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1.
J Infect Chemother ; 29(8): 820-824, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37182841

RESUMO

We report a case of prolonged shedding of the infective SARS-CoV-2 omicron variant BA.1.1.2 in a 79-year-old male patient with diffuse large B-cell lymphoma, after receiving chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP). The patient was admitted to our hospital in late March 2022 for the sixth course of R-CHOP chemotherapy. Initially, the patient tested negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using an in-hospital loop-mediated amplification assay with a nasopharyngeal swab, both on the day of admission and three days later. However, the patient developed fever and was diagnosed with coronavirus disease (COVID-19) six days after admission and was suspected to have contracted the infection in the ward. Viral shedding continued for more than three months, with confirmed viral infectivity. As compared to the original Wuhan-Hu-1/2019 strain, amino acid substitutions including S36 N in non-structural protein (NSP)2, S148P, S1265del and L1266I in NSP3, G105D in NSP4, G496S, A831V, or V987F in spike protein, and I45T in open-reading frame (ORF)9b were randomly detected in isolated viruses. Although the patient had received two doses of the BNT162b2 vaccine approximately six months earlier and the third dose on day 127 after the infection, both serum anti-spike and anti-nuclear protein IgG and IgM tests were negative at day 92, 114, and 149 after the infection. The patient finally cleared the virus after the third course of remdesivir and did not have further recurrence.


Assuntos
COVID-19 , Linfoma Difuso de Grandes Células B , Masculino , Humanos , Idoso , SARS-CoV-2 , Vacina BNT162 , Tratamento Farmacológico da COVID-19 , Linfoma Difuso de Grandes Células B/tratamento farmacológico
2.
Int J Hematol ; 118(5): 642-646, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37084069

RESUMO

Myelodysplastic neoplasms (MDS) are defined by cytopenia and morphologic dysplasia originating from clonal hematopoiesis. They are also frequently complicated with diseases caused by immune dysfunction, such as Behçet's disease (BD) and secondary pulmonary alveolar proteinosis (sPAP). MDS with both BD and sPAP is extremely rare, and their prognosis is poor. In addition, haploinsufficiency of the hematopoietic transcription factor gene GATA2 is recognized as a cause of familial MDS and is frequently complicated by sPAP. Herein, we report a case of MDS combined with both BD and sPAP in association with GATA2 deficiency in a Japanese woman. Because she developed progressive leukopenia and macrocytic anemia during BD treatment at the age of 61, she underwent a bone-marrow examination and was diagnosed with MDS. She subsequently developed sPAP. At the age of 63, she underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT). Since allo-HSCT, she has maintained complete remission of MDS as well as the symptoms of BD and sPAP. Furthermore, we performed whole exome sequencing and identified the GATA2 Ala164Thr germline mutation. These findings suggest that patients with MDS, BD and sPAP should be considered for early allo-HSCT.


Assuntos
Síndrome de Behçet , Transplante de Células-Tronco Hematopoéticas , Leucopenia , Síndromes Mielodisplásicas , Neoplasias , Proteinose Alveolar Pulmonar , Feminino , Humanos , Proteinose Alveolar Pulmonar/genética , Proteinose Alveolar Pulmonar/terapia , Síndrome de Behçet/complicações , Síndrome de Behçet/terapia , Neoplasias/complicações , Síndromes Mielodisplásicas/complicações , Síndromes Mielodisplásicas/genética , Síndromes Mielodisplásicas/terapia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Mutação em Linhagem Germinativa , Fator de Transcrição GATA2/genética
3.
Tohoku J Exp Med ; 259(4): 285-291, 2023 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-36653160

