Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 454.632
Filtrar
2.
BMC Infect Dis ; 21(1): 522, 2021 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-34082705

RESUMO

BACKGROUND: Leptospirosis is a zoonotic spirochetal disease caused by Leptospira interrogans. The clinical presentation ranges from an asymptomatic state to a fatal multiorgan dysfunction. Neurological manifestations including aseptic meningitis, spinal cord and peripheral nerve involvement, cranial neuropathies and cerebellar syndrome are well recognized with varying frequencies among patients with this disease. Posterior reversible encephalopathy syndrome is a very rare occurrence in leptospirosis and only two cases are reported in the medical literature up to now. We report a case of posterior reversible encephalopathy syndrome in a patient with leptospirosis with rhabdomyolysis and acute kidney injury. CASE PRESENTATION: A 21 year-old male presented with fever and oliguric acute kidney injury with rhabdomyolysis. A diagnosis of leptospirosis was made and he was being managed according to the standard practice together with regular hemodialysis. The clinical condition was improving gradually. On day 8 of the illness, he developed headache and sudden painless complete bilateral vision loss followed by several brief generalized tonic clonic seizure attacks. Examination was significant for a Glasgow Coma Scale of 14/15, blood pressure of 150/90 mmHg and complete bilateral blindness. The findings of magnetic resonance imaging of the brain were compatible with posterior reversible encephalopathy syndrome. He was managed with blood pressure control and antiepileptics with supportive measures and standard treatment for leptospirosis and made a complete recovery. CONCLUSION: Posterior reversible encephalopathy syndrome, though very rare with leptospirosis, should be considered as a differential diagnosis in a patient with new onset visual symptoms and seizures, especially during the immune phase. Optimal supportive care together with careful blood pressure control and seizure management would yield a favourable outcome in this reversible entity.


Assuntos
Injúria Renal Aguda/complicações , Leptospirose/complicações , Síndrome da Leucoencefalopatia Posterior/etiologia , Rabdomiólise/complicações , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/fisiopatologia , Injúria Renal Aguda/terapia , Encéfalo/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Leptospirose/diagnóstico , Leptospirose/fisiopatologia , Leptospirose/terapia , Imageamento por Ressonância Magnética , Masculino , Síndrome da Leucoencefalopatia Posterior/diagnóstico , Síndrome da Leucoencefalopatia Posterior/fisiopatologia , Síndrome da Leucoencefalopatia Posterior/terapia , Rabdomiólise/diagnóstico , Rabdomiólise/fisiopatologia , Rabdomiólise/terapia , Resultado do Tratamento , Adulto Jovem
3.
BMJ Case Rep ; 14(6)2021 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-34099442

RESUMO

Chronic fatigue syndrome (CFS) is often preceded by a viral illness and has recurrent 'flulike' symptoms which include a wide spectrum of musculoskeletal and neurological clinical features. The condition is also known as myalgic encephalomyelitis and systemic exertional intolerance syndrome. CFS has been reported following dengue among adult patients. We report the case of an 11-year-old boy who developed CFS following recovery of dengue haemorrhagic fever (DHF). The reported child was initially managed as for DHF and was clinically asymptomatic on post-discharge day 3. He was re-admitted after 3 weeks with severe joint pains, myalgia and unbearable headache. As his symptoms persisted, he was investigated in-depth. All investigations were normal except mild elevation of liver functions. The diagnosis of CFS secondary to DHF was made by exclusion of differential diagnosis. At 1-year follow-up, patient continues to have symptoms after treatment with physiotherapy and nutrition counselling.


Assuntos
Síndrome de Fadiga Crônica , Adolescente , Adulto , Assistência ao Convalescente , Criança , Diagnóstico Diferencial , Síndrome de Fadiga Crônica/diagnóstico , Síndrome de Fadiga Crônica/etiologia , Síndrome de Fadiga Crônica/terapia , Humanos , Masculino , Alta do Paciente , Modalidades de Fisioterapia
4.
BMJ Case Rep ; 14(6)2021 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-34099445

RESUMO

A 75-year-old woman was admitted with sepsis and treated with broad-spectrum antibiotics until examination of her lower limbs noted necrotising wounds. Surgical intervention was advised by the plastic surgeons; however, she was deemed unsuitable for intensive care. She underwent incision and drainage of the necrotic area and biopsies were taken. She deteriorated clinically and the decision was made for best supportive care and was therefore transferred to the inpatient palliative care unit for end-of-life care. However, she stabilised, and based on culture sensitivities, antibiotics were restarted. It was also noted that the patient had a 3-month history of loose stools, which had not been addressed previously. The biopsies were suggestive of pyoderma gangrenosum, prompting a dermatology review, and prednisolone and doxycycline were started. The wounds and her loose stools improved, and with ongoing rehabilitation, she made a full recovery. Referral to gastroenterology was made.


