Post-acute COVID-19 in three doses vaccinated autoimmune rheumatic diseases patients: frequency and pattern of this condition

Abstract Background Data on post-acute COVID-19 in autoimmune rheumatic diseases (ARD) are scarce, focusing on a single disease, with variable definitions of this condition and time of vaccination. The aim of this study was to evaluate the frequency and pattern of post-acute COVID-19 in vaccinated patients with ARD using established diagnosis criteria. Methods Retrospective evaluation of a prospective cohort of 108 ARD patients and 32 non-ARD controls, diagnosed with SARS-CoV-2 infection (RT-PCR/antigen test) after the third dose of the CoronaVac vaccine. Post-acute COVID-19 (≥ 4 weeks and > 12 weeks of SARS-CoV-2 symptoms) were registered according to the established international criteria. Results ARD patients and non-ARD controls, balanced for age and sex, had high and comparable frequencies of ≥ 4 weeks post-acute COVID-19 (58.3% vs. 53.1%, p = 0.6854) and > 12 weeks post-acute COVID-19 (39.8% vs. 46.9%, p = 0.5419). Regarding ≥ 4 weeks post-acute COVID-19, frequencies of ≥ 3 symptoms were similar in ARD and non-ARD controls (54% vs. 41.2%, p = 0.7886), and this was also similar in > 12 weeks post-acute COVID-19 (68.3% vs. 88.2%, p = 0.1322). Further analysis of the risk factors for ≥ 4 weeks post-acute COVID-19 in ARD patients revealed that age, sex, clinical severity of COVID-19, reinfection, and autoimmune diseases were not associated with this condition (p > 0.05). The clinical manifestations of post-acute COVID-19 were similar in both groups (p > 0.05), with fatigue and memory loss being the most frequent manifestations. Conclusion We provide novel data demonstrating that immune/inflammatory ARD disturbances after third dose vaccination do not seem to be a major determinant of post-acute COVID-19 since its pattern is very similar to that of the general population. Clinical Trials platform (NCT04754698).

Predictors of renal damage in systemic lupus erythematous patients: data from a multiethnic, multinational Latin American lupus cohort (GLADEL).

AIM: A decrease in proteinuria has been considered protective from renal damage in lupus nephritis (LN), but a cut-off point has yet to be established. The aim of this study was to identify the predictors of renal damage in patients with LN and to determine the best cut-off point for a decrease in proteinuria. METHODS: We included patients with LN defined clinically or histologically. Possible predictors of renal damage at the time of LN diagnosis were examined: proteinuria, low complement, anti-double-stranded DNA antibodies, red cell casts, creatinine level, hypertension, renal activity (assessed by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)), prednisone dose, immunosuppressive drugs and antimalarial use. Sociodemographic variables were included at baseline. Proteinuria was assessed at baseline and at 12 months, to determine if early response (proteinuria <0.8 g/day within 12 months since LN diagnosis) is protective of renal damage occurrence. Renal damage was defined as an increase of one or more points in the renal domain of The Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) Damage Index (SDI). Cox regression models using a backward selection method were performed. RESULTS: Five hundred and two patients with systemic lupus erythematosus patients were included; 120 patients (23.9%) accrued renal damage during their follow-up. Early response to treatment (HR=0.58), antimalarial use (HR=0.54) and a high SES (HR=0.25) were protective of renal damage occurrence, whereas male gender (HR=1.83), hypertension (HR=1.86) and the renal component of the SLEDAI (HR=2.02) were risk factors for its occurrence. CONCLUSIONS: Early response, antimalarial use and high SES were protective of renal damage, while male gender, hypertension and higher renal activity were risk factors for its occurrence in patients with LN.

The Influence of Income and Formal Education on Damage in Brazilian Patients With Systemic Lupus Erythematosus.