RESUMO

Castleman disease (CD) is a lymphoproliferative disorder that manifests as hypergammaglobulinemia and severe inflammation with multiorgan involvement. However, renal involvement has been infrequently described in CD. We present a case of a 63-year-old Japanese male patient with multicentric CD (MCD) in whom kidney involvement, including impaired renal function and massive proteinuria, is present. He had a 2-year history of inflammatory arthritis and was referred to our clinic with newly developed proteinuria, renal dysfunction, and elevated levels of acute-phase proteins. Abdominal computed tomography scan revealed hepatosplenomegaly, including mesenteric and inguinal lymph node enlargements. The patient underwent inguinal lymph node resection. Excisional biopsy of the inguinal lymph node showed multiple lymphoid follicles and expansion of interfollicular areas by marked plasmacytosis consistent with mixed type CD. The patient was diagnosed with human herpes virus 8-negative MCD according to the international diagnostic criteria for CD. Diagnostic renal biopsy was not performed following the medical viewpoint. Tocilizumab (TCZ) treatment was highly effective in reducing proteinuria and stabilizing renal function, as well as improving other clinical symptoms. The patient responded to TCZ treatment, and the renal involvement was rapidly improved. Our preliminary immunohistochemical analysis indicated AA amyloid deposits in urinary epithelial cells suggesting a possible renal involvement of AA amyloidosis. TCZ could potentially be one of the therapeutic options in patients with MCD with renal involvement.


Assuntos
Hiperplasia do Linfonodo Gigante , Humanos , Masculino , Pessoa de Meia-Idade , Hiperplasia do Linfonodo Gigante/complicações , Hiperplasia do Linfonodo Gigante/tratamento farmacológico , Hiperplasia do Linfonodo Gigante/diagnóstico , Proteinúria/complicações , Proteinúria/tratamento farmacológico
4.
Front Immunol ; 13: 1002329, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36353621

RESUMO

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Most of the infected individuals have recovered without complications, but a few patients develop multiple organ involvements. Previous reports suggest an association between COVID-19 and various inflammatory myopathies, in addition to autoimmune diseases. COVID-19 has been known to exacerbate preexisting autoimmune diseases and trigger various autoantibodies and autoimmune disease occurrence. Here we report a case of complicated COVID-19 with anti-synthetase autoantibodies (ASSs) presenting with skin rash, muscle weakness, and interstitial lung disease (ILD) and subsequently diagnosed with dermatomyositis (DM). A 47-year-old Japanese male patient without any previous history of illness, including autoimmune diseases, presented with a high fever, sore throat, and cough. Oropharyngeal swab for SARS-Cov-2 polymerase chain reaction tested positive. He was isolated at home and did not require hospitalization. However, his respiratory symptoms continued, and he was treated with prednisolone (20 mg/day) for 14 days due to the newly developing interstitial shadows over the lower lobes of both lungs. These pulmonary manifestations remitted within a week. He presented with face edema and myalgia 4 weeks later when he was off corticosteroids. Subsequently, he presented with face erythema, V-neck skin rash, low-grade fever, and exertional dyspnea. High-resolution computed tomography of the chest showed ILD. Biochemical analysis revealed creatine kinase and aldolase elevations, in addition to transaminases. Anti-aminoacyl tRNA synthetase (ARS) was detected using an enzyme-linked immunosorbent assay (170.9 U/mL) (MESACUP™ (Medical & Biological Laboratories, Japan), and the tRNA component was identified as anti-PL-7 and anti-Ro-52 antibodies using an immunoblot assay [EUROLINE Myositis Antigens Profile 3 (IgG), Euroimmun, Lübeck,Germany]. The patient was diagnosed with DM, especially anti- synthase antibody syndrome based on the presence of myositis-specific antibodies, clinical features, and pathological findings. The present case suggests that COVID-19 may have contributed to the production of anti-synthetase antibodies (ASAs) and the development of de novo DM. Our case highlights the importance of the assessment of patients who present with inflammatory myopathy post-COVID-19 and appropriate diagnostic work-up, including ASAs, against the clinical features that mimic DM after post-COVID-19.


Assuntos
Doenças Autoimunes , COVID-19 , Dermatomiosite , Exantema , Doenças Pulmonares Intersticiais , Miosite , Humanos , Masculino , Pessoa de Meia-Idade , Dermatomiosite/complicações , Dermatomiosite/diagnóstico , Dermatomiosite/tratamento farmacológico , COVID-19/complicações , SARS-CoV-2 , Doenças Pulmonares Intersticiais/diagnóstico , Doenças Pulmonares Intersticiais/tratamento farmacológico , Doenças Pulmonares Intersticiais/etiologia , Autoanticorpos , Doenças Autoimunes/complicações
5.
Mod Rheumatol Case Rep ; 6(1): 41-46, 2022 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-34651654

RESUMO

Type B insulin resistance syndrome (TBIR) is a rare autoimmune disease characterised by autoantibodies targeting insulin receptors. TBIR is often complicated by systemic lupus erythematosus (SLE). We describe the case of a 59-year-old Japanese man with TBIR complicated with lupus nephritis (LN), who presented with nephrotic syndrome and severe hypoglycaemia. Treatment with prednisolone (PSL), mycophenolate mofetil (MMF), and tacrolimus (TAC) resulted in improved SLE activity and glucose intolerance with the reduction of anti-insulin receptor autoantibodies. To the best of our knowledge, this is the first reported case of TBIR complicated with LN that was successfully treated using multitarget therapy with PSL, MMF, and TAC.


