Actualización en el tratamiento de la dermatomiositis; a propósito de un caso / Update in the treatment of dermatomyositis; a case study

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[Neuroschistosomiasis: a challenging diagnosis]. / Neuroesquistosomiasis: un reto para el diagnóstico.

INTRODUCTION: Neuroschistosomiasis is an uncommon and under diagnosed disease in our country because of the no clinical suspicion. The most common neurological manifestations are epileptic seizures as central nervous system involvement or different types of myelopathies: transverse myelitis, myeloradiculopathy, cauda equina syndrome or Brown-Sequard syndrome. CASE REPORT: A 27 years-old male from an endemic area, with atypical neurological affectation as he presented myelopathy and multifocal neuritis. Diagnosis was based on the epidemiological exposure datums, the myelopathy, the positive serological studies for Schistosoma haematobium, no detection of other parasitic infections and the clinical and radiological improvement after treatment. Cervical and thoracic magnetic resonance showed areas of hyper signal in T2 as it was described in other cases. It was detected S. haematobium in the bladder, the rest of serological and microbiological studies were negative. Besides, eosinophils on the biopsy of sural nerve orientative to parasitic etiology. CONCLUSION: In patient with myelopathy or another unexplained neurological manifestation we have to suspect neuroschistosomiasis. In a world where migrations and travels are so frequent we have to think in this type of diseases.

Neuroesquistosomiasis: un reto para el diagnóstico / Neurochistosomiasis: a challenging diagnosis

Introducción. La neuroesquistosomiasis es una entidad poco frecuente e infradiagnosticada en nuestro medio por la falta de sospecha clínica. Las formas más habituales de presentación son afectación cerebral o distintas variantes de mielopatías: mielitis transversa, mielorradiculopatía, síndrome de cola de caballo, síndrome de Brown-Séquard. Caso clínico. Varón de 27 años oriundo de zona endémica, con afectación neurológica atípica, pues presenta sintomatología medular y neuropatía multifocal. Los datos epidemiológicos de exposición, la clínica de mielopatía, la serología positiva para Schistosoma haematobium, el descarte de otras posibles parasitosis y la mejoría tanto clínica como radiológica tras el tratamiento nos han permitido llegar al diagnóstico. Las imágenes cervicales y dorsales observadas en la resonancia magnética son similares a las descritas en otras ocasiones. En la investigación etiológica se detecta S. haematobium vesical, siendo el resto de serologías y análisis microbiológicos negativos. Además la presencia de eosinófilos en la biopsia del nervio sural orienta hacia el origen parasitario de dicha afectación. Conclusión. Ante un paciente con mielopatía u otra afectación neurológica no explicada debemos sospechar neuroesquistomiasis. En un mundo donde las migraciones y los viajes son tan frecuentes, cada día debemos pensar más en este tipo de enfermedades de origen tropical

Introduction. Neuroschistosomiasis is an uncommon and under diagnosed disease in our country because of the no clinical suspicion. The most common neurological manifestations are epileptic seizures as central nervous system involvement or different types of myelopathies: transverse myelitis, myeloradiculopathy, cauda equina syndrome or Brown-Séquard syndrome. Case report. A 27 years-old male from an endemic area, with atypical neurological affectation as he presented myelopathy and multifocal neuritis. Diagnosis was based on the epidemiological exposure datums, the myelopathy, the positive serological studies for Schistosoma haematobium, no detection of other parasitic infections and the clinical and radiological improvement after treatment. Cervical and thoracic magnetic resonance showed areas of hyper signal in T2 as it was described in other cases. It was detected S. haematobium in the bladder, the rest of serological and microbiological studies were negative. Besides, eosinophils on the biopsy of sural nerve orientative to parasitic etiology. Conclusion. In patient with myelopathy or another unexplained neurological manifestation we have to suspect neuroschistosomiasis. In a world where migrations and travels are so frequents we have to think in this type of diseases

Haemolytic-uraemic syndrome with thrombotic microangiopathy of the retina following cytomegalovirus infection: postmortem findings.

Haemolytic-uraemic syndrome is characterized by thrombotic microangiopathy of the glomeruli and smaller arterial vessels of the kidney. Extrarenal thrombotic microangiopathy occurs, but ocular involvement is rarely demonstrated microscopically. We describe a 33 year old woman with a 3 week febrile episode and seropositivity for cytomegalovirus infection who developed acute renal failure, blindness and severe encephalopathy which was the cause of death. Thrombotic microangiopathy of retinal vessels may be more common than is expected from the literature. The exclusion of ocular structures in postmortem examinations explains the lack of anatomoclinical correlation.

[Rosai-Dorfman disease of the mesenteric lymph nodes and appendix. Secondary to salmonellosis?]. / Enfermedad de Rosai-Dorfman en ganglios mesentéricos y apéndice. Secundaria a salmonelosis?

A 28 year-old female patient was operated for acute abdominal pain. At the surgical intervention the mesenteric nodes turned out to be enlarged and the appendix was apparently normal. Microscopically, the changes observed were of the Rosai-Dorfman disease type in the appendix as well as in the nodes. A salmonella D was cultivated in the mesenteric nodes. This association, which has not been described in the literature, permits us to comment clinicopathological aspects, poorly defined, with special reference to the possibility that some instances of Rosai-Dorfman disease could be secondary to an infectious process.