OBJECTIVE: The aim of this study was to evaluate the association of socioeconomic status and American College of Rheumatology/Systemic Lupus International Collaborating Clinics Damage Index (SDI) score in Brazilian patients with systemic lupus erythematosus (SLE). METHODS: Five hundred twenty-three patients (SLE ACR criteria) 18 years or older who were at 12 months or greater since diagnosis were included. Socioeconomic status was assessed by per-capita income and years of education. Race was categorized as white and nonwhite. The SDI and Mexican SLE Disease Activity Index were used. STATISTICAL ANALYSIS: Mean ± SD and median were used for descriptive analysis. Student t test, Mann-Whitney U test, χ test, and Spearman rank correlation coefficient and univariate and multivariate regression analyses were performed. The level of significance was set at 5% for all statistical tests. RESULTS: Ninety-six percent were female, 51.2% were nonwhite, and the mean age was 37.8 ± 1.4 years. Disease duration was 8.2 ± 10.3 years and formal education was 10.2 ± 3.5 years. Unemployment among patients was 63.7%, with median monthly per-capita income of US $276. Mean SDI score was 1.4 ± 1.52, and 65.6% had some type of damage (SDI ≥1). Patients with SDI of 1 or greater had lower income (P = 0.039). Nonwhite patients had higher SDI than did white patients (P = 0.005). The SDI presented a positive correlation with disease duration (P < 0.001) and age (P < 0.001) and a negative correlation with years of education (P = 0.001). Working patients had lower SDI than did inactive ones (P ≤ 0.001). In a multivariate analysis, older age, higher disease duration, nonwhite race, low income, and out-of-work profile were associated with damage. CONCLUSIONS: Besides nonmodifiable characteristics such as longer disease duration and older age, low income was also associated with damage. Therefore, interventions to give adequate socioeconomic support are necessary to improve outcome, mainly in poorer and nonwhite SLE patients.

Qualidade de vida em pacientes com lúpus eritematoso sistêmico / Quality of life in patients with systemic lupus erythematosus

Avaliação comparativa da qualidade de vida dos pacientes com lúpus eritematoso sistêmico (LES) nas diferentes manifestações clínicas da doença, por meio do questionário SF-36. Métodos - Participaram do estudo 21 sujeitos saudáveis, denominado grupo controle, e 75 pacientes com diagnóstico de LES, agrupados como articular (n=15), renal (n=21), outro (n=17), e remissão (n=22). A qualidade devida foi avaliada pelo questionário SF-36 nos escores Capacidade Funcional (CF), Limitação por Aspecto Físico (LAF), Dor (DOR), Estado Geral de Saúde (EGS), Vitalidade (VIT), Aspectos Sociais (AS), Limitações por Aspectos Emocionais (LAE) e Saúde Mental (SM). Na inclusão foi avaliado o escore do SLEDAI (Systemic Lupus Erythematosus Disease Activity Index). Resultados - O grupo articular apresentou os menores valores em todos os escores e o controle os maiores. No escore CF o grupo articular apresentou valores significativamente menores em relação ao grupo renal (p=0,001) e grupo controle (p=0,001). Na LAF, o grupo articular apresentou escore menor que o controle(p=0,003). Na Dor, o grupo articular esteve menor em relação ao renal (p=0,023), remissão (p=0,041), e controle (p=0,003). No SM o grupo articular esteve menor que o controle (p=0,036). No EGS, o grupo controle se diferenciou do articular (p=0,037), outros (p=0,029), e remissão(p=0,036). Nos itens VIT e LAE não houve diferença entre os grupos. Conclusão - O LES interfere na qualidade de vida dos pacientes avaliados através do SF-36. A manifestação articular é o principal fator de piora comparativamente às demais manifestações...

To compare the quality of life of systemic lupus erythematosus (SLE) patients in different clinical manifestations of disease by means of the SF-36. Methods - The study invited 21 healthy subjects, called the control group and 75 patients with SLE, grouped as articular (n=15), renal (n=21), other (n=17) and remission (n=22). The quality of life was assessed by SF-36 scores in the Functional Capacity (FC), limitations due to Physical Aspect (LAF), Pain (PAIN), General Health (EGS), Vitality (VIT), Social Aspects (AS) , Limitations on the emotional aspects (LAE) and Mental Health (MH). In addition we evaluated the SLEDAI score. Results - The joint group had the lowest values in all control and the highest scores. Score in the CF group had significantly less articulate in relation to the renal group (p = 0.001) and control group (p=0.001). In LAF, the joint group had lower scores than the control (p=0.003). Pain in the joint group was lower than in the kidney (p=0.023), remission (p=0.041) and control (p=0.003). In the SM group was less articulate them the control (p=0.036). In EGS, the control group differed from the joint (p=0.037), other (p=0.029) and remission (p=0.036). In items VIT and LAE no difference between groups. Conclusion - SLE alters the quality of life of patients assessed by the SF-36. The joint demonstration is the main factor in the worsening compared to other events...