Assuntos
Resistência à Insulina , Nefrite Lúpica , Humanos , Imunossupressores/uso terapêutico , Nefrite Lúpica/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Ácido Micofenólico/uso terapêutico , Prednisolona/uso terapêutico , Tacrolimo/uso terapêutico , Resultado do Tratamento
6.
BMC Gastroenterol ; 21(1): 488, 2021 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-34930121

RESUMO

BACKGROUND: Gastrointestinal lesions, which sometimes develop in Behçet's disease (BD), are referred to as intestinal BD. Although rare, intestinal BD can be accompanied by myelodysplastic syndrome (MDS) with abnormal karyotype trisomy 8, which is refractory to immunosuppressive therapy. Pulmonary alveolar proteinosis is a rare lung complication of BD and MDS. Herein, we present an extremely rare case of intestinal BD presenting with MDS and several chromosomal abnormalities, followed by secondary pulmonary proteinosis. CASE PRESENTATION: A 58-year-old Japanese woman with a 3-year history of genital ulcers and oral aphthae was admitted to our hospital. The patient developed abdominal pain and persistent diarrhea. Colonoscopy revealed multiple, round, punched-out ulcers from the terminal ileum to the descending colon. Intestinal BD was diagnosed and the patient was treated with colchicine, prednisolone, and adalimumab. However, her symptoms were unstable. Bone marrow examination to investigate the persistent macrocytic anemia revealed the presence of trisomy 8, trisomy 9, and X chromosome abnormalities (48, + 8, + 9, X, i(X) (q10) in 12 out of the examined 20 cells). Based on her hypoplastic bone marrow, the patient was diagnosed with low-risk MDS (refractory anemia). At the age of 61, the patient developed pneumonia with fever and diffuse ground-glass opacities on the lung computed tomography (CT). Chest high-resolution CT and histopathology via transbronchial lung biopsy revealed the presence of pulmonary alveolar proteinosis (PAP). These findings combined with the underlying disease led to the diagnosis of secondary PAP. CONCLUSIONS: Secondary pulmonary proteinosis may accompany intestinal BD with MDS and several chromosomal abnormalities. Physicians should pay attention to lung complications, such as PAP, in patients with intestinal BD complicated by MDS. Genetic abnormalities may be associated with the development of such diseases.


Assuntos
Síndrome de Behçet , Enteropatias , Síndromes Mielodisplásicas , Proteinose Alveolar Pulmonar , Síndrome de Behçet/complicações , Síndrome de Behçet/tratamento farmacológico , Feminino , Humanos , Pessoa de Meia-Idade , Síndromes Mielodisplásicas/complicações , Proteinose Alveolar Pulmonar/complicações , Proteinose Alveolar Pulmonar/diagnóstico por imagem , Trissomia
7.
Tohoku J Exp Med ; 255(2): 157-162, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34690203

RESUMO

Immunoglobulin A (IgA) vasculitis is a systemic small-vessel vasculitis involving the skin, kidney, joints, and gastrointestinal tract. Familial Mediterranean fever (FMF) is the most common autoinflammatory disease characterized by periodic fever, peritonitis, pleuritis, or arthritis. It is well known that FMF may coexist with vasculitis, especially small and medium vessel vasculitis. Here we present a Japanese male patient with FMF who later developed IgA vasculitis and a relapsing disease course. A 51-year-old Japanese male was referred because of upper abdominal pain, arthralgia, and bilateral purpura of the lower limbs. He fulfilled the criteria for IgA vasculitis, which was successfully treated by corticosteroid and immunosuppressive therapy. He had a medical history of periodic fever since the age of 10 years old. The Mediterranean fever (MEFV) gene analysis revealed that he was heterozygous for M694I and E148Q mutations. Colchicine therapy resolved his periodic febrile attacks. To our knowledge, coexistence of FMF with IgA vasculitis has not been reported in East Asia, including Japan. Our case suggests that MEFV gene exon 10 mutations could be related to the development of IgA vasculitis and affects its clinical course.


