therapy in the management of psoriasis: experience of a state referral center.

BACKGROUND: Psoriasis is a chronic immune-mediated disease, characterized by increased levels of TNFα. Anti-TNFα agents have revolutionized the treatment of severe psoriasis by targeting an important molecule involved in its pathogenesis. OBJECTIVES: We report the experience of a state referral center that uses anti-TNFα agents for psoriasis. METHODS: We conducted a retrospective case series. Seventy-four out of 120 patients met the inclusion criteria. Clinical and laboratory data was analyzed using the chi-squared, Wicoxon and McNemar's tests. Associations were considered statistically significant when p-value<0.05. RESULTS: Forty-one subjects (55.40%) were male, with a mean age of 47.69 ± 14.99 years. Median disease duration and pre-treatment PASI were 14.0 months (IQR 9.0-20.0), and 13.55 points (IQR 8.5-20.32). Sixty patients (81.10%) had arthropathic psoriasis. Forty-six subjects (62.20%) had comorbidities; the most frequent was dyslipidemia (25.70%). In 55.40% of patients, insufficient response to conventional therapies was the principal indication for using anti-TNFα drugs. Clinical improvement occurred in 93.20% of cases, and the post-treatment PASI median was 0.0 points (IQR 0.0-0.0). Adverse effects occurred in 6.80% of patients. Infections and elevation of transaminases occurred in 28.40% and 8.10% of cases, respectively. CONCLUSION: Post-treatment reduction in PASI was satisfactory and the occurrence of adverse effects was minor, mostly mild infusion effects and local reactions at drug administration sites.

Anti-TNFα therapy in the management of psoriasis: experience of a state referral center

BACKGROUND: Psoriasis is a chronic immune-mediated disease, characterized by increased levels of TNFα. Anti-TNFα agents have revolutionized the treatment of severe psoriasis by targeting an important molecule involved in its pathogenesis. OBJECTIVES: We report the experience of a state referral center that uses anti-TNFα agents for psoriasis. METHODS: We conducted a retrospective case series. Seventy-four out of 120 patients met the inclusion criteria. Clinical and laboratory data was analyzed using the chi-squared, Wicoxon and McNemar's tests. Associations were considered statistically significant when p-value<0.05. RESULTS: Forty-one subjects (55.40%) were male, with a mean age of 47.69±14.99 years. Median disease duration and pre-treatment PASI were 14.0 months (IQR 9.0-20.0), and 13.55 points (IQR 8.5-20.32). Sixty patients (81.10%) had arthropathic psoriasis. Forty-six subjects (62.20%) had comorbidities; the most frequent was dyslipidemia (25.70%). In 55.40% of patients, insufficient response to conventional therapies was the principal indication for using anti-TNFα drugs. Clinical improvement occurred in 93.20% of cases, and the post-treatment PASI median was 0.0 points (IQR 0.0-0.0). Adverse effects occurred in 6.80% of patients. Infections and elevation of transaminases occurred in 28.40% and 8.10% of cases, respectively. CONCLUSION: Post-treatment reduction in PASI was satisfactory and the occurrence of adverse effects was minor, mostly mild infusion effects and local reactions at drug administration sites. .

Inherited epidermolysis bullosa: clinical and therapeutic aspects.

Inherited epidermolysis bullosa (EB) is a heterogeneous group of genetic disorders that present with skin and, in some cases, mucosal fragility, predisposing patients to the development of blisters and/or erosions after minimal trauma or friction. Children with a recurrent history of these kinds of lesions or neonates that present them in the absence of another reasonable explanation should be investigated. Diagnosis must be based on clinical and histopathological findings. To date, management of inherited EB basically consists in avoiding traumas that trigger lesions, as well as preventing infection and facilitating healing of the wounds with the systematic use of bandages.

Inherited epidermolysis bullosa: clinical and therapeutic aspects / Epidermólise bolhosa hereditária: aspectos clínicos e terapêuticos

Inherited epidermolysis bullosa (EB) is a heterogeneous group of genetic disorders that present with skin and, in some cases, mucosal fragility, predisposing patients to the development of blisters and/or erosions after minimal trauma or friction. Children with a recurrent history of these kinds of lesions or neonates that present them in the absence of another reasonable explanation should be investigated. Diagnosis must be based on clinical and histopathological findings. To date, management of inherited EB basically consists in avoiding traumas that trigger lesions, as well as preventing infection and facilitating healing of the wounds with the systematic use of bandages.