Dieta e aspectos nutricionais no lúpus eritematoso sistêmico / Diet and nutritional aspects in systemic lupus erythematosus

Os autores revisaram a influência dos fatores nutricionais sobre o lúpus eritematoso sistêmico (LES) e abordaram uma alternativa complementar em seu tratamento. A autoimunidade e o processo inflamatório do LES estão relacionados à presença de dislipidemias, obesidade, hipertensão arterial sistêmica e síndrome metabólica, que devem ser adequadamente consideradas para diminuir o risco cardiovascular. Uma alimentação com moderado teor energético e proteico, mas rica em vitaminas, minerais (principalmente os antioxidantes) e ácidos graxos mono/poli-insaturados, pode promover ação benéfica protetora contra danos tissulares e supressão da atividade inflamatória, além de auxiliar no tratamento dessas comorbidades. A dietoterapia é uma abordagem promissora, e algumas recomendações podem oferecer melhor qualidade de vida aos pacientes com LES.

The authors reviewed the influence of nutritional factors on systemic lupus erythematosus (SLE) and discussed an alternative treatment option. The autoimmunity and inflammatory process of SLE are related to the presence of dyslipidemia, obesity, systemic arterial hypertension, and metabolic syndrome, which should be properly considered to decrease cardiovascular risk. A diet with moderate protein and energy content, but rich in vitamins, minerals (especially antioxidants), and mono/polyunsaturated fatty acids can promote a beneficial protective effect against tissue damage and suppression of inflammatory activity, in addition to helping the treatment of those comorbidities. Diet therapy is a promising approach and some recommendations may offer a better quality of life to patients with SLE.

Diet and nutritional aspects in systemic lupus erythematosus.

The authors reviewed the influence of nutritional factors on systemic lupus erythematosus (SLE) and discussed an alternative treatment option. The autoimmunity and inflammatory process of SLE are related to the presence of dyslipidemia, obesity, systemic arterial hypertension, and metabolic syndrome, which should be properly considered to decrease cardiovascular risk. A diet with moderate protein and energy content, but rich in vitamins, minerals (especially antioxidants), and mono/polyunsaturated fatty acids can promote a beneficial protective effect against tissue damage and suppression of inflammatory activity, in addition to helping the treatment of those comorbidities. Diet therapy is a promising approach and some recommendations may offer a better quality of life to patients with SLE.

Estudo longitudinal do anticorpo antilipoproteína lipase e sua relação com atividade de doença nos indivíduos com lúpus eritematoso sistêmico sem anticorpos anti-dsDNA / Longitudinal fluctuation of anti-lipoprotein lipase antibody is related with disease activity in systemic lupus erythematosus patients without anti-dsDNA antibodies

