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1.
Niger J Clin Pract ; 23(1): 116-119, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31929217

RESUMO

We present two rare cases of hypereosinophilia (HE) in acute myeloid leukemia with normal karyotype (NK-AML) at diagnosis. The first case is a 29-year-old female who presented with HE. On evaluation, she was found to have NK-AML. She failed to achieve complete remission (CR) after the first induction therapy with standard idarubicin and cytarabine (IA). She achieved CR after two cycles of reinduction chemotherapy with cytarabine, aclarubicin, and granulocyte colony-stimulating factor (G-CSF) (CAG) but had early relapsed. Reinduction chemotherapy with fludarabine, Ara-C, and G-CSF (FLAG) led to her second remission, followed by unrelated umbilical cord hematopoietic stem cell transplantation (HSCT). Unfortunately, she died of thrombotic thrombocytopenic purpura. The second case is a 23-year-old male who was diagnosed as NK-AML with HE. IA regimen was successively used in two cycles treatment achieving CR. He underwent haploidentical HSCT but had a relapse after 17 months of sustained remission and died 4 months later. The presence of HE may be a poor prognostic feature in NK-AML.


Assuntos
Eosinofilia/complicações , Fator Estimulador de Colônias de Granulócitos , Transplante de Células-Tronco Hematopoéticas , Leucemia Mieloide Aguda/cirurgia , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Evolução Fatal , Feminino , Humanos , Cariótipo , Leucemia Mieloide Aguda/patologia , Masculino , Prognóstico , Recidiva , Indução de Remissão , Adulto Jovem
2.
BMJ Case Rep ; 12(10)2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31604720

RESUMO

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome represents a severe adverse drug reaction driven by eosinophilia. Treatment is focused on withdrawal of medication, supportive care and immunosuppression such as high-dose corticosteroid therapy. Here we report a 56-year-old male patient who initially presented with breathlessness and eosinophilia, subsequent development of respiratory failure and admission to ITU for non-invasive ventilation. The patient continued to deteriorate despite high-dose prednisolone and methylprednisolone. Other causes of hypereosinophilia were normal. He was diagnosed with DRESS syndrome secondary to pregabalin and was treated with subcutaneous mepolizumab. We observed the rapid resolution of eosinophilia and clinical improvement; the patient was discharged home within a month of administration. This represents the successful use of mepolizumab in the acute setting of pulmonary failure secondary to DRESS. A similar approach could be adopted in other acute conditions with refractory eosinophilic inflammation where standard steroid therapy has failed.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Síndrome de Hipersensibilidade a Medicamentos/complicações , Eosinofilia/complicações , Eosinofilia/tratamento farmacológico , Pneumonia/tratamento farmacológico , Pneumonia/etiologia , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Pregabalina/efeitos adversos
3.
Actas dermo-sifiliogr. (Ed. impr.) ; 110(7): 590-596, sept. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-185530

RESUMO

La vasculitis eosinofílica recurrente cutánea primaria es una enfermedad rara, caracterizada por placas purpúricas, eritematosas y pruriginosas asociadas a edema. Comparamos y analizamos las características clínicas, dermatoscópicas e histológicas de la enfermedad en 4 pacientes de nuestro hospital y en 13 casos de pacientes publicados previamente. Se incluyeron 17 pacientes, con una mediana de edad de 56 años, y una mediana de duración de la enfermedad de 6 meses. En la mayoría de los casos las lesiones fueron generalizadas (47%) o localizadas en los miembros inferiores (41%). Las características histológicas más frecuentes fueron: color purpúrico (71%), edema local (65%), vasculitis necrosante (94%) e infiltración eosinofílica (100%). La mayoría de los pacientes (82,4%) recibió esteroides orales (mediana de la dosis de 30 mg). La vasculitis eosinofílica recurrente cutánea primaria podría ser una entidad clínica infradiagnosticada. El análisis de los pacientes nos permitió proponer algunos criterios diagnósticos para su definición. Recomendamos una estrategia terapéutica con esteroides de alta potencia y dapsona, pudiéndose considerar como el tratamiento de primera línea


Primary recurrent cutaneous eosinophilic vasculitis is a rare condition characterized by pruritic, erythematous, purpuric plaques associated to edema. We compared and analyze the clinical, dermoscopic and histological features of the disease in 4 patients from our hospital and 13 patients published in the literature. Seventeen patients were included, with a median age of 56 yo, a median duration of disease of 6 months. Lesions were most frequently generalized (47%) or localized in lower limbs (41%). The most frequent features were purpuric color (71%), local edema (65%), necrotizing vasculitis (94%) and eosinophil infiltration (100%) in histology. Most of the patients (82.4%) were given oral steroids with a median dose of 30 mg. Primary recurrent cutaneous eosinophilic vasculitis might be an infra-diagnosed condition. The analysis of the patients allowed us to propose diagnostic criteria for the definition of this disease. We suggest a therapeutic strategy with high-potency steroids and dapsone, which might be considered as first-line treatment