Assuntos
Pioderma Gangrenoso , Idoso , Biópsia , Diagnóstico Diferencial , Drenagem , Feminino , Humanos , Prednisolona/uso terapêutico , Pioderma Gangrenoso/diagnóstico
5.
No Shinkei Geka ; 49(3): 683-688, 2021 May.
Artigo em Japonês | MEDLINE | ID: mdl-34092575

RESUMO

Cerebral tuberculoma is a rare and serious form of tuberculosis. Despite advancements in imaging and laboratory diagnostics, it is challenging to diagnose cerebral tuberculoma due to its insidious nature and nonspecific findings. A 56-year-old woman was referred to our hospital for headaches. The patient had previously undergone treatment for pulmonary tuberculosis, which had been completely cured 2 months prior to presentation. Brain MRI revealed an enhanced mass lesion with surrounding edema in the right frontal lobe. Although a mild increase in the serum carcinoembryonic antigen(CEA)level and a moderate accumulation of FDG on FDG-PET indicated inflammatory changes or a malignant brain tumor, other imaging and laboratory findings were nonspecific. The mass lesion was indistinguishable from a brain tumor. Hence, the patient underwent surgical removal, and the pathological diagnosis was tuberculoma. In patients with a history of tuberculosis, cerebral tuberculoma should be considered in the differential diagnosis of intracranial mass lesions, even if the original lesion is completely cured. A mild increase in the serum CEA level and a moderate accumulation of FDG on FDG-PET were considered indicative of intracranial inflammation and consistent with cerebral tuberculoma.


Assuntos
Neoplasias Encefálicas , Tuberculoma , Diagnóstico Diferencial , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons , Tuberculoma/diagnóstico por imagem , Tuberculoma/cirurgia
6.
Klin Lab Diagn ; 66(6): 364-370, 2021 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-34105913

RESUMO

The aim of the work was to assess the possibility of the cytological method in the diagnosis of epithelial liver tumors and to determine the cytomorphological criteria in the differential diagnosis of liver carcinomas. The authors analyzed the data of 106 fine-needle aspiration biopsies and 167 smears-prints during cor-biopsy of masses of the liver in patients who were examined at the polyclinic of the oncological dispensary in Nizhny Novgorod in 2016. - 2017 As a result, full-fledged material for cytological examination in the form of smears-prints from cor-biopsy and fine-needle aspiration biopsies was obtained in 75.4% (n=126) and 95.2% (n=101), respectively. The great possibilities of the cytological method are shown: an affirmative diagnosis of the presence of primary or metastatic liver lesions was made in 88.8% (n=112) based on smears of sorbiopsy prints and in 87.1% (n = 88) with fine-needle aspiration biopsies. Typical cytomorphological criteria for primary and metastatic liver carcinomas made it possible to determine the origin of the primary tumor in 56.6% of cases (n=98).


Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Biópsia por Agulha Fina , Carcinoma Hepatocelular/diagnóstico , Diagnóstico Diferencial , Humanos , Neoplasias Hepáticas/diagnóstico
7.
Med Clin North Am ; 105(4): 577-597, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34059239

RESUMO

Severe cutaneous adverse reactions to medications (SCARs) include drug reaction with eosinophilia and systemic symptoms, Stevens-Johnson syndrome, toxic epidermal necrolysis, and acute generalized exanthematous pustulosis. They are all non-immunoglobulin E mediated hypersensitivity reaction patterns, distinguished from simple cutaneous drug eruptions by immunologic pathogenesis and internal organ involvement. Herein the clinical features, diagnostic workup, and management considerations are presented for each of these major SCARs.