INTRODUÇÃO: O Lúpus Eritematoso Sistêmico (LES) se caracteriza por períodos de exacerbação e remissão clínica que frequentemente são acompanhados por alterações nos níveis séricos de anticorpos específicos, como o anti-dsDNA, que está presente em 40 por cento dos casos, associado principalmente à atividade renal. Recentemente houve a descrição de duas subpopulações de anticorpos antilipoproteína lipase (anti-LPL) no LES: uma com e a outra sem atividade anti-dsDNA. A possível relação desse último grupo de anticorpos com a atividade inflamatória de doença ainda não foi analisada no LES. OBJETIVOS: Avaliar longitudinalmente a associação dos níveis séricos dos anticorpos anti-LPL com atividade do LES em pacientes com anti-dsDNA persistentemente negativo. PACIENTES E MÉTODOS: Cinco pacientes com LES com anti-dsDNA persistentemente negativo mensurado por ELISA e por imunofluorescência indireta em crithidia luciliae e altos títulos de anti-LPL por ELISA (> 5 desvios-padrão (DP) da média de 20 controles normais) foram selecionados e acompanhados longitudinalmente durante um período mínimo de dois anos. RESULTADOS: Caso 1: Homem, 24 anos com LES desde 2001 apresentou hemorragia alveolar, proteinúria, hipertensão arterial sistêmica, eritema malar, aftas, artrite, FAN+, com SLEDAI (systemic lupus erythematosus disease activity index) = 16 e anti-LPL = 144UA. Tratado com pulso de metilprednisolona e prednisona com melhora clínica e SLEDAI = 0 e redução do anti-LPL (109UA). Nova atividade com acometimento renal em abril de 2002, SLEDAI = 10 e aumento de anti-LPL (150UA). Iniciada pulsoterapia de ciclofosfamida e metilprednisolona com boa resposta, SLEDAI = 0 e diminuição de anti-LPL (77UA) até a sua total negativação acompanhando a remissão do quadro no ano de 2003. Caso 2: Mulher, 32 anos, com LES desde 1997. Em setembro de 2001 iniciou vasculite cutânea, febre e rash, SLEDAI = 10, anti-LPL = 80UA. Em janeiro de 2002, teve atividade renal e HAS...

INTRODUCTION: Systemic lupus erythematosus (SLE) is characterized by periods of clinical flares and remission that are followed by alterations of sera specific autoantibodies such as anti-dsDNA, present in 40 percent of the cases and strongly associated with renal involvement. Recently, there was a description of two subpopulations of anti-lipoprotein lipase antibodies (anti-LPL) in SLE: with and without anti-dsDNA activity. A possible relationship between these antibodies with inflammatory activity of SLE was not analyzed. OBJECTIVES: To evaluate longitudinally the association between anti-LPL with lupus activity in patients persistently negatives for anti-dsDNA antibodies. PATIENTS AND METHODS: Five SLE patients with persistently negative anti-dsDNA measured by ELISA and indirect immunofluorescence using crithidia luciliae and high titers of anti-LPL by ELISA (> 5 SD) were selected and followed for at least 2 years. RESULTS: Case 1: A 24-year-old male with SLE since 2001, presented with alveolar hemorrhage, proteinuria, systemic hypertension, malar rash, oral ulcers, polyarthritis, positive ANA, SLEDAI=16 and anti-LPL=144U. He was treated with intravenous (IV) methylprednisolone followed by prednisone and had an excellent response. SLEDAI=0, anti-LPL decreased to 109U. New renal flare in April 2002, SLEDAI=10 and a new increment of anti-LPL (150U). IV Cyclophosphamide and methylprednisolone were started and he achieved remission, SLEDAI=0 and a decrease of anti-LPL (77U) until become negative in 2003. Case 2: A 32-year-old female had SLE since 1997. In September 2001 began cutaneous vasculitis, fever and rash, SLEDAI=10, anti-LPL=80U. In January 2002, she had renal involvement and systemic hypertension, SLEDAI=8 and anti-LPL= 25U. She received corticosteroid and cyclophosphamide and improved. In 2003, she was asymptomatic, SLEDAI=2 and anti-LPL=12U. Case 3: A 39-year-old male has SLE since 1997. He was stable, under chloroquine use...

Childhood systemic lupus erythematosus in Latin America. The GLADEL experience in 230 children.

To evaluate disease characteristics of childhood onset SLE in Latin America and to compare this information with an adult population in the same cohort of GLADEL. A protocol was designed as a multicenter, multinational, inception cohort of lupus patients to evaluate demographic, clinical, laboratory and serological variables, as well as classification criteria, disease activity, organ damage and mortality. Descriptive statistics, chi square, Fisher's exact test, Student's t test and multiple logistic regression were used to compare childhood and adult onset SLE. 230 patients were <18 years and 884 were adult SLE patients. Malar rash, fever, oral ulcers, thrombocytopenia and hemolytic anemia and some neurologic manifestations were more prevalent in children (p<0.05). On the other hand, myalgias, Sjögren's syndrome and cranial nerve involvement were more frequently seen in adults (p<0.05). Afro-Latin-American children had a higher prevalence of fever, thrombocytopenia and hemolytic anemia. White and mestizo children had a higher prevalence of malar rash. Mestizo children had a higher prevalence of cerebrovascular disease and cranial nerve involvement. Children met SLE ACR criteria earlier with higher mean values than adults (p: 0.001). They also had higher disease activity scores (p: 0.01), whereas adults had greater disease damage (p: 0.02). In Latin America, childhood onset SLE seems to be a more severe disease than adults. Some differences can be detected among ethnic groups.