A epidermólise bolhosa hereditária (EBH) compreende um grupo heterogêneo de desordens genéticas que têm em comum a fragilidade cutânea e, em alguns casos mucosa, predispondo ao desenvolvimento de bolhas e/ou erosões após fricção ou trauma mínimo. Crianças com história recorrente deste tipo de lesão ou neonatos que as apresentem na ausência de outra explicação plausível devem ser investigados. O diagnóstico deve se basear em achados clínicos e histopatológicos. Até o presente momento, o manejo da EBH consiste basicamente em evitar os traumas desencadeadores das lesões, bem como evitar a infecção e facilitar a cicatrização das feridas com o uso sistemático de curativos.

Psoriasis and uveitis: a literature review.

Psoriasis is a systemic, chronic, immunologically mediated disease, with significant genetic and environmental influences. It affects from 1 to 3% of the world population. Recently, the relation between psoriasis and different comorbidities, particularly metabolic syndrome, has become extremely relevant. Uveitis is characterized by a process of intraocular inflammation resulting from various causes. Considering psoriasis and uveitis as immune-mediated diseases, this study aims to evaluate the possible association of psoriasis and/or psoriatic arthritis with uveitis and its subtypes. Few studies have evaluated the association of uveitis and psoriasis without joint involvement. It seems that psoriasis without arthropathy is not a risk factor for the development of uveitis. Uveitis tends to develop more frequently in patients with arthropathy or pustular psoriasis than in patients with other forms of psoriasis. Ophthalmic examination should be performed periodically in patients with psoriasis and uveitis. If ophthalmopathy is diagnosed, the patient should receive adequate treatment with anti-inflammatory drugs or immunomodulators to prevent vision loss.

Psoriasis and uveitis: a literature review / Psoríase e uveíte: uma revisão da literatura

Psoriasis is a systemic, chronic, immunologically mediated disease, with significant genetic and environmental influences. It affects from 1 to 3% of the world population. Recently, the relation between psoriasis and different comorbidities, particularly metabolic syndrome, has become extremely relevant. Uveitis is characterized by a process of intraocular inflammation resulting from various causes. Considering psoriasis and uveitis as immune-mediated diseases, this study aims to evaluate the possible association of psoriasis and/or psoriatic arthritis with uveitis and its subtypes. Few studies have evaluated the association of uveitis and psoriasis without joint involvement. It seems that psoriasis without arthropathy is not a risk factor for the development of uveitis. Uveitis tends to develop more frequently in patients with arthropathy or pustular psoriasis than in patients with other forms of psoriasis. Ophthalmic examination should be performed periodically in patients with psoriasis and uveitis. If ophthalmopathy is diagnosed, the patient should receive adequate treatment with anti-inflammatory drugs or immunomodulators to prevent vision loss.

Psoríase é uma doença sistêmica, crônica, imunologicamente mediada, com importante influência genética e ambiental, que afeta 1 à 3% da população mundial. Nos últimos anos, a relação da psoríase com diferentes comorbidades, em especial a síndrome metabólica, tornou-se extremamente relevante. A uveíte é caracterizada por um processo de inflamação intra-ocular resultante de várias causas. Considerando a psoríase e a uveíte como doenças imunologicamente mediadas, o presente trabalho visa avaliar a possível associação da psoríase e/ou artrite psoriática com a uveíte e seus subtipos. Poucos são os estudos que avaliam a associação de uveíte e psoríase sem comprometimento articular. Parece que a psoríase sem artropatia não seria um fator de risco para desenvolvimento de uveíte. A uveíte tende a desenvolver mais frequentemente em pacientes com artropatia ou psoríase pustulosa que em outras formas de psoríase. Avaliação oftalmológica deve ser feita periodicamente em pacientes com psoríase, proporcionando ao paciente um diagnóstico precoce da oftalmopatia e a instituição de tratamento adequado com anti-inflamatórios não hormonais ou drogas imunomoduladoras, no intuito de evitar a perda da visão nos pacientes com psoríase e uveíte.