[Tuberculous rheumatism "Poncet's disease". Case report]. / Reumatismo tuberculoso "enfermedad de Poncet". Reporte de caso.

BACKGROUND: Deaths due to tuberculosis have reached 2.5 million cases per year worldwide. Poncet's disease is an infrequent form of tuberculosis characterised by a clinical picture of polyarthritis. CLINICAL CASE: A 24-year-old male presented with morning stiffness, arthralgias, bilateral symmetric arthritis of the proximal interphalangeal joints, wrists, knees, ankles, and shoulders, and adenomegalies at the cervical, submandibular, left supraclavicular, axillary and inguinal levels, without fever. Laboratory results were as follows: ESR 44mm/h, C-reactive protein 4.35, normal levels of complement C3 and C4, negative rheumatoid factor and anticyclic citrullinated peptide antibodies, positive antinuclear antibodies with fine speckled pattern (1:320) and cytoplasm (1:160) pattern and negative anti-Smith, -double-stranded DNA, Sjogren's syndrome-antigen A and Sjogren's syndrome-antigen B. Histological report of cervical node tissue revealed granulomatous lesions compatible with tuberculosis. Rheumatoid arthritis and systemic lupus erythematosus were ruled out. Anti-tuberculosis agents were initiated that resolved the clinical picture. Diagnosis of Poncet's disease was confirmed. CONCLUSION: The differential diagnosis between tuberculosis and autoimmune inflammatory joint diseases is a clinical challenge.

Prospective study of urinary tract infection surveillance after kidney transplantation.

BACKGROUND: Urinary tract infection (UTI) remains one of the main complications after kidney transplantation and it has serious consequences. METHODS: Fifty-two patients with kidney transplantation were evaluated for UTI at 3-145 days (mean 40.0 days) after surgery.. Forty-two received a graft from a live donor and 10 from a deceased donor. There were 22 female and 30 male patients, aged 11-47 years. Microscopic examinations, leukocyte esterase stick, and urinary culture were performed every third day and weekly after hospitalization. A positive culture was consider when patients presented bacterial counts up to 105 counts. RESULTS: UTI developed in 19/52 (37%) patients at 3-75 days (mean 19.5 days after transplantation. Recurrent infection was observed in 7/52 (13.4%) patients at days 17-65. UTI was more frequent in patients who received deceased grafts compared with live grafts (7/10, 70% vs. 12/42, 28%; p < 0.007). Female patients were more susceptible than male (11/22, 50% vs. 8/22, 36.35%; p < 0.042). Five-year survival rate was 94.5% (49/52 patients). Kidney Graft exit update is 47/52 (90.2%), and there were no significant differences between graft rejection and UTI (p = 0.2518). Isolated bacteria were Escherichia coli (31.5%), Candida albicans (21.0%) and Enterococcus spp. (10.5%), followed by Pseudomonas aeruginosa, Klebsiella pneumoniae, Morganella morganii, Enterobacter cloacae and Micrococcus spp. Secondary infections were produced by (7/19, 36.8%). Enterococcus spp. (57%), E. coli (28%) and Micrococcus spp. (14.2%). Antibiotic resistance was 22% for ciprofloxacin and 33% for ampicillin. Therapeutic alternatives were aztreonam, trimethoprim-sulfamethoxazole, netilmicin and fosfomycin. CONCLUSIONS: Surveillance of UTI for the first 3 months is a good option for improving quality of life of kidney transplantation patients and the exit of graft function especially for female patients and those receiving deceased grafts. Antibiograms provided a good therapeutic alternative to patients who presented with UTIs after receiving a kidney allograft.

Tumor hipofisario familiar de compromiso somatomamotrópico / Familiar pituitary tumor with somatotropic compromise

Se describe por vez primera el adenoma hipofisario de estirpe familiar, con afección aparente sobre el somatomamotropo responsable de la secreción de hormona de crecimiento y prolactina, cuya transmisión fue de carácter antosómico domiante. Destacó que un par de miembros sin tumor demostrable, cursaron con datos clínicos (fenotipo) de acromegaloidismo. Al investigarse antígenos de histocompatibilidad resaltó que tanto los pacientes con tumor y otros sintomáticos pero sin tumor compartieron los mismos haplotipos, por lo que es muy posible que la investigación de antígenos HLA en los pacientes con tumor hipofisiario ayude a reconocer mejor su naturaleza y frecuencia