Contribuição da doença e sua terapêutica no índice de dano SLICC/ACR na fase precoce do lúpus eritematoso sistêmico / Contribution of the disease and its therapy on the SLICC-ACR-DI in early systemic lupus erythematosus

A maioria das informações relativas ao curso da doença de pacientes com lúpus eritematoso sistêmico (LES) é restrito aos primeiros cinco anos após o diagnóstico. Entretanto, dados sobre a precocidade de instalação dos danos são pouco descritos. Objetivo: identificar os danos precoces de pacientes com LES de diagnóstico recente e verificar a influência da própria doença ou de sua terapêutica como principal causa para a instalação destes danos. Métodos: foram estudados retrospectivamente 82 pacientes com LES, cujo diagnóstico foi realizado de 1998 até 1999 em nosso serviço. Em todos os pacientes o escore do índice de dano do Systemic Lupus International Collaborating Clinics/American College of Rheumatology-Damage Index (SLICC/ACR-DI) foi avaliado no momento do diagnóstico e anualmente três vezes consecutivas. As manifestações clínicas e o esquema terapêutico foram avaliados nas consultas médicas. O escore do SLICC/ACR para cada órgão/sistema e a prevalência dos danos foi identificado, assim como a sua possível causa (doença ou terapia). Resultados: A idade (média) inicial foi de 31,6 anos com predomínio do sexo feminino (94 por cento). A maioria dos pacientes (94 por cento) apresentou manifestações cutâneas e articulares, seguidas pelas renais (40 por cento), pulmonares (28 por cento) e neurológicas (18 por cento). Ao final do estudo, 52 pacientes (63,4 por cento) não apresentaram seqüelas (sem pontuação no SLICC). Dos 30 pacientes restantes, 16 tiveram escore = 1 e 14 pacientes apresentaram escore = 2. No total observamos 36 danos, sendo 23 atribuídos à doença e 13 à terapia (64 por cento vs 36 por cento, p < 0,05). Os sistemas mais freqüentemente acometidos foram o articular e o neurológico (27,7 por cento), seguidos pelo renal (13,8 por cento). Todos os pacientes com comprometimento neurológico tiveram danos precoces decorrentes da própria doença (apesar da terapêutica agressiva) enquanto a terapêutica com corticóide foi responsável pelos danos em 7/10 pacientes com dano articular (osteonecrose). O dano renal foi observado em 13,8 por cento dos pacientes (nefrite grave não responsiva ao tratamento). Outros efeitos adversos da terapia foram angina, catarata, diabetes e menopausa precoce. Conclusões: este estudo sugere que o dano precoce é ainda um importante problema no LES. São necessárias estratégias eficazes no sentido de minimizar as seqüelas, com destaque para as neurológicas. Redução da morbidade associada à terapia com corticóide...

[Contribution of the disease and its therapy on the SLICC/ACR-DI in early systemic lupus erythematosus]. / Contribuição da doença e sua terapêutica no índice de dano SLICC/ACR na fase precoce do lúpus eritematoso sistêmico.