Assuntos
Febre Familiar do Mediterrâneo , Vasculite por IgA , Criança , Éxons/genética , Febre Familiar do Mediterrâneo/complicações , Febre Familiar do Mediterrâneo/tratamento farmacológico , Febre Familiar do Mediterrâneo/genética , Febre , Humanos , Imunoglobulina A , Japão , Masculino , Pessoa de Meia-Idade , Mutação , Pirina/genética
8.
Medicine (Baltimore) ; 100(15): e24889, 2021 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-33847609

RESUMO

RATIONALE: Anti-myelin oligodendrocyte protein antibody-associated disease (MOGAD) is a new disease entity with various clinical phenotypes. MOGAD often present with recurrent optic neuritis (ON), and it can also develop as a compartment of neuromyelitis optica spectrum disorder (NMOSD). Moreover, multiple autoantibodies such as an anti-myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA) had been reported in the serum of patients with NMOSD. PATIENT CONCERNS: We report an 86-year-old woman with a 2-year history of microscopic polyangiitis (MPA). The patient had a rapid loss of vision in her left eye. No abnormal findings were observed on her left fundus, and she tested negative for MPO-ANCA upon admission. However, anti-MOG antibodies were observed in the patient's serum and cerebrospinal fluid. DIAGNOSIS: A diagnosis of MOGAD complicated with MPA was made. INTERVENTIONS: The patient received twice steroid pulse therapy and oral azathioprine as maintenance therapy. OUTCOMES: Her vision rapidly recovered, and no subsequent relapse was observed during the 8-month observation period. CONCLUSION: To the best of our knowledge, this is the first case of MOGAD complicated with MPA, and steroid pulse therapy and azathioprine therapy were effective for ON caused by MOGAD.


Assuntos
Doenças Autoimunes/complicações , Glicoproteína Mielina-Oligodendrócito/imunologia , Neurite Óptica/complicações , Idoso de 80 Anos ou mais , Doenças Autoimunes/tratamento farmacológico , Cegueira/etiologia , Feminino , Humanos , Imunossupressores/uso terapêutico , Neurite Óptica/tratamento farmacológico
9.
Fukushima J Med Sci ; 65(3): 140-145, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31827012

RESUMO

We report a patient with dermatomyositis (DM) complicated with progressive pleural effusion and ascites. A 40-year-old woman was hospitalized in our department because of severe myalgia and dysphagia, complicated with pleural effusion and massive ascites. Elevated muscle enzymes, Gottron's papules, and electromyography (EMG) confirmed the diagnosis of DM. Combined immunosuppressive treatment consisting of intravenous immunoglobulin (IV-IG), intravenous-cyclophosphamide (IV-CY) and tacrolimus resolved her myopathy and dysphagia as well as pleural effusion and massive ascites. Her clinical course and the absence of other factors that cause pleural effusion and ascites suggest that these symptoms were related to the pathophysiology of DM.


Assuntos
Ascite/etiologia , Dermatomiosite/complicações , Derrame Pleural/etiologia , Adulto , Dermatomiosite/tratamento farmacológico , Feminino , Humanos , Imunossupressores/uso terapêutico
10.
Intern Med ; 52(22): 2503-9, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24240788

RESUMO

OBJECTIVE: The aim of this study was to elucidate the efficacy of cyclophosphamide (CY) in Japanese patients with antineutrophil cystoplasmic antibody (ANCA)-associated microscopic polyangiitis (MPA). METHODS: Sixty-four patients, newly diagnosed with ANCA-associated MPA were included in this retrospective study. The patients were divided into two groups based on whether they received combination therapy of CY and corticosteroid (CS) (CY group, n=29) or CS alone (CS group, n=35) for remission induction. The primary outcome was all-cause mortality. RESULTS: Most patients in the CY group were treated with oral CY. Between the two groups, there were no differences in the baseline characteristics except for a higher proportion of male patients in the CY group. The remission rate was not substantially different between the two groups (86.2% in the CY group vs. 91.4% in the CS group). The survival rate was slightly higher in the CY group than in the CS group (not statistically significant; 0.86 vs. 0.77 at 1 year and 0.73 vs. 0.64 at 5 years, p=0.648). In the CY group, the hazard ratio after adjusting for age, sex, Birmingham vasculitis activity score values, serum albumin levels and C-reactive protein (CRP) levels was 0.657 (95% CI, 0.254-1.699; p=0.386). CONCLUSION: We observed no increased efficacy of CY in ANCA-positive MPA in the Japanese patients, and hence, its efficacy may be limited in these patients.