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Vasculite/tratamento farmacológico , Dermatopatias Vasculares/tratamento farmacológico , Eosinofilia/complicações , Recidiva , Dermoscopia/instrumentação , Vasculite/diagnóstico , Dapsona/uso terapêutico , Corticosteroides/uso terapêutico , Dermatopatias Vasculares/fisiopatologia , Prednisona/uso terapêutico , Diagnóstico Diferencial
5.
Acta Otolaryngol ; 139(10): 881-889, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31438745

RESUMO

Background: Olfactory dysfunction in eosinophilic chronic rhinosinusitis (ECRS) is poorly understood. Objective: To compare olfactory mucosal injury due to eosinophil infiltration in ECRS with postoperative olfactory function. Methods: Seventeen ECRS patients (ECRS group) and 18 bilateral rhinosinusitis (non-ECRS group) patients were compared. At 3 and 12 months post-endoscopic sinus surgery (ESS), all patients were evaluated for subjective symptoms (nasal obstruction, nasal discharge and olfactory dysfunction), endoscopic nasal findings, CT score and T&T olfactometer recognition threshold test. The eosinophil count, OMP-positive cells and epithelial erosion in olfactory mucosa collected during ESS were compared with the postoperative olfactory function. Results: The non-ECRS group showed significant improvement in all clinical findings at 3 and 12 months, but the ECRS group showed worsening of the olfactory dysfunction symptoms and T&T olfactometer recognition threshold at 12 months because of recurrence of sinusitis. The groups differed significantly in the ΔT&T value (i.e. pre-ESS T&T recognition threshold - post-ESS T&T recognition threshold) at both 3 and 12 months, and the degree of olfactory improvement differed. Histologically, the ECRS group showed significantly more eosinophils, fewer OMP-positive cells and greater epithelial erosion than the non-ECRS group. Conclusions: Eosinophilic inflammation was thought to cause olfactory mucosal injury/dysfunction.


Assuntos
Endoscopia , Eosinofilia/complicações , Transtornos do Olfato/etiologia , Transtornos do Olfato/patologia , Rinite/cirurgia , Sinusite/cirurgia , Adolescente , Adulto , Doença Crônica , Eosinofilia/patologia , Feminino , Humanos , Masculino , Mucosa Olfatória/patologia , Estudos Retrospectivos , Rinite/complicações , Rinite/patologia , Sinusite/complicações , Sinusite/patologia , Resultado do Tratamento , Adulto Jovem
6.
Medicine (Baltimore) ; 98(35): e16985, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464947

RESUMO

RATIONALE: Angiostrongylus cantonensis-induced eosinophilic meningoencephalitis (AEM) in infants is a very rare but fatal disease. Utilization of genetic assay to detect the cerebral parasite plays an important role for the treatment of the infection. PATIENT CONCERNS: Two infants (<2 years) presented with cough, intermittent fever, mental fatigue, and poor diet. DIAGNOSIS: The patients were under clinical examination and laboratory test including cardiac ultrasound, chest X-ray, blood or cerebrospinal fluid (CSF) cell counting, serum enzyme-linked immunosorbent assay (ELISA), head magnetic resonance imaging (MRI) and next-generation sequencing (NGS) on DNA from CSF. Due to hypereosinophils in patients' peripheral blood and CSF, and abundant DNA sequences from A cantonensis in CSF, the patients were diagnosed with Angiostrongylus eosinophilic meningoencephalitis. INTERVENTIONS: The patients were treated with albendazole to deworm, and methylprednisolone to reduce inflammation. OUTCOME: The patients were completely recovered from AEM without relapse after 10-day treatment. LESSONS: ELISA and MRI are not sufficiently accurate for the diagnosis of AEM in infants. NGS can specify the infection by the cerebral parasite and offers a new effective approach for the early and precise diagnosis of AEM in infants.


