[Relapsing pleural effusion and gastric polyposis: a case report]. / Derrame pleural recidivante e polipose gástrica - Caso clínico.

The authors present the case of a lymphoproliferative disorder (LPD) with pleuro-pulmonary involvement. It was a very aggressive primary gastric lymphoma of the MALT subtype, diagnosed in an 86-year-old woman admitted in Pulmonology ward at our Hospital with pleural effusion. Helicobacter pylori search was negative, what is infrequent. The disease was already disseminated at the time of the diagnosis and did not respond to various treatment modalities, what is also an uncommon finding. Clinical presentation, diagnosis and management of this disease are reviewed, pointing out its unique features and comparing the particular aspects of this case with the published literature. The authors stress that LPD is an important diagnosis to be held in mind in the case of a pleural effusion of unknown aetiology.

Spontaneous rupture of the spleen as presenting event in infectious mononucleosis.

We report the case of a patient who underwent a life-saving splenectomy after spontaneous rupture of the spleen. The patient had no history of recent trauma and developed obvious clinical signs of infectious mononucleosis only 5 d after the splenectomy. Also of note was the late seroconversion in this patient.

[Cytomegalovirus-induced colitis in HIV infection. Considerations on its diagnosis, treatment and complications]. / Colite pelo citomegalovirus na infecção pelo VIH. Considerações sobre o diagnóstico, terapêutica e complicações.

The diagnosis of cytomegalovirus intestinal disease in patients with HIV (human immunodeficiency virus) infection frequently raises diagnostic problems in view of the absence of definite pathological, serological or virological markers of active CMV infection. We describe the case of a 47-year-old man with a CMV colitis which illustrates several diagnostic and therapeutic problems and that was complicated by an intestinal perforation. We emphasize that in HIV+ patients with chronic diarrhea, the presence of abdominal pain should suggest the possibility of a CMV colitis and that in such cases a colonoscopy with biopsies of the right colon should be performed, in view of the higher frequency of the typical histopathological changes at this level. On the other hand, this case presented a marked thickening of the colon wall, simulating pseudotumoral images on CAT scans, as recently described in literature. The therapeutic possibilities as well as the complications of CMV colitis are discussed in the context of the occurrence of an ileal perforation, which represents the first report of this complication in Portuguese literature and which had the particularity of having a long survival after surgery in comparison with the previous cases described in international literature.

[Collagenous colitis: clinical and histologic improvement after sulfasalazine and topical betamethasone]. / Colite colagenosa: melhoria clínica e histológica após sulfasalazina e betametasona tópica.

We here by report a case of a 42 year-old white woman with an eight-year history of watery diarrhea where the rectal biopsies performed in endoscopically normal mucosa led to the diagnosis of collagenous colitis, characterized histologically by a thickening of the colonic subepithelial basement membrane. A brief review of the current etiopathogenic concepts of this entity is done and the importance of performing rectal biopsies in patients with unexplained diarrhea and normal appearing colon mucosa is stressed. A clinical improvement following therapy with Sulfasalazine and Beta-methasone enemas was found in this patient. We discuss the current views on the therapy and the difficulties of assessing responses to drugs in this condition.

Caroli's disease of the left hepatic lobe associated with hepatic fibrosis.

We report a case of segmental Caroli's disease limited to the left hepatic lobe in a 32-year-old woman who presented with cholangitis. Histologic examination showed hepatic fibrosis also limited to the left lobe.