Assuntos
Pustulose Exantematosa Aguda Generalizada/patologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/patologia , Eosinofilia/diagnóstico , Síndrome de Stevens-Johnson/etiologia , Síndrome de Stevens-Johnson/patologia , Pustulose Exantematosa Aguda Generalizada/diagnóstico , Pustulose Exantematosa Aguda Generalizada/etiologia , Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , Adulto , Idoso , Diagnóstico Diferencial , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/terapia , Eosinofilia/induzido quimicamente , Feminino , Humanos , Hipersensibilidade/imunologia , Masculino , Pessoa de Meia-Idade , Farmacogenética , Prognóstico , Fatores de Risco , Índice de Gravidade de Doença , Síndrome de Stevens-Johnson/diagnóstico , Síndrome de Stevens-Johnson/mortalidade
8.
Med Clin North Am ; 105(4): 611-626, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34059241

RESUMO

This is a comprehensive and current guide for the diagnosis, differential diagnosis, treatment, and management of eczematous dermatitis, with a focus on atopic dermatitis, irritant and allergic contact dermatitis, hand dermatitis including recurrent vesicular and hyperkeratotic types, asteatotic dermatitis, and nummular or discoid dermatitis. Diagnostic options highlighted are clinical history, physical examination, and patch testing. Therapeutic options highlighted are moisturizers, topical corticosteroids, topical calcineurin inhibitors, crisaborole, phototherapy, and systemic medications including biologics.


Assuntos
Dermatite Alérgica de Contato/patologia , Dermatite Atópica/patologia , Eczema/patologia , Administração Tópica , Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , Idoso , Produtos Biológicos/uso terapêutico , Compostos de Boro/administração & dosagem , Compostos de Boro/uso terapêutico , Compostos Bicíclicos Heterocíclicos com Pontes/administração & dosagem , Compostos Bicíclicos Heterocíclicos com Pontes/uso terapêutico , Inibidores de Calcineurina/administração & dosagem , Inibidores de Calcineurina/uso terapêutico , Criança , Pré-Escolar , Dermatite Alérgica de Contato/diagnóstico , Dermatite Alérgica de Contato/tratamento farmacológico , Dermatite Atópica/diagnóstico , Dermatite Atópica/tratamento farmacológico , Diagnóstico Diferencial , Eczema/diagnóstico , Eczema/tratamento farmacológico , Humanos , Lactente , Pessoa de Meia-Idade , Testes do Emplastro/métodos , Fototerapia/métodos , Qualidade de Vida
9.
Med Clin North Am ; 105(4): 699-721, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34059246

RESUMO

Chronic pruritus (itch lasting ≥6 weeks) is a bothersome chief complaint that may present in a broad variety of diseases. Most itch-causing diagnoses fit into 1 of 5 categories (inflammatory, secondary to systemic disease, neuropathic, chronic pruritus of undetermined origin, and psychogenic itch) and this broad differential can be narrowed using key findings in the history and physical. In this article, we discuss which key findings are most pertinent for narrowing this differential and guiding further workup and treatment, as well as how to treat many itchy conditions.


Assuntos
Inflamação/complicações , Doenças do Sistema Nervoso Periférico/complicações , Prurido/diagnóstico , Prurido/etiologia , Dermatopatias/patologia , Administração Tópica , Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , Algoritmos , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Antidepressivos/administração & dosagem , Antidepressivos/uso terapêutico , Inibidores de Calcineurina/administração & dosagem , Inibidores de Calcineurina/uso terapêutico , Doença Crônica , Aconselhamento/métodos , Detergentes/administração & dosagem , Detergentes/uso terapêutico , Diagnóstico Diferencial , Emolientes/administração & dosagem , Emolientes/uso terapêutico , Antagonistas dos Receptores Histamínicos/administração & dosagem , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/uso terapêutico , Masculino , Neurotransmissores/administração & dosagem , Neurotransmissores/uso terapêutico , Apoio Nutricional/métodos , Prurido/tratamento farmacológico , Terapia de Relaxamento/métodos
10.
Med Clin North Am ; 105(4): 723-735, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34059247

RESUMO

Cellulitis is a common skin infection resulting in increasing hospitalizations and health care costs. There is no gold standard diagnostic test, making cellulitis a potentially challenging condition to distinguish from other mimickers. Physical examination typically demonstrates poorly demarcated unilateral erythema with warmth and tenderness. Thorough history and clinical examination can narrow the differential diagnosis of cellulitis and minimize unnecessary hospitalization. Antibiotic selection is determined by patient history and risk factors, severity of clinical presentation, and the most likely microbial culprit.


