Alterações retinianas em pacientes com leucemia linfocítica aguda (lla): discussão de tema a partir de relato de caso / Retinal changes in patients with acute lymphocytic leukemia (all): discussion of topic from a case report

RESUMO A Leucemia Linfocitica Aguda (LLA) é uma doença caracterizada por uma alta taxa de sobrevida, porém o número absoluto de crianças que morrem por ela representa uma grande parcela dos casos de óbitos infantis por câncer. A morbidade decorrente de seu tratamento pode deixar sequelas em pessoas com grande expectativa de vida, tornando-se extremamente necessário o entendimento da patogênese desta doença, possibilitando o desenvolvimento de novos tratamentos e diminuição de sequelas provocadas pela doença. O diagnóstico precoce é importante para se evitar complicações oculares que possam levar a baixa de acuidade visual em longo prazo e para avaliação de recaídas de tratamento sendo determinante no direcionamento de condutas.

ABSTRACT The Acute Lymphocytic Leukemia (ALL) is a disease characterized by a high survival rate, but the absolute number of children who die from it represents a large proportion of cases of infant deaths from cancer. The morbidity resulting from its treatment can leave sequelae in people with high life expectancy, making it extremely necessary to understand the pathogenesis of this disease, enabling the development of new treatments and reduction of sequelae caused by the disease. This early diagnosis is important to avoid ocular complications that may lead to low long-term visual acuity and to evaluate treatment relapses and determine the conducts.

Predictive risk factors for autoimmune thyroid diseases in patients with pernicious anemia / Factores predictivos de riesgo de enfermedades tiroideas autoinmunes en pacientes con anemia perniciosa

BACKGROUND: Patients with pernicious anemia (PA) have a higher prevalence of other autoimmune diseases. We assessed the correlation between PA and autoimmune thyroid diseases (AITD), and evaluated the risk factors for this association. METHODS: A longitudinal study was conducted involving patients with PA between 2010 and 2017. RESULTS: A total of 86 patients with PA were evaluated, 74 (86%) female, with a median age of 51.5 years. Thyroid abnormalities were detected in 45 (52.3%) patients, including 28 (32.3%) hypothyroidism, 3 (3.5%) hyperthyroidism and 20 (23.3%) thyroperoxidase antibody positivity. Logistic regression analysis identified risk factors for having AITD in PA patients: weight loss (OR 12.03; 95% CI 1.06-137.02, P=0.045), diabetes mellitus (OR 4.68, 95% CI 1.15-26.58, P=0.047) and gastric antibodies positivity (OR 5.05, 95% CI 1.45-18.24, P=0.013). CONCLUSION: PA and AITD are frequently associated, suggesting all patients with PA should be investigated for occult thyroid disease, especially those with weight loss, diabetes mellitus and gastric autoantibodies

ANTECEDENTES: Los pacientes con anemia perniciosa (AP) tienen una mayor prevalencia de otras enfermedades autoinmunes. Evaluamos la correlación entre AP y enfermedades tiroideas autoinmunes (AITD), así como los factores de riesgo para esta asociación. MÉTODOS: Realizamos un estudio longitudinal que incluyó a pacientes con AP entre 2010 y 2017. RESULTADOS: Evaluamos a un total de 86 pacientes con AP, 74 (86%) mujeres, con una edad media de 51,5 años. Detectamos alteraciones tiroideas en 45 (52,3%) pacientes, incluyendo 28 (32,3%) casos de hipotiroidismo, 3 (3,5%) de hipertiroidismo y 20 (23,3%) de positividad para anticuerpos anti-tiroperoxidasa. El análisis de regresión logística identificó los factores de riesgo de padecer AITD en pacientes de AP: pérdida de peso (OR: 12,03; IC 95%: 1,06-137,02; p = 0,045), diabetes mellitus (OR: 4,68; IC 95%: 1,15-26,58; p = 0,047) y positividad frente a anticuerpos gástricos (OR: 5,05; IC 95%: 1,45-18,24; p = 0,013). CONCLUSIÓN: AP y AITD están frecuentemente asociados, lo cual sugiere que deberían investigarse las enfermedades tiroideas ocultas en todos los pacientes con AP, especialmente aquellos con pérdida de peso, diabetes mellitus y auto-anticuerpos gástricos

Predictive risk factors for autoimmune thyroid diseases in patients with pernicious anemia.

