Colitis como forma de presentación de una granulomatosis eosinofílica con poliangitis / Colitis as a form of presentation of eosinophilic granulomatosis with polyangiitis

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Prostatitis y retención aguda de orina como comienzo de granulomatosis de Wegener / Prostatitis and acute urinary retention as first manifestations of Wegener's granulomatosis

Objetivos. Presentar un caso de prostatitis con retención aguda de orina como manifestación inicial poco frecuente de granulomatosis de Wegener. Métodos. Se presenta el caso de un varón de 48 años con un cuadro de prostatitis de 10 días de evolución, que presentó retención de orina, con respuesta parcial al tratamiento antibiótico, y con niveles elevados de anticuerpos citoplasmáticos contra los neutrófilos con patrón citoplasmático y estudio anátomo-patológico de la biopsia prostática compatible con granulomatosis de Wegener. Resultados. Tras el inicio de tratamiento mediante glucocorticoides y ciclofosfamida se observa mejoría notable de los síntomas hasta su desaparición. A los 3 meses inicia clínica pulmonar y de vías aéreas superiores, precisando para el control de sus síntomas dosis mayores de ciclofosfamida. Conclusiones. La granulomatosis de Wegener es una entidad multisistémica cuya forma de presentación como prostatitis con retención de orina es poco frecuente (AU)

Objectives. We present a case of prostatitis with acute urinary retention as a rare initial manifestation of Wegener's granulomatosis. Methods. The case was a 48-year-old male with symptoms of prostatitis over 10 days. The patient presented urinary retention, with partial response to antibiotic treatment. High levels of cytoplasmic antineutrophil cytoplasmic antibody and a prostatic biopsy were compatible with Wegener's granulomatosis. Results. After starting treatment with glucocorticoids and cyclophosphamide, a significant improvement to the point of disappearance of symptoms was observed. At 3 months pulmonary and upper airway symptoms began, requiring higher doses of cyclophosphamide to control symptoms. Conclusions. Wegener's granulomatosis is a multisystem entity whose presentation as prostatitis with urinary retention is rare (AU)

[Primary endometriosis: a differential diagnosis with the umbilical nodular lesions]. / Endometriosis primaria: un diagnóstico diferencial dentro de las lesiones nodulares umbilicales.

The onset of umbilical nodules with no previous abdominal surgeries or known endometriosis in other locations characterizes primary umbilical endometriosis. We present a 43-year-old woman with a painful umbilical nodule for several months. We report this case to emphasize the importance of the differential diagnosis of umbilical nodules, especially in women during the reproductive period.

Prostatitis and acute urinary retention as first manifestations of Wegnener's granulomatosis.

OBJECTIVES: We present a case of prostatitis with acute urinary retention as a rare initial manifestation of Wegener' Granulomatosis. METHODS: The case was a 48-year-old male with symptoms of prostatitis over ten days. The patient presented urinary retention, with partial response to antibiotic treatment. High levels of cytoplasmic antineutrophil cytoplasmic antibody and a prostatic biopsy were compatible with Wegener' Granulomatosis. RESULTS: After starting treatment with glucocorticoids and cyclophosphamide, a significant improvement to the point of disappearance of symptoms was observed. At 3 months pulmonary and upper airway symptoms began, requiring higher doses of cyclophosphamide to control symptoms. CONCLUSIONS: Wegener's Granulomatosis is a multisystem entity whose presentation as prostatitis with urinary retention is rare.

[Down syndrome: another cause of immunosuppression associated with multiple eruptive dermatofibromas?]. / Síndrome de Down: ¿otra causa de inmunosupresión asociada con dermatofibromas eruptivos múltiples?

The term "multiple eruptive dermatofibromas" usually refers to a clinical situation characterized by the development of between five and eight dermatofibromas during a period of up to four months. It is usually linked to immunodeficiency associated conditions as autoimmune disorders, hematologic malignancies, HIV infection, and transplants. We report three patients with Down syndrome. One patient had psoriatic arthritis under treatment with methotrexate, one had Graves-Basedow disease, and one had hypercholesterolemia. All three patients developed multiple eruptive dermatofibromas. We suggest that the immunologic disturbances associated with Down syndrome, together with other underlying conditions present in these patients, could trigger the development of cutaneous lesions.

Multiple pulmonary nodules in a patient with Crohn's disease.

Crohn's disease (CD) can be associated with respiratory involvement. Multiple pulmonary nodules are an infrequent finding in patients with CD. When they are found, histology usually shows sterile necrobiotic nodules, which are spherical aggregates of neutrophils, which frequently cavitate. We report a patient with inactive CD treated with mesalazine, who presented with multiple pulmonary nodules. Transthoracic biopsy of one of the nodules disclosed a benign, nongranulomatous inflammatory lymphoid infiltration. The radiographic abnormalities responded well to oral prednisone. Focal, nongranulomatous lymphoid infiltration thus must be considered in the differential diagnosis of multiple pulmonary nodules in patients with CD.

Solitary perirenal metastasis from a malignant peripheral nerve sheath tumour mimicking a primary renal tumour.

