Undiagnosed Primary Sjögren's Syndrome With Pleural Involvement.

Sjögren's syndrome (SS) is a systemic autoimmune disorder characterized by the lymphocytic infiltration of the exocrine glands, primarily the salivary and lacrimal glands, resulting in the dryness of the eyes and mouth. However, Sjögren's syndrome is not limited to glandular involvement, as it can also affect various other organ systems, leading to a wide range of extraglandular manifestations and delaying the diagnosis. In this scenario, a high level of suspicion is required.

IgA Vasculitis involving four systems / Vasculitis IgA que afecta a cuatro sistemas

Henoch-Schonlein Purpura (HSP) is a systemic vasculitis now called IgA vasculitis, that infrequently occurs in adults. While rheumatological andgastrointestinal complications are common, lung involvement is a rare complication. We report the case of a 70 year-old female that presented tothe hospital with purpuric lesions on her legs and ileitis. During her hospital stay she developed respiratory distress, and the computed tomography (CT scan) showed evidence of Diffuse Alveolar Hemorrhage (DAH). She also had renal dysfunction, and the renal biopsy confirmed the presence of leukocytoclastic vasculitis on histology, consistent with HSP. The patient was initiated on corticosteroid therapy and cyclophosphamide,in addition to supportive management, leading to the resolution of her symptoms.This case is unique, as it presents a rare complication of HSP, with pulmonary disease, causing DAH. Furthermore, adult onset HSP is also anuncommon occurrence.It is very important to recognize DAH early in HSP, as it holds a high mortality rate. (AU)

Drug-Induced Liver Injury Due To Losartan.

Drug-induced liver injury (DILI) is a challenging diagnosis since a wide variety of medicines can cause adverse reactions. Losartan is an angiotensin II receptor antagonist (ARA-II) approved for the treatment of arterial hypertension. The most common adverse effects are fatigue, anaemia, weakness and cough. An increase in transaminases has been reported with less frequency (<2% of cases). Although the mechanism is not fully understood, DILI onset is usually within 1-8 weeks of therapy, and hepatic enzymology usually normalizes 2-4 months after drug suspension. The authors present the case of a 66-year-old male patient with a medical history of arterial hypertension and a prior hospitalization (4 years previously) for drug-induced hepatitis, which, at the time, was attributed to a dietary supplement. Four years later, because of new onset of hypertension, losartan was reintroduced. After 3 weeks, the patient was admitted to the emergency department with complaints of acute abdominal pain associated with asthenia, nausea and increased abdominal volume that had first developed 8 days previously. After exclusion of other causes, DILI associated with losartan was assumed. This is a very rare adverse effect since only seven cases have been described in the literature. LEARNING POINTS: Toxic hepatitis due to losartan is very rare, despite widespread use of the drug.A high index of suspicion for drug-induced liver injury (DILI) should be maintained while other diagnoses are carefully excluded.Monitoring the use of the offending drug is crucial, since DILI recurrence is associated with worse prognosis.