BACKGROUND: Patients with pernicious anemia (PA) have a higher prevalence of other autoimmune diseases. We assessed the correlation between PA and autoimmune thyroid diseases (AITD), and evaluated the risk factors for this association. METHODS: A longitudinal study was conducted involving patients with PA between 2010 and 2017. RESULTS: A total of 86 patients with PA were evaluated, 74 (86%) female, with a median age of 51.5 years. Thyroid abnormalities were detected in 45 (52.3%) patients, including 28 (32.3%) hypothyroidism, 3 (3.5%) hyperthyroidism and 20 (23.3%) thyroperoxidase antibody positivity. Logistic regression analysis identified risk factors for having AITD in PA patients: weight loss (OR 12.03; 95% CI 1.06-137.02, P=0.045), diabetes mellitus (OR 4.68, 95% CI 1.15-26.58, P=0.047) and gastric antibodies positivity (OR 5.05, 95% CI 1.45-18.24, P=0.013). CONCLUSION: PA and AITD are frequently associated, suggesting all patients with PA should be investigated for occult thyroid disease, especially those with weight loss, diabetes mellitus and gastric autoantibodies.

Perfil epidemiológico dos pacientes com evolução subaguda e crônica de infecção por Chikungunya / Epidemiologic profile of patients with subacute and chronic Chikungunya infection evolution

OBJETIVO: Analisar o perfil epidemiológico dos pacientes com evolução subaguda e crônica da infecção por Chikungunya, e avaliar suas principais alterações laboratoriais. MÉTODOS: Estudo observacional, realizado por meio da análise de 31 prontuários de pacientes atendidos em um centro de referência de doenças imunoinfecciosas, no Estado do Rio de Janeiro, no período de janeiro a maio de 2016. Foram selecionados prontuários de pacientes com Chikungunya em fase subaguda ou crônica com diagnóstico confirmado por sorologia IgM, de ambos os sexos e de todas as faixas etárias. As seguintes variáveis foram consideradas: sexo, idade, leucócitos, plaquetas, velocidade de hemossedimentação, e aspartato aminotransferases e alanina transaminase (AST/ALT). RESULTADOS: A faixa etária predominante foi de 50 a 69 anos (64,5%). Pertenciam ao sexo feminino 83,9% dos pacientes. Dentre as alterações laboratoriais, destacaram-se elevação da velocidade de hemossedimentação (46,15%), leucopenia (37%), elevação de transaminases (30,8% AST e 23% ALT) e trombocitopenia (11,1%). CONCLUSÃO: Observou-se a importância epidemiológica na determinação de pacientes potencialmente capazes de desenvolver tais sequelas, representada principalmente pela artralgia incapacitante. A identificação desse grupo, caracterizado como pacientes do sexo feminino e de faixa etária entre 50 e 69 anos, pode ser de grande valia para a prevenção da evolução mórbida dessa arbovirose, sabendo que tais pacientes necessitam de cuidados especiais e acompanhamento clínico mais rigoroso.(AU)

OBJECTIVES: To analyze the epidemiological profile of patients with subacute and chronic Chikungunya infection, and to evaluate their main laboratory abnormalities. METHODS: This is an observational study, carried out through the analysis of 31 medical records of patients attended at a Reference Center for Immunopathological Diseases in the state of Rio de Janeiro, from January to May 2016. Patients with Chikungunya were selected in the subacute or chronic phase with diagnosis confirmed by IgM serology; both genders and all age ranges. The following variables were considered: gender, age, leukocytes, platelets, erythrocyte sedimentation rate, and aspartate aminotransferases and alanine transaminase (ASTALT). RESULTS: The predominant age range was 50 to 69 years (64.5%), with 83.9% of the patients being female. Among the laboratory alterations, high erythrocyte sedimentation rate (46.15%), leukopenia (37%), high transaminases (30.8% AST, and 23% ALT), and thrombocytopenia (11.1%) were observed. CONCLUSIONS: The epidemiological importance in the determination of patients potentially capable of developing such sequels, represented mainly by incapacitating arthralgia, was observed. The identification of this group, characterized as female patients, and between 50 and 69 years of age, may be of great value in the prevention of the morbid progression of this arbovirosis, knowing that such patients require special care, and stricter clinical follow-up.(AU)