Assuntos
Ciclofosfamida/uso terapêutico , Poliangiite Microscópica/tratamento farmacológico , Corticosteroides/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Anticorpos Anticitoplasma de Neutrófilos/sangue , Povo Asiático , Ciclofosfamida/administração & dosagem , Quimioterapia Combinada , Feminino , Humanos , Japão , Masculino , Metilprednisolona/administração & dosagem , Poliangiite Microscópica/imunologia , Pessoa de Meia-Idade , Prednisolona/administração & dosagem , Estudos Retrospectivos , Resultado do Tratamento
11.
Mod Rheumatol ; 21(3): 320-4, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21174143

RESUMO

A 69-year-old man presented shortness of breath and acute renal failure. He had undergone pulmonary partial resection for lung cancer 5 months prior. On examination, severe hypertension, skin sclerosis of his forearms, and anticentromere antibody were observed. A renal biopsy specimen showed characteristic findings for scleroderma renal crisis, and a right heart catheterization revealed severe pulmonary arterial hypertension. Re-examination of the resected lung specimen revealed sclerodermatous vascular involvement was present.


Assuntos
Injúria Renal Aguda/patologia , Hipertensão Pulmonar/patologia , Fibrose Pulmonar/patologia , Escleroderma Sistêmico/patologia , Idoso , Biópsia , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Rim/patologia , Pulmão/diagnóstico por imagem , Pulmão/patologia , Masculino , Fibrose Pulmonar/diagnóstico por imagem , Fatores de Tempo , Tomografia Computadorizada por Raios X
12.
Kyobu Geka ; 63(9): 795-9, 2010 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-20715461

RESUMO

UNLABELLED: We performed bronchoplasty for a bronchogenic tumor of low-grade malignancy without lung parenchyma resection. A 69-year-old man visited our hospital in March 2008 because of cough. Chest computed tomography (CT) revealed atelectasis of the entire left upper lobe and a 2-cm mass with strong contrast enhancement in the lumen of the left main bronchus. Bronchoscopy identified a polypoid mass in the left main bronchus, about 3 cm distal to carina, obstructing the lumen. Biopsy led to a diagnosis of typical carcinoid tumor. Surgery : Thoracotomy showed complete atelectasis of the left upper lobe. After lymph node dissection, resection of the left main bronchus including the site of tumor origin was performed. From the extent of expansion, the left upper lobe was decided to be possible to be spared, and end-to-end anastomosis of the bronchus was performed. Postoperative respiratory rehabilitation resulted in improved aeration of the left upper lobe and markedly improved respiratory function. CONCLUSION: The judgment of whether the long-standing atelectatic left upper lobe could be spared or not was a key in choosing this procedure.


Assuntos
Brônquios/cirurgia , Neoplasias Brônquicas/cirurgia , Tumor Carcinoide/cirurgia , Idoso , Humanos , Masculino , Procedimentos Cirúrgicos Pulmonares/métodos
13.
Fukushima J Med Sci ; 54(1): 38-42, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18924551

RESUMO

A 19-year-old Japanese woman had melena 2 months after systemic lupus erythematosus was diagnosed. Colonoscopy showed diffuse ulceration with bleeding in the ileum, suggesting that the melena was due to ischemic enteritis associated with lupus enteritis. Because treatment with high doses of steroid, anticoagulants, and cyclophosphamide pulse was ineffective, surgical intervention was planned. On exploration, it was impossible to determine the extent of resection visually. Intraoperative esophagogastroduodenoscopy clearly revealed the border between the ulcer and normal area, permitting successful resection of the ileum and ileostomy. This is the first report to document the usefulness of esophagogastroduodenoscopy in surgical treatment of ischemic enteritis in a patient with systemic lupus erythematosus.