Assuntos
Celulite (Flegmão)/diagnóstico , Celulite (Flegmão)/tratamento farmacológico , Hospitalização/estatística & dados numéricos , Dermatopatias Infecciosas/patologia , Idoso , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Gestão de Antimicrobianos/métodos , Celulite (Flegmão)/fisiopatologia , Diagnóstico Diferencial , Progressão da Doença , Eritema/patologia , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/economia , Humanos , Exame Físico/métodos , Valor Preditivo dos Testes , Fatores de Risco , Índice de Gravidade de Doença , Dermatopatias Infecciosas/microbiologia
11.
Med Clin North Am ; 105(4): 737-755, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34059248

RESUMO

The cutaneous lymphomas are malignancies of T-cell and B-cell lymphocytes in which the skin is the primary organ of involvement. The cutaneous T-cell lymphomas include variants that can mimic the presentation of common skin diseases or arthropod bites. Mycosis fungoides, the most common cutaneous T-cell lymphoma, usually presents as fixed asymptomatic patches or plaques in sun-protected areas. The cutaneous B-cell lymphomas have fewer variants that often present as papules or nodules that can mimic nonmelanoma skin cancers. Some therapies for cutaneous lymphoma have unique side effects such as central hypothyroidism, hyperlipidemia, and peripheral neuropathy.


Assuntos
Linfoma Cutâneo de Células T/diagnóstico , Linfoma Cutâneo de Células T/terapia , Dermatopatias/diagnóstico , Neoplasias Cutâneas/patologia , Idoso , Idoso de 80 Anos ou mais , Animais , Antineoplásicos/efeitos adversos , Antineoplásicos Imunológicos/efeitos adversos , Artrópodes , Bexaroteno/efeitos adversos , Mordeduras e Picadas/diagnóstico , Brentuximab Vedotin/efeitos adversos , Diagnóstico Diferencial , Humanos , Hiperlipidemias/induzido quimicamente , Hipotireoidismo/induzido quimicamente , Linfoma Anaplásico Cutâneo Primário de Células Grandes/diagnóstico , Linfoma Cutâneo de Células T/classificação , Papulose Linfomatoide/diagnóstico , Micose Fungoide/diagnóstico , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Prognóstico , Síndrome de Sézary/diagnóstico , Dermatopatias/patologia
12.
Med Clin North Am ; 105(4): 757-782, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34059249

RESUMO

Connective tissue diseases (CTDs) encompass a broad spectrum of clinical presentations that involve multidisciplinary management. Cutaneous findings are common in CTD and careful examination of these features aids in appropriate diagnosis and subsequent evaluation. Thorough work-up of CTD is crucial to properly identify disease subtypes and systemic involvement. Management plans can be developed based on diagnosis and systemic manifestations of disease. Disease management often requires treatment with pharmacotherapies with potential for toxicities, further underscoring the importance of diagnostic accuracy in this patient population. Evolving research strives to better elucidate the pathogenic mechanisms of CTDs allowing for more targeted treatment modalities.


Assuntos
Doenças do Tecido Conjuntivo/complicações , Doenças do Tecido Conjuntivo/tratamento farmacológico , Doenças do Tecido Conjuntivo/patologia , Tratamento Farmacológico/métodos , Adulto , Comorbidade , Doenças do Tecido Conjuntivo/diagnóstico , Dermatomiosite/diagnóstico , Dermatomiosite/etiologia , Dermatomiosite/patologia , Diagnóstico Diferencial , Tratamento Farmacológico/estatística & dados numéricos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Diagnóstico Precoce , Feminino , Humanos , Comunicação Interdisciplinar , Lúpus Eritematoso Cutâneo/diagnóstico , Lúpus Eritematoso Cutâneo/etiologia , Lúpus Eritematoso Cutâneo/patologia , Lúpus Eritematoso Discoide/diagnóstico , Lúpus Eritematoso Discoide/etiologia , Lúpus Eritematoso Discoide/patologia , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/etiologia , Lúpus Eritematoso Sistêmico/patologia , Masculino , Administração dos Cuidados ao Paciente/métodos , Escleroderma Sistêmico/diagnóstico , Escleroderma Sistêmico/etiologia , Escleroderma Sistêmico/patologia , Vasculite/diagnóstico , Vasculite/etiologia , Vasculite/patologia
13.
World J Surg Oncol ; 19(1): 180, 2021 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-34134706