Acometimento visceral e ocular simultâneo em infecção por toxocara canis acompanhado de farmacodermia / Concurrent visceral and ocular involvementin toxocara canis infection and pharmacodermia

A toxocaríase humana é uma infecção parasitária de distribuição mundial causada pelos nematelmintos das espécies Toxocara canis e Toxocara cati, presentes no intestino do cão e do gato, respectivamente. Clinicamente, na maioria das vezes, é assintomática, porém pode apresentar-se de duas formas: visceral ou ocular. Visceralmente, gera uma síndrome hipereosinofílica crônica, acompanhada por leucocitose e hepatomegalia, podendo ocorrer algum grau de infiltrado pulmonar e febre. Na toxocaríase ocular, ocorre uveite intermediária ou posterior, podendo haver formação de granuloma, geralmente unilateral. O acometimento misto é raro, o que motivou este relato. Trata-se de paciente de 19 anos, sexo masculino, que apresentou como sintoma inicial perda da acuidade visual em olho esquerdo. Recebeu tratamento, sem melhora, com sulfametoxazol + trimetoprima e corticoide, fazendo farmacodermia. Evoluiu com diarreia, febre, dor abdominal e hepatoesplenomegalia. Descartadas infecções agudas por toxoplasmose, sífilis, vírus da imunodeficiência humana (HIV), citomegalovirose e dengue; apresentou leucocitose com hipereosinofilia. Foi solicitada sorologia para toxocaríase, confirmando esta infecção. Após o tratamento, apresentou completa remissão dos sintomas. O objetivo aqui foi debater os fatores confundidores, diagnósticos diferenciais, necessidade de exames complementares específicos e conduta terapêutica, de acordo com o quadro clínico.(AU)

Human toxocariasis is a worldwide parasitic infection caused by ascarid nematodes species: Toxocara canis and Toxocara cati, that are present in the intestines of dogs and cats, respectively. Although clinically, most human infections are asymptomatic, two syndromes of human toxocariasis are recognized: visceral and ocular. The visceral form is a hypereosinophilic syndrome accompanied by leukocytosis, hepatomegaly, some degree of pulmonary infiltrate and fever. In ocular toxacariasis there is intermediate or posterior uveitis, and there may be granuloma formation, usually unilateral. The simultaneous involvement of the two forms is rare, which is what, motivated this report. It is a 19-year-old male patient who initially presented loss of visual acuity in the left eye. He received treatment, without improvement, with sulfamethoxazole-trimethoprim and corticoid, causing a pharmacodermia. He developed diarrhea, fever, abdominal pain and hepatosplenomegaly. It was discarded acute infections by toxoplasmosis, syphilis, human immunodeficiency virus (HIV), cytomegalovirus and dengue. The patient also manifested leukocytosis with hypereosinophilia. Serological testing for toxacariasis was requested, diagnosing the infection. After treatment, he progressed with full symptoms remission. The aim of this study was to discuss confounding factors, differential diagnoses, the need for specific complementary exams and therapeutic management, according to the clinical aspects.(AU)

Evidence of dengue virus replication in a non-traumatic spleen rupture case.

The present report describes a case of splenic rupture due to dengue, a rare complication of dengue that should be considered in any patient with suspected dengue disease who started with left upper quadrant abdominal pain and hypotension. The pathophysiology of this entity is not yet well elucidated, but one of the theories present in the literature is that it is due to a depletion of coagulation factors and platelets leading to intra-splenic hemorrhage and rupture. The RT-PCR technique detected serotype 1 and histopathological studies of the spleen revealed significant atrophy of lymphoid follicles and extensive hemorrhage areas. Besides histopathological observations, virus replication was investigated by detection of dengue antigens, especially the non-structural 3 protein (NS3) in endothelial cells and splenic macrophages. This important complication has serious clinical repercussions and high mortality, due to the diagnostic difficulty and many factors that usually confuse or delay its diagnosis. Therefore, it is of the utmost importance to recognize their manifestations and their management to try to best minimize their consequences and mortality.