RESUMO
We present 3 cases of autoimmune liver disease in human immunodeficiency virus (HIV)-infected patients and describe the different diagnostic and therapeutic approaches used in each case. The first patient was diagnosed with primary biliary cholangitis (PBC) with features of autoimmune hepatitis (AIH), requiring second-line therapy due to incomplete response to ursodeoxycholic acid. The second patient was diagnosed with AIH with features of PBC and had the particular challenges of presenting with advanced liver fibrosis and having a past history of disseminated cytomegalovirus infection. The last case concerns an AIH with acute liver injury, successfully treated with corticosteroids and azathioprine. Recently, the number of patients on antiretroviral therapy (ART) for HIV disease has increased significantly. Therefore, more patients with this chronic infection have been diagnosed with autoimmune diseases, leading to concerns regarding immunosuppressive therapies in this population. With these cases, we alert for these increasingly incident diseases and support the safety of immunosuppressive therapies, provided that HIV is suppressed with ART.
Apresentamos três casos distintos de doença hepática autoimune em doentes com infeção pelo vírus da imunodeficiência humana (VIH), descrevendo as diferentes abordagens diagnósticas e terapêuticas. O primeiro doente foi diagnosticado com colangite biliar primária (CBP) com caraterísticas de hepatite autoimune (HAI), necessitando de terapêutica de segunda linha por resposta incompleta ao ácido ursodesoxicólico (AUDC). O segundo doente foi diagnosticado com HAI com caraterísticas de CBP, com as particularidades de se apresentar com fibrose hepática avançada e de ter tido uma infeção disseminada pelo citomegalovírus. O terceiro caso apresentou-se como uma hepatite aguda grave, tratada com corticoterapia e azatioprina. Recentemente, o número de doentes sob terapêutica antirretroviral (TARV) para a infeção pelo VIH tem aumentado significativamente. Consequentemente, mais doentes com esta infeção crónica têm sido diagnosticados com doenças autoimunes, levando a receios na administração de terapêuticas imunossupressoras. Com esta série de casos pretendemos alertar para esta incidência crescente e para a segurança dos imunossupressores, desde que os doentes apresentem a sua infeção pelo VIH controlada com a TARV.
RESUMO
OBJECTIVE: To describe a rare case of acute Q fever with tache noire. CLINICAL PRESENTATION AND INTERVENTION: A 51-year-old man experienced acute Q fever showing tache noire, generally considered a pathognomonic sign of Mediterranean spotted fever (MSF) and MSF-like illness, but not a clinical feature of Q fever. The patient was treated with doxycycline 100 mg every 12 h. CONCLUSION: In the Mediterranean area, tache noire should be considered pathognomonic of MSF but it should not rule out Q fever. Clinical diagnosis should be supported by accurate laboratory diagnostic tests to guide proper management.