Assuntos
Endoscopia do Sistema Digestório , Enterite/complicações , Enterite/diagnóstico , Lúpus Eritematoso Sistêmico/complicações , Adulto , Enterite/cirurgia , Feminino , Humanos , Ileíte/complicações , Ileíte/diagnóstico , Ileíte/cirurgia , Íleo/irrigação sanguínea , Período Intraoperatório , Isquemia/complicações , Isquemia/diagnóstico , Isquemia/cirurgia
14.
Fukushima J Med Sci ; 54(2): 73-8, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19418969

RESUMO

Synovial vascularization in metacarpophalangeal joints of a patient with rheumatoid arthritis treated with leukocytapheresis (LCAP) was evaluated by Doppler sonography. After the treatment with LCAP, evaluation with American College of Rheumatology core set showed improvement, and the levels of C-reactive protein and serum amyloid A protein decreased. Power Doppler sonography demonstrated a reduction of color flow signals of the joints, and spectral Doppler sonography demonstrated an increase in vascular resistant, indicating a reduction of vessel's permeability. This is the first report evaluating a synovial vascularization and blood flow of the joints by Doppler sonography before and after LCAP therapy. Doppler sonography might be one of the useful methods for evaluating the therapeutic response of LCAP.


Assuntos
Artrite Reumatoide/terapia , Leucaférese , Membrana Sinovial/irrigação sanguínea , Ultrassonografia Doppler , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/fisiopatologia , Feminino , Humanos , Pessoa de Meia-Idade , Membrana Sinovial/diagnóstico por imagem , Resistência Vascular
15.
Fukushima J Med Sci ; 53(1): 27-32, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17957963

RESUMO

We present a case of late-onset ulcerative colitis (UC) complicated with cytomegalovirus (CMV) pneumonia revealed by autopsy. A 77-year-old woman had a diagnosis of UC, and received high-dose steroids and leukocytapheresis. Then she received ganciclovir because CMV-pp65 antigenemia test revealed positive which suggested systemic or colonic CMV infection. But ganciclovir was discontinued because of thrombocytopenia and liver dysfunction. After that she had interstitial pneumonia and died of a respiratory failure. Autopsy revealed CMV colitis based on UC, and CMV pneumonia with diffuse alveolar damage. Evaluation of CMV infection in patients with steroid-refractory UC should be considered before proceeding with immunosuppressive therapy or surgery, especially in elderly patients.


Assuntos
Colite Ulcerativa/complicações , Infecções por Citomegalovirus/complicações , Pneumonia Viral/complicações , Idoso , Colite Ulcerativa/tratamento farmacológico , Colite Ulcerativa/patologia , Infecções por Citomegalovirus/patologia , Evolução Fatal , Feminino , Humanos , Imunossupressores/efeitos adversos , Pneumonia Viral/patologia , Esteroides/efeitos adversos
16.
J Clin Ultrasound ; 35(9): 524-6, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17373684

RESUMO

We report a case of phlegmonous gastritis in a 36-year-old man presenting with anorexia, epigastralgia, and high fever. Endoscopy showed an edematous lesion suggesting a submucosal lesion. Endosonography revealed thickening of the gastric wall, mainly involving the submucosa, with a few anechoic areas. The separation between the submucosa and the muscularis propria was unclear. The patient was treated with antibiotics and endoscopic mucosal resection. Culture of the aspirated pus from the lesion revealed Streptococcus pyogenes. Follow-up endosonography performed 1 week later showed significant improvement.


Assuntos
Celulite (Flegmão)/diagnóstico por imagem , Endossonografia , Gastrite/diagnóstico por imagem , Adulto , Antibacterianos/uso terapêutico , Celulite (Flegmão)/microbiologia , Seguimentos , Mucosa Gástrica/diagnóstico por imagem , Mucosa Gástrica/microbiologia , Gastrite/microbiologia , Humanos , Masculino , Infecções Estreptocócicas/diagnóstico , Streptococcus pyogenes/isolamento & purificação
17.
J Neuroimmunol ; 181(1-2): 150-6, 2006 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17064784

RESUMO

We detected anti-triosephosphate isomerase antibodies (anti-TPI) in cerebrospinal fluid (CSF) in 5 of 12 neuropsychiatric lupus patients (41.6%) by Western blotting. C3d index was significantly higher in anti-TPI-positive patient (n=5, median 0.446) than in anti-TPI-negative patient (n=7, median 0.098) (p=0.019) CSF samples. TPI was detected from immune complexes (IC) isolated from CSF in 2 of 2 anti-TPI-positive patients tested and was not detected from IC in 5 of 5 anti-TPI-negative patients tested. Our results suggest that anti-TPI form IC in CSF and contribute to the pathogenesis of neuropsychiatric lupus by activating the complement system.