Assuntos
Eosinofilia/complicações , Meningoencefalite/complicações , Meningoencefalite/diagnóstico , Meningoencefalite/parasitologia , Infecções por Strongylida/diagnóstico , Albendazol/uso terapêutico , Angiostrongylus cantonensis , Animais , Anti-Helmínticos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Ensaio de Imunoadsorção Enzimática , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Humanos , Lactente , Imagem por Ressonância Magnética , Masculino , Meningoencefalite/tratamento farmacológico , Metilprednisolona/uso terapêutico , Infecções por Strongylida/tratamento farmacológico , Infecções por Strongylida/parasitologia
7.
Medicina (Kaunas) ; 55(7)2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31277327

RESUMO

A 56-year-old man with severe asthma underwent bronchial thermoplasty (BT). However, his asthma exacerbated and hypereosinophilia developed 2 months later, thus necessitating oral corticosteroid (OCS) therapy. Six months after BT, a diagnosis of severe asthma with eosinophilic chronic rhinosinusitis (ECRS) was made and benralizumab treatment was initiated; the blood eosinophil count subsequently decreased and lung function improved, thereby permitting OCS dose tapering. Surprisingly, benralizumab both reduced nasal polyps and ameliorated ECRS. Thus, benralizumab may be a useful drug for the rapid treatment of severe asthma with ECRS, especially in patients with hypereosinophilia.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Asma/tratamento farmacológico , Eosinofilia/tratamento farmacológico , Sinusite/tratamento farmacológico , Anticorpos Monoclonais Humanizados/farmacologia , Asma/complicações , Termoplastia Brônquica/métodos , Progressão da Doença , Eosinofilia/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Sinusite/complicações
8.
Medicine (Baltimore) ; 98(28): e16382, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305439

RESUMO

RATIONALE: Type I monoclonal cryoglobulinemia is usually associated with lymphoproliferative disorders, such as monoclonal gammopathy of undetermined significance (MGUS), myeloma, chronic lymphocytic leukemia (CLL) and lymphoplasmocytic lymphoma (LPL). Clinical symptoms related to Type I cryoglobulin (CG) isotype often include skin, neurological and renal manifestations. PATIENT CONCERNS: A 42-year-old woman who initially presented urticaria, palpable purpura in both her upper extremities and legs, eosinophilia and Raynaud phenomenon. Skin biopsy revealed eosinophil infiltration. Monoclonal immunoglobulin (Ig) G-κprotein was detected and CG was also positive. DIAGNOSES: The patient was finally diagnosed as MGUS related Type I CG. INTERVENTIONS: Cyclophosphamide-dexamethasone-thalidomide (CDT) therapy was initiated. OUTCOMES: The treatment relieved the skin symptoms efficiently. LESSONS: To our knowledge, this is a rare case of Type I cryoglobulinemic vasulitis with eosinophilia complicated by MGUS, and the effective treatment of cyclophosphamide combined with thalidomide and prednisone may provide a new therapeutic option for cryoglobulinemic vasulitis.


Assuntos
Crioglobulinemia/complicações , Eosinofilia/complicações , Gamopatia Monoclonal de Significância Indeterminada/complicações , Vasculite/complicações , Adulto , Crioglobulinemia/diagnóstico , Crioglobulinemia/tratamento farmacológico , Diagnóstico Diferencial , Eosinofilia/diagnóstico , Eosinofilia/tratamento farmacológico , Feminino , Humanos , Gamopatia Monoclonal de Significância Indeterminada/diagnóstico , Gamopatia Monoclonal de Significância Indeterminada/tratamento farmacológico , Vasculite/diagnóstico , Vasculite/tratamento farmacológico
10.
Intern Med ; 58(20): 3045-3050, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31243203

RESUMO

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic vasculitis characterized by asthma, eosinophilia, and diffuse eosinophilic infiltration. Although cardiovascular involvement is common and a leading cause of EGPA-related mortality, severe pericarditis-led cardiac tamponade occurs rarely. We herein report a 72-year-old man with anti-proteinase 3 (anti-PR3) anti-neutrophil cytoplasmic antibody (ANCA)-positive EGPA diagnosed by the presence of cardiac tamponade, which responded quickly to pericardiocentesis and a single administration of prednisolone. This is the first case of anti-PR3 ANCA-positive EGPA with cardiac tamponade; the patient displayed clinical features of both ANCA-positive and ANCA-negative cases.