RESUMO

BACKGROUND: There have been many studies on the clinical characteristics of neutrophilic, lymphocytic, and/or eosinophilic pleural effusion. While caring for patients with pleural effusion, we found that histiocytic pleural effusion (HisPE) was not uncommon. However, few studies have explored HisPE. The purpose of the present study was to determine the clinical characteristics and etiologies of HisPE. METHODS: In this retrospective study, HisPE was defined as pleural fluid white blood cells comprised of ≥ 50% histiocytes. Using a clinical data warehouse, patients with HisPE among all patients aged >18 years who underwent thoracentesis and pleural fluid analysis between January 2010 and December 2019 at Ulsan University Hospital were enrolled. A total of 295 (9.0%) of 3279 patients who underwent thoracentesis were identified as HisPE patients. Among them, 201 with exudative HisPE were included. Clinical characteristics and etiologies were extracted from medical records and analyzed. RESULTS: Among the 201 patients with exudative HisPE, the major causes were malignant pleural effusion (n = 102 [50.7%]), parapneumonic effusion (n = 9 [4.5%]), and tuberculous pleurisy (n = 9 [4.5%]). In the 102 patients with malignant pleural effusion, the main types of cancer were lung (n = 42 [41.2%]), breast (n = 16 [15.7%]), and stomach cancer (n = 11 [10.8%]). Among lung cancers, adenocarcinoma (n = 34 [81.0%]) was the most common histology. CONCLUSIONS: The leading cause of exudative HisPE was malignancy, particularly lung cancer. Physicians should consider the possibility of malignant disease if histiocytes are predominantly present in pleural effusion.


Assuntos
Derrame Pleural Maligno , Derrame Pleural , Tuberculose Pleural , Diagnóstico Diferencial , Histiócitos , Humanos , Derrame Pleural/epidemiologia , Derrame Pleural/etiologia , Derrame Pleural Maligno/etiologia , Prognóstico , Estudos Retrospectivos , Tuberculose Pleural/diagnóstico
14.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 50(2): 148-154, 2021 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-34137235

RESUMO

Melkersson-Rosenthal syndrome (MRS) is a rare neuro-muco-cutaneous syndrome, which is characterized by recurrent orofacial swelling, recurrent facial paralysis and fissured tongue. It has a high prevalence in young adults. Up to now, the etiology of MRS is still not clear, it may related to infection, immune deficiency and hereditary factors. The pharmacological therapy and surgery are the main treatment. Corticosteroids seems to be the drug of choice for MRS patient, but the specific dosage and therapeutic effect have not yet been determined. Surgeries of lips provide excellent results in persistentlip edema MRS cases. This article reviews the research progress on MRS, focusing on its epidemiology, etiology, histopathological characteristics, clinical manifestations, classification, diagnostic criteria, differential diagnosis and treatment, to provide information for its early diagnosis and appropriate treatment.


Assuntos
Síndrome de Melkersson-Rosenthal , Corticosteroides , Diagnóstico Diferencial , Humanos , Lábio , Síndrome de Melkersson-Rosenthal/diagnóstico , Síndrome de Melkersson-Rosenthal/tratamento farmacológico , Pele , Adulto Jovem
15.
BMC Infect Dis ; 21(1): 537, 2021 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-34098877

RESUMO

BACKGROUND: Invasive aspergillosis of the central nervous system is a rare but increasingly prevalent disease. We present the unusual case of an immunosuppressed patient suffering from unexpected superinfected invasive aspergillosis with cerebral, pulmonal, and adrenal manifestations, mimicking a metastasized bronchial carcinoma. This report reveals the importance of including aspergillosis in the differential diagnosis of a cerebral mass lesion in the light of unspecific clinical findings. CASE PRESENTATION: A 58-year-old immunocompromised female presented to our emergency department with a single tonic-clonic seizure. Imaging showed a ring enhancing cerebral mass with perifocal edema and evidence of two smaller additional hemorrhagic cerebral lesions. In the setting of a mass lesion in the lung, and additional nodular lesions in the left adrenal gland the diagnosis of a metastasized bronchus carcinoma was suspected and the cerebral mass resected. However, histology did not reveal any evidence for a neoplastic lesion but septate hyphae consistent with aspergillus instead and microbiological cultures confirmed concomitant staphylococcal infection. CONCLUSIONS: A high index of suspicion for aspergillus infection should be maintained in the setting of immunosuppression. Clinical and radiological findings are often unspecific and even misleading. Definite confirmation usually relies on tissue diagnosis with histochemical stains. Surgical resection is crucial for establishing the diagnosis and guiding therapy with targeted antifungal medications.