Assuntos
Autoanticorpos/líquido cefalorraquidiano , Ativação do Complemento/imunologia , Vasculite Associada ao Lúpus do Sistema Nervoso Central/imunologia , Triose-Fosfato Isomerase/imunologia , Autoanticorpos/isolamento & purificação , Western Blotting , Complemento C3d/líquido cefalorraquidiano , Complemento C3d/metabolismo , Humanos , Vasculite Associada ao Lúpus do Sistema Nervoso Central/líquido cefalorraquidiano , Microesferas
18.
Mod Rheumatol ; 16(2): 92-6, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16633928

RESUMO

A 53-year-old woman who had been diagnosed with rheumatoid arthritis was found to have thrombocytopenia, splenomegaly, and gastric varices. She was diagnosed as having idiopathic portal hypertension on the basis of liver biopsy and angiography. Treatment with prednisolone was not sufficiently effective for thrombocytopenia. After transabdominal devascularization with splenectomy, thrombocytopenia subsided and gastric varices disappeared. In this case, the autoimmune mechanism as well as hypersplenism was suspected of being involved in the mechanism of thrombocytopenia.


Assuntos
Artrite Reumatoide/complicações , Hipertensão Portal/complicações , Varizes Esofágicas e Gástricas/etiologia , Varizes Esofágicas e Gástricas/cirurgia , Feminino , Humanos , Hipertensão Portal/diagnóstico , Hipertensão Portal/cirurgia , Fígado/patologia , Pessoa de Meia-Idade , Esplenectomia , Trombocitopenia/terapia , Tomografia Computadorizada por Raios X
19.
Mod Rheumatol ; 16(2): 109-12, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16633932

RESUMO

We describe a 49-year-old woman who presented in 2002 with pure red cell aplasia (PRCA), systemic lupus erythematosus (SLE), and idiopathic portal hypertension (IPH) that developed following a thymectomy. She underwent a thymectomy at 40 years of age to treat myasthenia gravis. PRCA developed 3 years after the thymectomy and she was successfully treated with cyclosporin. Systemic lupus erythematosus and IPH were diagnosed 6 years later. We conclude that immunological dysfunction resulting from the thymectomy contributed significantly to the subsequent development of PRCA, SLE, and IPH in this patient. This is the first report to describe this extremely rare occurrence.


Assuntos
Hipertensão Portal/etiologia , Lúpus Eritematoso Sistêmico/etiologia , Miastenia Gravis/cirurgia , Complicações Pós-Operatórias , Aplasia Pura de Série Vermelha/etiologia , Timectomia/efeitos adversos , Adulto , Feminino , Humanos , Hipertensão Portal/patologia , Hipertensão Portal/terapia , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/patologia , Prednisolona/uso terapêutico , Aplasia Pura de Série Vermelha/tratamento farmacológico , Aplasia Pura de Série Vermelha/patologia , Escleroterapia , Resultado do Tratamento
20.
World J Gastroenterol ; 12(13): 2136-8, 2006 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-16610072

RESUMO

A 46-year-old woman was diagnosed with palmoplantar pustulosis (PPP) at the Department of Dermatology, Fukushima Medical University Hospital in 2000, and was treated with ointment. However, because liver dysfunction developed in 2003, she was referred to our department, where primary biliary cirrhosis (PBC) was also diagnosed on the basis of clinical findings. One year later, at the age of 49, she developed manifestations of Behçet's disease (BD), including erythema nodosum in the lower extremities. Because she had a history of uveitis, recurrent oral ulceration was present, and the HLA typing was positive for B51, BD was additionally diagnosed. Liver function normalized within three months of the start of treatment with ursodesoxycholic acid (UDCA). This is the first case of PBC associated with BD and PPP.


Assuntos
Síndrome de Behçet/complicações , Cirrose Hepática Biliar/complicações , Psoríase/complicações , Adulto , Feminino , Humanos
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