Chronic pain and vitamin B12 deficiency, a challenging and important differential diagnosis. Case report / Dor crônica e deficiência de vitamina B12, um diagnóstico diferencial desafiador e importante. Relato de caso

ABSTRACT BACKGROUND AND OBJECTIVES: The study's objective was to present a case of diffuse chronic pain with 36 months of development, associated with recurrent oral aphthous ulcers and glossitis, highlighting the importance of the wide differential diagnosis and the possibility of vitamin B12 deficiency as a cause. CASE REPORT: Male patient, 39 years-old, white, reported diffuse pain predominantly in the cervical, thoracic, abdominal, thighs and left knee regions, besides the presence of frequent oral aphtae, lasting more than 5 days, multiple and painful, predominantly on the tongue, for 6 months. The condition was attributed to Behçet's disease, but there was complete and permanent remission after treatment with vitamin B12. CONCLUSION: It's important to insert vitamin B12 deficiency for differential diagnosis in chronic pain scenarios.

RESUMO JUSTIFICATIVA E OBJETIVOS: O objetivo deste estudo foi apresentar um caso de dor crônica difusa com 36 meses de evolução, associada com aftas orais de repetição e glossite, destacando a importância do amplo diagnóstico diferencial e da possibilidade da deficiência de vitamina B12 como causa. RELATO DO CASO: Paciente do sexo masculino, 39 anos, branco, referindo dores difusas que predominavam em região cervical, torácica, abdominal, coxas e joelho esquerdo, além da presença de aftas orais frequentes, com duração superior a 5 dias, múltiplas e dolorosas, predominando na língua, há 6 meses. O quadro foi atribuído à doença de Behçet, mas houve remissão total e permanente após tratamento com vitamina B12. CONCLUSÃO: É importante inserir a deficiência de vitamina B12 para o diagnóstico diferencial em quadros de dor crônica.

[Endocarditis with negative blood cultures and immunological alterations: a grand challenge]. / Endocardite com hemoculturas negativas e alterações imunológicas: um grande desafio.

Subacute Infectious endocarditis can present immunological phenomena and extracardiac manifestations such as anemia and musculoskeletal pain which can mimic rheumatological disease. It is related a case on infectious endocarditis presenting symptomatology similar to Polymyalgia Rheumatica despite acute nephritis after antibiotic. The differential diagnostic features of Libman-Sacks endocarditis versus infective endocarditis are discussed.