RESUMO
A 37-year-old man was admitted to our hospital because of toxic shock-like syndrome (TSLS) induced by Streptococcus pyogenes. After the pathogenic bacteria had been eradicated, serious diarrhoea appeared and a protein-losing gastroenteropathy developed. An immunohistochemical study of the biopsy specimens of both small and large intestines revealed the infiltration of T-lymphocytes, predominantly CD8+ cells, into the lamina propria of affected mucosa, villus atrophy and crypt hyperplasia. Considering these histological findings, some immunological mechanism which lead the activation of cytotoxic T-lymphocytes may play an important role in the pathogenesis of this rare intestinal manifestation of TSLS.
Assuntos
Diarreia/microbiologia , Hipoproteinemia/microbiologia , Choque Séptico/complicações , Choque Séptico/diagnóstico , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/diagnóstico , Adulto , Antibacterianos/uso terapêutico , Colo/patologia , Diagnóstico Diferencial , Diarreia/patologia , Duodeno/patologia , Endoscopia Gastrointestinal , Humanos , Hipoproteinemia/tratamento farmacológico , Hipoproteinemia/patologia , Imuno-Histoquímica , Masculino , Choque Séptico/tratamento farmacológico , Choque Séptico/microbiologia , Choque Séptico/patologia , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/patologia , Streptococcus pyogenesRESUMO
A 54-year-old woman came to our office because of pretibial edema. She had no gastrointestinal symptoms. Laboratory tests revealed severe hypoproteinemia. Upper gastrointestinal endoscopy demonstrated enlarged gastric folds and multiple aphthoid nodules on the body and the fornix of the stomach. The biopsy specimen revealed a large number of CD8 positive intraepithelial T-lymphocytes infiltrating the gastric mucosa. Both serum total protein and the gastric lesions improved eight months after her first visit without any therapy for peptic ulcer or eradication of Helicobacter pylori. The data suggest that spontaneous remission may occur in lymphocytic gastritis without any gastrointestinal symptoms.