Assuntos
Aspergilose/diagnóstico , Neoplasias Encefálicas/diagnóstico , Infecções Fúngicas do Sistema Nervoso Central/diagnóstico , Superinfecção/diagnóstico , Antifúngicos/uso terapêutico , Aspergilose/tratamento farmacológico , Aspergilose/imunologia , Aspergilose/patologia , Aspergillus/isolamento & purificação , Neoplasias Encefálicas/tratamento farmacológico , Neoplasias Encefálicas/patologia , Infecções Fúngicas do Sistema Nervoso Central/tratamento farmacológico , Infecções Fúngicas do Sistema Nervoso Central/imunologia , Infecções Fúngicas do Sistema Nervoso Central/patologia , Diagnóstico Diferencial , Feminino , Humanos , Hospedeiro Imunocomprometido , Pessoa de Meia-Idade , Staphylococcus/isolamento & purificação , Superinfecção/tratamento farmacológico , Superinfecção/imunologia , Superinfecção/patologia
16.
BMC Infect Dis ; 21(1): 540, 2021 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-34098890

RESUMO

BACKGROUND: A decision to diagnose certain skin diseases in patient undergoing psychotic break is challenging; this includes establishing the diagnosis of leprosy. Diagnosis of leprosy is established if there is at least one of the three cardinal signs of leprosy. Histopathological examination is not a gold standard, but remains useful in atypical or clinically suspicious cases. CASE PRESENTATION: We report for the first time, an interesting case of leprosy with atypical clinical manifestations in a psychotic homeless male with unknown history of present illness. Upon examination, hypopigmented macules, hyperpigmented macules, and plaques were observed, with unclear sensation impairment. Peripheral nerve thickening and acid-fast bacilli from slit-skin smear were not found. Histopathological examination from hypopigmented macule on the upper right limb showed no granulomatous reaction and other histopathological features of leprosy. Although the condition did not fulfill the cardinal signs of leprosy, we found lagophthalmos, claw hands, pseudomutilation of fingers and toes. Therefore, the diagnosis of suspected leprosy was established. The patient was hospitalized and attempts to administer oral rifampicin and clofazimine were made. Several days after treatment, annular erythematous macules appeared on the patient's face, abdomen, and back. Histopathological examination results on sample taken from erythematous macule and right sural nerve were consistent with the diagnosis of leprosy with reversal reaction. CONCLUSION: In certain conditions, histopathological examination of the skin and nerves are a highly rewarding test in establishing a diagnosis of leprosy.


Assuntos
Pessoas em Situação de Rua , Hanseníase/diagnóstico , Transtornos Psicóticos/complicações , Dermatopatias/diagnóstico , Diagnóstico Diferencial , Humanos , Hansenostáticos/uso terapêutico , Hanseníase/complicações , Hanseníase/tratamento farmacológico , Hanseníase/patologia , Masculino , Dermatopatias/complicações , Dermatopatias/tratamento farmacológico , Dermatopatias/patologia , Resultado do Tratamento
19.
BMC Infect Dis ; 21(1): 517, 2021 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-34078290

RESUMO

BACKGROUND: We report an unusual case of infective colitis by Yersinia enterocolitica complicated by microliver abscesses mimicking multiple liver metastases in a 79 yr old female without any risk factors for bacteriaemia by this pathogen. CASE PRESENTATION: The patient was admitted to the Internal Medicine with Stroke Care ward of University Policlinico "P. Giaccone" in Palermo because of the appearance of diarrhoea. After the antimicrobial treatment for infective colitis, the clinicians observed a persistently increased white blood cells (WBC) count and multiple hepatic lesions; after having excluded any neoplastic disease and inflammatory bowel disease (IBD), blood cultures positive for Y. enterocolitica allowed to establish the final diagnosis was infective micro liver abscesses consequent to infective colitis due to Y. enterocolitica, which were successfully treated with cefixime and doxycycline. CONCLUSIONS: This case report should make clinicians reflect on how complex the differential diagnosis between microliver abscesses and metastasis could be and the possibility of bacteriaemia by Y. enterocolitica even without iron overload conditions.


Assuntos
Colite/diagnóstico , Abscesso Hepático/diagnóstico , Neoplasias Hepáticas/diagnóstico , Yersiniose/diagnóstico , Yersinia enterocolitica/isolamento & purificação , Idoso , Antibacterianos/uso terapêutico , Bacteriemia/complicações , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Colite/complicações , Colite/tratamento farmacológico , Diagnóstico Diferencial , Feminino , Humanos , Abscesso Hepático/tratamento farmacológico , Abscesso Hepático/etiologia , Resultado do Tratamento , Yersiniose/complicações , Yersiniose/tratamento farmacológico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...