Tuberculoma epidural espinal simulando Síndrome de Guillain-Barré: presentación de un caso

El sistema nervioso central es uno de los focos extrapulmonares afectados con mayor frecuencia por tuberculosis, no obstante, el tuberculoma epidural espinal es considerado una rareza. Se presenta el caso de un paciente de cuatro años de edad, quien consulta por cuadro de cuadriparesia progresiva. Al examen de líquido cefalorraquídeo se evidenció disociación proteínico celular diagnosticándose síndrome de Guillain Barré, sin embargo, tras la aparición de signos meníngeos, se realizó una resonancia nuclear magnética de columna en la que se evidenció lesión compresiva a nivel cervicodorsal que fue posteriormente explorada quirúrgicamente por neurocirugía, encontrándose una lesión epidural cuyo estudio microbiológico, cultivo y estudio de reacción en cadena de la polimerasa se reportaron positivos para Mycobacterium tuberculosis, por lo que se inició tratamiento antituberculoso observándose mejoría clínica y progresiva con recuperación de la marcha tras el procedimiento quirúrgico. MÉD.UIS. 2016;29(2):155-9.

The central nervous system is one of the most affected focus in extrapulmonary tuberculosis, however, spinal epidural tuberculoma is considered very unusual. We present a clinical report of a four years old patient who presented with clinical symptoms of a progressive quadriparesis. The cerebroespinal fluid examination showed protein-cell dissociation, and the diagnosis of Guillain Barré syndrome was made. However, because it called the attention the appearance of meningeal signs, a magnetic resonance imaging was performed, and evidenced a compressive lesion in the cervicodorsal level. It was explored by neurosurgery, finding an epidural lesion studied by cultures and polymerase chain reaction. Both reported positive results for Mycobacterium tuberculosis. The anti-tuberculosis treatment was started and a progressive clinical improvement was observed with recuperation of the gait after the surgical procedure.MÉD.UIS. 2016;29(2):155-9.

Aborto Recurrente de Etiología Autoinmune / Autoimmune Recurrent Abortion

El curso normal del embarazo implica una serie de cambios inmunológicos que permiten el desarrollo armónico fetal. En mujeres con pérdida recurrente de la gestación, diversas etiologías se han relacionado como desencadenantes de dichas pérdidas; jugando el factor autoinmune un papel cada vez más importante. En el presente artículo, a partir de una búsqueda sistemática de información, se exponen en detalle los aspectos inmunológicos del embarazo normal, así como las alteraciones que a este nivel se presentan en mujeres con aborto recurrente. Además, se realiza una orientación diagnóstica y se exponen las diversas opciones terapéuticas utilizadas, haciendo énfasis en la necesidad de establecer protocolos estandarizados para el manejo de esta entidad.

Normal development of the pregnancy involves a number of immunological changes that allow harmonic fetal development. In women with recurrent pregnancy loss several etiologies have been implicated as triggers of such losses; autoimmune factor is nowadays playing an increasingly more important roll. In this article, based on a systematic search of information, are exposed in details the immunological aspects of normal pregnancy, as well as the immune alterations that occur in women with recurrent abortion. In addition, a diagnostic guidance is made and the various therapeutic options used are pointed out, emphasizing the need to establish standardized protocols for the management of this entity.

Skin manifestations of arthropod-borne infection in Latin America.

PURPOSE OF REVIEW: Arthropods are a significant cause of human skin lesions and infections, especially in Latin America. This review summarizes recent articles on the cutaneous manifestations of arthropod-borne diseases, with an emphasis on those diseases causing direct skin damage but also considering those systemic diseases with cutaneous manifestations. RECENT FINDINGS: Studies have shown a variety and increase of cutaneous manifestations caused by arthropod-borne infections, including petechiae, purpura, ulcers, nodules, atrophic, miliary and hyperpigmented lesions. Although unspecific, when considering other features they become a useful tool in the diagnostic approach. Unusual cutaneous presentation of these diseases has been found to be associated with development of immunity, virulent strain, drug resistance and immunosuppressive states. Also, because of globalization, climate change and large-scale migration, these manifestations have spread to new areas. SUMMARY: Cutaneous manifestations of arthropod-borne infections are varied and nonspecific. Their atypical presentations are mainly related to immune impairment and strain virulence. When considering a patient with skin lesions, other clinical and laboratory features must be taken into account in order to make an accurate diagnostic approach.