UNLABELLED: The majority of the information available about the disease course of patients with systemic lupus erythematosus (SLE) is restricted to the first five years after disease onset. However, data about early damage were rarely reported. OBJECTIVE: to describe the early damage outcome of SLE patients in early disease and to discriminate the influence of disease itself or its therapy as the main cause of their damage. METHODS: we retrospectively studied 82 patients with SLE, diagnosed during the period from 1998 to 1999 in our institution. In all patients the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR-DI) was scored at the diagnosis and annually for the next three years. Clinical manifestations were evaluated at each visit as well as the therapy. The SLICC/ACR-DI scores for each organ system and the prevalence of damage within organ systems were assessed, as well as its possible main cause (disease or therapy). RESULTS: the mean age at entry was 31.6 years with female predominance of 94%. The majority of the patients (94%) presented cutaneous and articular involvement, 40% renal, 28% pulmonary, and 18% neurological manifestations. At the end of the study, 52 (63.4%) patients had no damage to score with SLICC. From the remaining 30 patients, 16 had a score of 1 and 14 had a score = 2. In total, 36 damages occurred, 23 of them attributed to the disease and 13 to the therapy (64% vs. 36%; p < 0.05). The most frequently injured systems were the articular and the neurological (27.7%) ones, followed by the renal (13.8%) system. All patients with neurological involvement have early damage due to the disease itself in spite of the aggressive therapeutic whereas from 10 patients with articular damage, 70% (7) were associated with steroid therapy (osteonecrosis). In contrast, premature renal injury was observed in 13.8%, all of them with unresponsive severe nephritis. Other adverse effect of therapy included 1 angina, 2 cataracts, 1 diabetes and 2 premature menopauses. CONCLUSIONS: this study suggests that early damage is still a major problem in SLE that reinforces the need for new strategies in order to minimize injury, particularly for neurological manifestations. Moreover, it also seems important to reduce morbidity induced by corticosteroid therapy with the use of steroid-sparing agents.

Doença inflamatória intestinal com gangrena cutânea mimetizando a poliarterite nodosa / Intestinal inflammatory disease with cuvaneous gangrene simulating polyarteritis nodosa

Descrevemos o caso de uma paciente com retocolite ulcerativa que apresentou gangrena cutânea secundária à trombose microvascular. Esta rara complicação da doença inflamatória intestinal é decorrente do estado de hipercoagulabilidade observado na sua fase de atividade inflamatória. Foi necessário estabelecer diagnóstico diferencial com poliarterite nodosa pelo acometimento abdominal e cutâneo. As alterações intestinais foram demonstradas pela colonoscopia com biópsia e as vasculares por ultrasonografia com Doppler de membros inferiores e biópsia da lesão cutânea. A paciente foi tratada com prednisona (1 mg/kg), sulfassalazina e anticoagulação plena e evoluiu com remissão da doença cutânea e intestinal

Aftose bipolar na doença de Crohn ou envolvimento intestinal na doença de Behçet: um dilema diagnóstico / Bipolar aftose in the Crohn’s disease or intestinal involvement in the Behcet’s disease: a diagnostic dilemma

A doença de Behçet é uma vasculite sistêmica não-necrotizante que compromete vasos de todos os calibres, caracterizada por períodos de recidiva e remissão. Foi descrita por Hulusi Behçet em 1937 e o seu diagnóstico é baseado nos critérios clínicos definidos em 1990 pelo International Study Group, devendo ser excluídos diversos diagnósticos diferenciais, principalmente patologias que desencadeiam ulcerações de mucosas, sejam orais, genitais ou intestinais, como a doença de Crohn. O envolvimento intestinal na doença de Behçet é raro e foi primeiramente descrito em 1944, podendo envolver qualquer segmento do sistema gastrointestinal, principalmente a porção ileocecal. O diagnóstico diferencial deve ser feito principalmente com a doença de Crohn, em razão da semelhança do comprometimento intestinal. Da mesma forma, manifestações como úlceras orais, genitais, eritema nodoso e uveíte, que são utilizadas como critérios para o diagnóstico de Behçet, podem ocorrer em Crohn, dificultando o diagnóstico diferencial entre elas apenas pelo quadro clínico. Os autores relatam um caso cujas manifestações clínicas e achados anatomopatológicos ressaltam essa dificuldade, alertando que muitas vezes não é possível alcançar uma precisão diagnóstica e sugerindo a sobreposição das duas entidades ou uma associação entre elas.