Assuntos
Tamponamento Cardíaco/etiologia , Eosinofilia/complicações , Granulomatose com Poliangiite/complicações , Mieloblastina/imunologia , Idoso , Anticorpos Anticitoplasma de Neutrófilos/imunologia , Tamponamento Cardíaco/diagnóstico , Diagnóstico Diferencial , Ecocardiografia , Eosinofilia/diagnóstico , Eosinofilia/metabolismo , Granulomatose com Poliangiite/diagnóstico , Granulomatose com Poliangiite/metabolismo , Humanos , Masculino , Mieloblastina/metabolismo , Tomografia Computadorizada por Raios X
11.
Intern Med ; 58(20): 3051-3055, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31243218

RESUMO

A 45-year-old man was admitted with acute abdominal pain and eosinophilia. Abdominal computed tomography revealed thickness of the ascending and transverse colon with decreased contrast enhancement and a small amount of ascites. In an emergency operation, the necrotic colon was resected. Histopathology showed subserous medium-sized arteritis with abundant eosinophil infiltrates and thrombosis in the portal vein branches. He was diagnosed with polyarteritis nodosa (PAN), and immunosuppressive therapy improved his condition. Two years later, the disease recurred with ischemic cutaneous lesions and marked eosinophilia. Our experience suggests that marked eosinophilia in PAN may imply severe organ involvement, including gastrointestinal necrosis, as well as the association of venous thrombosis.


Assuntos
Eosinofilia/diagnóstico , Gastroenteropatias/etiologia , Poliarterite Nodosa/diagnóstico , Trombose Venosa/etiologia , Eosinofilia/complicações , Gastroenteropatias/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Poliarterite Nodosa/complicações , Recidiva , Tomografia Computadorizada por Raios X , Trombose Venosa/diagnóstico
12.
Dtsch Med Wochenschr ; 144(13): 893-896, 2019 07.
Artigo em Alemão | MEDLINE | ID: mdl-31252443

RESUMO

Eosinophilic Gastrointestinal Disease (EGID) is a rare disease of largely unknown etiology. We describe a case of a 79-year-old patient with the initial diagnosis of eosinophilic gastritis with a haemorrhagic-ulcerous course and a rapid recurrence of the disease after discontinuing drug therapy. ANAMNESIS AND CLINICAL FINDINGS: The patient stated that he had melena for several days. He was completely asymptomatic. The existing medication has not been changed lately. EXAMINATIONS AND DIAGNOSIS: Gastroscopy, endosonography and CT scan revealed a tumor suspicious for malignancy in the corpus ventriculi. Histopathological examination revealed the correct diagnosis. THERAPY AND COURSE: The patient was treated with prednisolone and PPI. This led to a regression of the findings and a complete clinical remission. A treatment-free interval led to a fulminant recurrence with again upper GI bleeding. After resumption of drug therapy, the detected gastric ulcer rapidly declined. CONCLUSION: EGID is hardly distinguishable from classic gastroenteritis in its clinical appearance. Diagnosis requires a histopathological examination of the affected tissue. Oral glucocorticoids play a role in the treatment of acute EGID. Both single episodes and chronic recurrent courses have been observed. The drugs used for therapy should therefore be discontinued carefully.


Assuntos
Enterite , Eosinofilia , Gastrite , Hemorragia Gastrointestinal , Úlcera Gástrica , Idoso , Anti-Inflamatórios/uso terapêutico , Diagnóstico Diferencial , Enterite/complicações , Enterite/diagnóstico , Eosinofilia/complicações , Eosinofilia/diagnóstico , Gastrite/complicações , Gastrite/diagnóstico , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Melena , Prednisolona/uso terapêutico , Inibidores da Bomba de Prótons/uso terapêutico , Recidiva , Úlcera Gástrica/diagnóstico por imagem , Úlcera Gástrica/etiologia
13.
Zhonghua Jie He He Hu Xi Za Zhi ; 42(6): 426-431, 2019 Jun 12.
Artigo em Chinês | MEDLINE | ID: mdl-31189228

