Mononeuritis múltiple y fascitis eosinofílica en una paciente con síndrome hipereosinofílico idiopático / Multiple mononeuritis and eosinophilic fasciitis in a patient with idiopathic hypereosinophilic syndrome

Introducción. El síndrome hipereosinofílico se produce por infiltración tisular habitualmente múltiple de eosinófilos, y puede ser secundario o idiopático según si se relaciona o no con etiología específica. No es raro que incluya enfermedad del nervio, pero es inusual que lo haga en forma de multineuritis. Excepcionalmente la patogenia en mononeuritis múltiple parece relacionarse con neurotoxicidad por productos derivados de eosinófilos y no con fenómenos infiltrativos o inflamatorios. Se presenta el caso de una paciente con síndrome hipereosinofílico sin causa demostrable, multineuritis y fascitis eosinofílica. Caso clínico. Mujer de 30 años sin antecedentes que consultó por nódulos inguinales indoloros que aparecieron semanas antes. Casi de manera simultánea presentó un cuadro sensitivo doloroso en las piernas con una impotencia funcional significativa. Se demostró una importante hipereosinofilia, fascitis eosinofílica e infiltración eosinofílica de médula ósea no neoplásica, así como mononeuritis múltiple. El tratamiento con corticoides orales mejoró la clínica dermatológica y hematológica, y la asociación con gabapentina, los síntomas neuropáticos. Conclusiones. La paciente, según criterios actuales, presentó síndrome hipereosinofílico idiopático con subtipo indeterminado. La asociación con fascitis eosinofílica y multineuritis constituye una asociación no documentada en nuestro conocimiento. No existe en mononeuritis múltiple un mecanismo infiltrativo demostrado, lo que apoya el mal control de la sintomatología neuropática con la corticoterapia oral. La asociación con gabapentina, estabilizador de la membrana axonal, también apoya la hipótesis patogénica neurotóxica (AU)

Introduction. Hypereosinophilic syndrome is produced by what is usually a multiple infiltration of eosinophils into tissues, and may be secondary or idiopathic, depending on whether it is related to a specific aetiology or not. It is not uncommon for it to include nerve disease, but it is unusual for it to do so in the form of multineuritis. Exceptionally, pathogenesis into multiple mononeuritis appears to be related with neurotoxicity due to products derived from eosinophils rather than with infiltrating or inflammatory phenomena. This study describes the case of a female patient with hypereosinophilic syndrome with no verifiable cause, multineuritis and eosinophilic fasciitis. Case report. A 30-year-old female with no relevant history who visited because of some painless inguinal nodules that had appeared several weeks before. At almost the same time, she presented painful sensitive symptoms in her legs with a significant functional incapacity. An important degree of hypereosinophilia, eosinophilic fasciitis and non-neoplastic eosinophilic infiltration of the bone marrow was found, together with multiple mononeuritis. Treatment with oral corticoids improved the dermatological and haematological clinical features, and associating it with gabapentin improved the neuropathic symptoms. Conclusions. The patient, in accordance with current criteria, presented idiopathic hypereosinophilic syndrome with an undetermined subtype. To our knowledge, the association with eosinophilic fasciitis and multineuritis has not been reported to date. There is no proven infiltrating mechanism in multiple mononeuritis, which corroborates the poor control of the neuropathic clinical symptoms with oral corticoid therapy. Association with gabapentin, which stabilises the axonal membrane, also backs up the neurotoxic pathogenetic hypothesis (AU)

[Isolated conjunctival involvement in Langerhans cell histiocytosis]. / Histiocitosis de células de Langerhans con afectación conjuntival aislada.

CASE REPORT: A 43-year-old woman referred for a hyperemic node in the inferior conjunctival fornix. No improvement was observed after 10 days of antibiotic and anti-inflammatory topical treatment, so biopsy-extirpation was performed. Histopathological and immunohistochemical findings suggested the diagnosis of Langerhans cell histiocytosis (LCH). No findings of extraocular manifestations were shown after an intensive clinical and analytical investigation. DISCUSSION: LCH is a disease with different organ manifestations whose diagnosis depends on histological findings. We present a patient with isolated conjunctival affectation, which to our knowledge is the third case published in the literature.

Histiocitosis de células de Langerhans con afectación conjuntival aislada / Isolated conjunctival involvement in langerhans cell histiocytosis

Caso clínico: Mujer de 43 años que consulta por unnódulo hiperémico en fondo de saco conjuntivalinferior. Tras diez días de tratamiento antibiótico yantiinflamatorio tópico no se observa mejoría, porlo que se realiza una biopsia-extirpación. El resultadoanatomopatológico e inmunohistoquímico esinformado como histiocitosis de células de Langerhans(HCL), procediéndose a realizar un estudiosistémico con diferentes pruebas complementarias,sin hallar afectación a otro nivel.Discusión: La histiocitosis de células de Langerhanses una enfermedad de afectación muy variada,cuyo diagnóstico se establece mediante hallazgoshistológicos. Presentamos un caso de implicaciónexclusivamente conjuntival, habiéndose publicadosólo tres casos previamente en la literatura médica consultada(AU)

Case report: A 43-year-old woman referred for ahyperemic node in the inferior conjunctival fornix.No improvement was observed after 10 days ofantibiotic and anti-inflammatory topical treatment,so biopsy-extirpation was performed. Histopathologicaland immunohistochemical findings suggestedthe diagnosis of Langerhans cell histiocytosis(LCH). No findings of extraocular manifestationswere shown after an intensive clinical and analyticalinvestigation.Discussion: LCH is a disease with different organmanifestations whose diagnosis depends on histologicalfindings. We present a patient with isolatedconjunctival affectation, which to our knowledge isthe third case published in the literature(AU)

[Prevalence of metabolic syndrome in the province of Albacete (Spain)]. / Prevalencia del síndrome metabólico en la provincia de Albacete.