Dislipidemias e aterosclerose no lúpus eritematoso sistêmico / Dyslipidemias and atherosclerosis in systemic lupus erythematosus

A aterosclerose precoce é uma complicação importante no lúpus eritematoso sistêmico (LES), sendo considerada a principal causa de morbidade e mortalidade na doença. As dislipidemias ocorrem com frequência no seu curso e contribuem para o agravamento desse processo. O objetivo deste artigo é resumir as evidências desta interação, descrever os principais mecanismos de dislipidemias e discutir uma abordagem preventiva deste problema

Dermatomiosite e toxoplasmose / Dermatomyositis and toxoplasmosis

A dermatomiosite (DM) é uma doença sistêmica difusa de caráter inflamatório, caracterizada pelo envolvimento muscular e cutâneo. Processos inflamatórios musculares também podem ser decorrentes de infecções por protozoários, como o Toxoplasma gondii. A associação dermatomiosite/polimiosite e toxoplasmose tem sido descrita na literatura. Apresenta-se um caso de DM com sorologia positiva para toxoplasmose aguda, enfatizando as dificuldades diagnóstica e terapêutica diante dessa situação

Fasciite eosinofílica com miopatia subclínica e exacerbação da miosite após o uso de d-penicilamina / Eosinophilic fasciitis with subclinical myopathy with exacerbated myositis after using the d-penicillamine

Descreve-se caso de fasciite eosinfofílica com acomentimento muscular com piora progressiva após o uso de d-penicilamina. Nos casos anteriormente relatados, o acometimento muscular na fasciite eosinofílica era clinicamente discreto e evidenciado por eletroneuromiografia e biópsia, uma vez que as enzimas musculares apresentavam valores habitualemnte dentro da normalidade. Ressalta-se a importância da realização de extensa biópsia que abranja desde a pelo até o músculo, alémde atentar para o uso de d-penicilamina em doenças auto-imunes

Doença de Kikuchi-Fujimoto associada a doença mista do tecido conjuntivo: relato de caso / Kikuchi-Fujimoto's disease associated with mixed connective tissue disease: case report

Relata-se caso de paciente jovem masculino com história de poliartrite, fenômeno de Raynaud, linfadenopatia, emagrecimento, febre, quadro cutâneo, anemia, leucopenia, linfopenia, anticorpo anti-RNP, miosite e padräo pulmonar intersticial com restriçäo, sugerindo o diagnóstico de doença mista do tecido conjuntivo (DMTC). O padräo histológico da biópsia ganglionar foi compatível com linfadenite histiocítica necrosante (doença de Kikuchi-Fujimoto), o que revela uma rara associaçäo. Essa entidade clínico-patológica é caracterizada por linfadenopatia cervical localizada e febre, que acomete principalmente mulheres jovens antes dos 30 anos. A etiologia é desconhecida. As culturas säo negativas, bem como os marcadores de auto-imunidade quando síndrome primária. Trata-se de condiçäo benigna e autolimitada, sem terapêutica específica com remissäo em até seis meses. Os autores apresentam a associaçäo de doença de Kikuchi com DMTC e descrevem revisäo de alteraçöes reumatológicas auto-imunes

Miopatia por droga hipolipidêmica: a propósito de um caso clínico / Myopathy associated with cholesterol lowering drug: case report

Os autores relatam um caso de miopatia inflamatória associada ao uso de lovastatina, uma HMG-CoA redutase. Uma paciente de 53 anos de idade, diabética insulino-dependente e hipertensa bem controlada, estava no serviço em acompanhamento para tratamento de osteoporose. Foi introduzida lovastatina 40mg/dia porque apresentou hiperlipidemia. Três semanans após iniciar a droga, a paciente desenvolveu miopatia aguda com fraqueza de membros superiores e inferiores, com aumento da creatinoquinase 500 vezes o normal. A biópsia muscular realizada no músculo bíceps esquerdo feita no terceiro dia da fraqueza muscular revelou necrose, degeneraçäo e sinais de atividade lisossomal. No entanto, nenhum infiltrado inflamatório foi observado no endomísio, no perimísio ou na regiäo perivascular. Os sintomas musculares melhoraram sete dias após a suspensäo da droga. As enzimas voltaram ao normal 45 dias após a interrupçäo da lovastatina