[Primary biliary cirrhosis-autoimmune hepatitis overlap syndrome. Contribution of two new cases]. / Síndrome "overlap" hepatitis autoinmune-cirrosis biliar primaria. Aportación de dos nuevos casos.

The autoimmune hepatitis (AIH)-primary biliary cirrhosis (PBC) overlap syndrome is characterized for clinical, biochemical, immunological, and histological features overlapping those of AIH and PBC, whose pathogenesis and more appropriate treatment are unknown at present. We describe two new patients of this entity, which made debut with cholestasic acute hepatitis accompanied of hypergammaglobulinemia. In the first patient was demonstrated the presence of AMA, ASMA, and anti-LKM1 autoantibodies; and ANA in the second one. The histological findings showed changes suggestive of AIH and PBC. After the start of immunosuppressive treatment, associated to ursodeoxycholic acid in one patient, a successful outcome was observed.

Síndrome “overlap” hepatitis autoinmune-cirrosis biliar primaria. Aportación de dos nuevos casos / Primary biliary cirrhosis-autoimmune hepatitis over lap syndrome. Contribution of two new cases

El síndrome “overlap” hepatitis autoinmune (HAI)-cirrosis biliar primaria (CBP) se caracteriza por un solapamiento de hallazgos clínicos, analíticos, inmunológicos e histológicos tanto de HAI como de CBP, cuya patogenia y tratamiento más adecuado se desconoce en la actualidad. Describimos dos nuevos casos de esta entidad, que debutaron con un brote de hepatitis aguda colestásica acompañado de hipergammaglobulinemia. En el primer caso se demostró la presencia de los anticuerpos AMA, ASMA y anti-LKM1; y en el segundo de los ANA. Los hallazgos histológicos mostraron alteraciones sugestivas de HAI y de CBP. Tras la instauración de tratamiento inmunosupresor, asociado a ácido ursodesoxicólico en un caso, se observó una buena evolución clínica

The autoimmune hepatitis (AIH)-primary biliary cirrhosis (PBC) overlap syndrome is characterized for clinical, biochemical, immunological, and histological features overlapping those of AIH and PBC, whose pathogenesis and more appropriate treatment are unknown at present. We describe two new patients of this entity, which made debut with cholestasic acute hepatitis accompanied of hypergammaglobulinemia. In the first patient was demonstrated the presence of AMA, ASMA, and anti-LKM1 autoantibodies; and ANA in the second one. The histological findings showed changes suggestive of AIH and PBC. After the start of immunosuppressive treatment, associated to ursodeoxycholic acid in one patient, a successfull outcome was observed

[Enterococcus faecalis bacteremia]. / Bacteriemia por Enterococcus faecalis.

OBJECTIVE: Analysis of Enterococcus faecalis bacteremia epidemiological, clinical, microbiological and prognostic characteristics. METHODS: Retrospective analysis of clinical records of patients with E. faecalis bacteremia throughout 7 years (January 1995-December 2001). RESULTS: 95 episodes of bacteremia were documented, 83.2% with nosocomial origin, 85.3% associated to previous invasive procedures and 9.5% in neonates. 57.9% patients suffered an underlying disease and 41.1% had received previously broad-spectrum antibiotics without activity against enterococcus. 32.6% bacteremia episodes was considered primary and, in the rest, the most frequent associated sources of infection were cardiovascular, intra-abdominal, urogenital, and lung. The resistance study showed a single case of resistance to ampicillin and none to glucopeptides. Global mortality was 23.9%, although only in 9.9% was directly attributable to bacteremia. Inadecuate treatment and mechanical ventilation were factors of poor prognosis in the multivariate analysis. CONCLUSIONS: E. faecalis bacteremia is in our environment essentially a hospital-acquired infection in patients with severe underlying diseases, subject to invasive procedures, and previously treated with wide spectrum antibiotherapy. Ampicillin continues to be the treatment of choice. Inappropriateness of the initial empirical antibiotic treatment and mechanical ventilation are factors of poor prognosis.

Paquimeningitis hipertrófica granulomatosa craneal / Cranial granulomatous hypertrophic pachymeningitis

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Celulitis por Aeromonas hydrophila / Cellulitis caused by aeromonas hydrophilia

Describimos el caso de un paciente cirrótico con vasculitis leucocitoclástica que desasrrolló un cuadro rápido y progresivo de celulitis con bullas hemorrágicas y sepsis por Aeromonas hydrophila, cuya puerta de entrada fue el lecho quirúrgico de la biopsia cutánea (AU)

[Cellulitis caused by Aeromonas hydrophila]. / Celulitis por Aeromonas hydrophila.

We report the case of a cirrhotic patient with leukocytoclastic vasculitis who developed a rapid and progressive cellulitis with hemorrhagic bulla and sepsis due to Aeromonas hydrophila, the portal of entry was the surgical leech of a cutaneous biopsy.