We present an uncommon case of a large solitary perirenal metastasis from a malignant peripheral nerve sheath tumour (MPNST) mimicking a primary renal tumour. A metastatic MPNST to the perirenal space is unusual and, in this rare location, is difficult to differentially diagnose from a primary renal tumour.

[Tuberculous epididymitis caused by Mycobacterium bovis]. / Epididimitis tuberculosa por Micobacterium bovis.

OBJECTIVES: To focus on the need of including tuberculosis among differential diagnoses of any epidymo-testicular mass, especially if its evolution is torpid. METHODS/RESULTS: A 73-year-old man who presented with scrotum abscess underwent surgical drainage and antibiotic treatment, but suppuration relapsed through cutaneous fistulae. A epipidymectomy was then performed, which demonstrated tuberculous granulomas. Torax Rx showed a cystic apical pulmonary wound which was treated with 3 antituberculostatics for 12 months. Sputum culture was positive for Micobacterium Bovis. CONCLUSIONS: Aspirative punction under sonographic control is a valuable technique to avoid mutilating surgeries and to permit an almost always effective treatment, before the appearance of permanent lesions which lead to sterility.

Epididimitis tuberculosa porMicobacterium Bovis / Mycobacterium bovis tuberculous epididymitis

OBJETIVOS: Enfatizar sobre la necesidad de incluir la tuberculosis en el diagnóstico diferencial de cualquier masa epidimo-testicular especialmente si su curso es tórpido. MÉTODO/RESULTADOS: Presentamos a un varón de 73 años que acude por clínica compatible con absceso escrotal que es drenado y tratado con antibióticos pero que presenta recidiva de la supuración apareciendo trayectos fistulosos cutáneos por lo que se practica epidimectomía que mostró afectación tuberculosa del mismo. Se comprobó entonces una lesión pulmonar quístico-cavitaria apical izquierda iniciándose tratamiento antituberculostático con 3 drogas durante 12 meses. El cultivo de esputo resultó positivo para M. Bovis. CONCLUSIÓN: La PAAF con control ecográfico es una técnica muy útil para evitar cirugías mutilantes y permitir un tratamiento, casi siempre efectivo, antes de que aparezcan lesiones permanentes que conduzcan a la esterilidad (AU)

Varón con fiebre y dolor en hipocondrio izquierdo de semanas de evolución / Male with fever and left hypochondrial pain of several weeks' duration

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[Unilateral renal agenesia and transitional cell carcinoma: report of 2 cases]. / Agenesia renal unilateral y carcinoma de células transicionales: a propósito de dos casos.

OBJECTIVE: To describe two cases of unilateral renal agenesis complicated by the association of a urothelial carcinoma and review the literature. METHODS: After reviewing our series of transitional cell carcinoma, we found two cases with associated unilateral renal agenesis. Case 1: A 46-year-old male with grade III stage C transitional cell carcinoma of the urinary bladder that was treated sequentially by transurethral resection of the bladder, systemic neoadjuvant polychemotherapy (gemcitabin, taxol and cisplatin) before radical cystectomy and Bricker urinary diversion were performed. Due to the extent of the tumor, complementary adjuvant therapy was administered, but the patient died 10 months after cystectomy due to disease progression. Case 2: An asymptomatic 71-year-old male in whom renal agenesis and ureteral pelvic filling defect, which was treated by ureterectomy, were incidentally discovered during a routine abdominal study. At one year follow-up, no evidence of tumor recurrence has been observed. RESULTS: 23 patients with unilateral renal agenesis in association with different endocrine or genitourinary cancers have been reported in the literature. In unilateral renal agenesis anomalies of some of the genes involved in renal development occur and may lead to dysplastic growth of the embryologically related organs and an increased risk of developing tumors. CONCLUSIONS: 93% of the tumors reported in patients with unilateral renal agenesis were found to arise from the genitourinary organs.

Agenesia renal unilateral y carcinoma de células transicionales: a propósito de dos casos / Unilateral renal agenesis and transitional cell carcinoma: Report of two cases

OBJETIVOS: Describir 2 casos de agenesia renal unilateral (ARU) complicada por la presencia de un carcinoma urotelial y realizar una amplia revisión de la literatura existente (1-19).MÉTODO: Tras una revisión de nuestra casuística de carcinoma transicional, hemos encontrado 2 casos que presentaban asociadamente ARU. Caso 1: Varón de 46 años diagnosticado de carcinoma transicional de vejiga grado III estadio C que fue tratado secuencialmente mediante resección transuretral de vejiga, poliquimioterapia sistémica (Gemcitabina, Taxol y Cisplatino) neoadjuvante previa a la realización de cistectomía radical y derivación urinaria tipo Bricker. Dada la extensión tumoral se realizó radioterapia adjuvante complementaria, a pesar de lo cual el paciente falleció por progresión de la enfermedad a los 10 meses de la cistectomía. Caso 2: Varón de 71 años que se encontraba asintomático y que tras un estudio rutinario abdominal se diagnosticó de agenesia renal y de un defecto de replección ureteral pélvico que fue tratado mediante ureterectomía. El paciente se encuentra libre de recidiva neoplásica después de un año de seguimiento. RESULTADOS: El 93 por ciento de los tumores publicados en pacientes con ARU tienen su origen sobre los órganos genitourinarios (AU)