OBJECTIVE: The primary objective of this study was to determine the prevalence of Metabolic Syndrome (MS) in people between 40-70 years of age in the province of Albacete (Spain). PATIENTS AND METHODS: A population-based, cross-sectional study was made of people between 40-70 years of age in three representative municipalities of the province of Albacete. A total of 425 subjects were included, with a mean age of 53.1 years (95% CI: 52.3-54). Women represented 50.4% of the series and males 49.6%. All participants were subjected to general laboratory testing, physical examination and the measurement of anthropometric parameters. MS was defined according to the ATP-III criteria. Prevalence of MS and its distribution according to the different epidemiological characteristics were calculated. RESULTS: Total prevalence of MS was 20.9% (88/421), with a mean age of 57 years (95% CI: 55.1-59). Prevalence was seen to increase with age, reaching up to one-third of all subjects over 60 years. Significant differences were observed in relationship to a background of ischemic heart disease, ultrasensitive C-reactive protein elevation and the detection of microalbuninuria in MS subjects. Arterial hypertension and abdominal obesity were the most prevalent criteria in MS subjects. CONCLUSIONS: Taking into consideration the important co-morbidity of MS, knowledge of the prevalence and characteristics of the syndrome in our setting and its early identification and intervention targeted to the different factors underlying MS will contribute to reduce the number of cardiovascular events associated with the syndrome.

Prevalencia del síndrome metabólico en la provincia de Albacete / Prevalence of metabolic syndrome in the province of Albacete (Spain)

Objetivo. El objetivo principal del estudio es determinar la prevalencia del síndrome metabólico (SM) en personas entre 40 y 70 años en la provincia de Albacete. Pacientes y métodos. Se trata de un estudio transversal poblacional en personas entre 40 y 70 años en tres municipios representativos de la provincia de Albacete. La participación total del estudio fue de 425 individuos. La edad media de la muestra fue de 53,1 años (intervalo de confianza [IC] 95%: 52,3-54), con un 50,4% de mujeres y un 49,6% de hombres. A todos los participantes se les realizó una analítica general y una exploración física con medición de parámetros antropométricos. El SM se definió según los criterios del Adult Treatment Panel-III (ATP-III). En el análisis estadístico se calculó la prevalencia del SM, así como su distribución según sus características epidemiológicas. Resultados. La prevalencia total del SM fue del 20,9% (88/421), con una edad media de 57 años (IC 95%: 55,1-59). Su prevalencia aumenta con la edad, siendo de hasta un tercio de la población mayor de 60 años. Por otra parte, se han encontrado diferencias significativas con antecedentes de cardiopatía isquémica, elevación de la proteína C reactiva ultrasensible y la detección de microalbuminuria en los pacientes con SM. La hipertensión arterial y la obesidad abdominal fueron los criterios más prevalentes en los pacientes con SM. Conclusiones. Teniendo en cuenta la importante comorbilidad que este síndrome conlleva, el conocimiento de su prevalencia y sus características en nuestro medio, así como su identificación y la intervención precoz sobre los distintos factores que la componen, contribuirían a una disminución de eventos cardiovasculares que se relacionan con este síndrome

Objective. The primary objective of this study was to determine the prevalence of Metabolic Syndrome (MS) in people between 40-70 years of age in the province of Albacete (Spain). Patients and methods. A population-based, cross-sectional study was made of people between 40-70 years of age in three representative municipalities of the province of Albacete. A total of 425 subjects were included, with a mean age of 53.1 years (95% CI: 52.3-54). Women represented 50.4% of the series and males 49.6%. All participants were subjected to general laboratory testing, physical examination and the measurement of anthropometric parameters. MS was defined according to the ATP-III criteria. Prevalence of MS and its distribution according to the different epidemiological characteristics were calculated. Results. Total prevalence of MS was 20.9% (88/421), with a mean age of 57 years (95% CI: 55.1-59). Prevalence was seen to increase with age, reaching up to one-third of all subjects over 60 years. Significant differences were observed in relationship to a background of ischemic heart disease, ultrasensitive C-reactive protein elevation and the detection of microalbuninuria in MS subjects. Arterial hypertension and abdominal obesity were the most prevalent criteria in MS subjects. Conclusions. Taking into consideration the important co-morbidity of MS, knowledge of the prevalence and characteristics of the syndrome in our setting and its early identification and intervention targeted to the different factors underlying MS will contribute to reduce the number of cardiovascular events associated with the syndrome

Artritis séptica y endocarditis por Escherichia coli / Arthritis and endocarditis due to Escherichia coli

No disponible

Síndrome coronario agudo en paciente tratado previamente con capecitabina y 5-fluorouracilo / Acute coronary syndrome in a patient previously treated with capecitabine and 5-fluorouracil

No disponible

Presentación inusual de absceso por Staphyloccoccus aureus / Unusual presentation of an abscess by Staphyloccoccus aureus

No disponible

Bacteriemia por Citrobacter freundii: presentación de dos casos / Bacteremia caused by Ctrobacter freundii: review

No disponible

Atelectasia secundaria a tumor carcinoide bronquial / Atelectasis secondary to bronchial carcinoid tumor

No disponible