RESUMO

Objective: To compare the clinical characteristics of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) by different levels of blood eosinophil (EOS) count and to investigate the predictive value of the response to glucocorticoid treatment and the readmission rate in the patients with higher blood eosinophils. Methods: A total of 120 patients with AECOPD were admitted to the Department of Pulmonary and Critical Care Medicine in The Second Xiangya Hospital of Central South University from January 01, 2017 to December 31, 2017. Patients were divided into two groups according to their admission blood eosinophil fractions. Patients with EOS%≥2% were in the EOS group (n=56) , while patients with EOS%<2% were in the Non-EOS group (n=64) . The clinical characteristics, hospitalization treatments especially the glucocorticoid treatment response were compared, and the risk of severe acute exacerbation of the two groups including the 12-month COPD-related readmission, and time to first COPD-related readmission were also compared. Results: Compared with the Non-EOS group, the EOS group had lower values of white blood cell (WBC) , neutrophil fraction (N%) , blood neutrophil-to-lymphocyte ratio (NLR) , and C-reactive protein (CRP) . The EOS group also required shorter course of antibiotic treatment [8 (6-10) and 9 (7-11) , P=0.033]. In glucocorticoid-treated patients (n=82) , the EOS group had significantly alleviated symptoms than the Non-EOS group (patients withδCAT≥2 were 86.8% and 68.2%, respectively, P=0.046) , and the duration of hospitalization of the EOS group was shorter [9 (7-11) and 10 (9 to 13) , P=0.042]. Patients with glucocorticoid treatment in the EOS group had significantly alleviated symptoms than those without glucocorticoid treatment (patients with δCAT ≥ 2 were 86.8% and 61.1%, respectively, P=0.040) . The follow-up one year after discharge showed a higher risk of severe acute exacerbation in the EOS group [Adjust OR 2.67 (1.10-6.46), P=0.030; HR: 1.57 (1.02-2.40), P=0.040]. Conclusion: The blood eosinophil levels were useful in predicting the AECOPD patients' response to glucocorticoid treatment and the risk of severe acute exacerbations.


Assuntos
Eosinofilia/complicações , Eosinófilos/metabolismo , Glucocorticoides/uso terapêutico , Readmissão do Paciente , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Biomarcadores/sangue , Progressão da Doença , Eosinofilia/tratamento farmacológico , Eosinófilos/efeitos dos fármacos , Humanos , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Estudos Retrospectivos , Resultado do Tratamento
15.
Pediatr Rheumatol Online J ; 17(1): 26, 2019 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-31138304

RESUMO

BACKGROUND: Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic vasculitis in children. A delayed or missed diagnosis of pediatric EGPA is common, owing to the atypical clinical manifestation and limited recognition of this disorder. The vasculitis in EGPA typically involves small to medium size vessels. Extensive occlusion of arteries in the extremities was being extremely rare and has never been reported in children. CASE PRESENTATION: A 10-year and 10-month-old girl with recurrent wheezing and breathlessness during exercise, was initially diagnosed with asthma at the age of five years. Despite unexplained manifestations, including intermittent remarkably increased eosinophilia, uncontrolled allergic rhinitis, and recurrent petechia, from the onset of asthma through to its remission, the consideration of EGPA was completely ignored until the patient presented with aggravated petechia and severe ulceration of the lower extremities, associated with extensive stenosis and/or occlusion of the arteries of the shank and foot. Given her history of asthma, eosinophilia, allergic rhinitis, mononeuropathy, pulmonary infiltrates, and vasculitis confirmed by the skin biopsy, the diagnosis of EGPA was ultimately confirmed. Regrettably, the initial inappropriate and irrational use of corticosteroid failed to relieve the symptoms until more aggressive treatment with intravenous methylprednisolone was started. This was followed by methotrexate treatment, with tapering of prednisone, without relapse over a six-month follow-up. CONCLUSIONS: Pediatric rheumatologists should be alert to the possibility of EGPA in children with refractory asthma associated with unexplained manifestations, and should be aware of the thromboembolic complications as vascular sequelae of EGPA.


Assuntos
Arteriopatias Oclusivas/diagnóstico , Síndrome de Churg-Strauss/diagnóstico , Granulomatose com Poliangiite/diagnóstico , Arteriopatias Oclusivas/patologia , Criança , Síndrome de Churg-Strauss/complicações , Constrição Patológica , Diagnóstico Tardio , Eosinofilia/complicações , Eosinofilia/diagnóstico , Feminino , Pé/irrigação sanguínea , Granulomatose com Poliangiite/complicações , Humanos , Lactente , Perna (Membro)/irrigação sanguínea , Vasculite/patologia
17.
J Int Med Res ; 47(6): 2452-2460, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31006357

RESUMO

BACKGROUND: To investigate the behaviour of the inflammatory marker neutrophil-to-lymphocyte ratio (NLR) in the presence of peripheral blood eosinophilia (PBE) in paediatric asthma patients with lower respiratory tract (LRT) infections. METHODS: This retrospective study enrolled consecutive patients aged ≥5 years who were diagnosed with asthma and whose haemogram values were available. The patients were further subdivided based on the presence or absence of LRT infections and allergies. NLR and C-reactive protein (CRP) were evaluated in relation to the presence or absence of PBE (≥4% eosinophils). RESULTS: A total of 991 patients were enrolled in the study. Patients with LRT infections had significantly higher leucocyte and neutrophil counts, a greater NLR and a higher level of CRP compared with patients without LRT infections. Overall, patients with PBE had significantly lower NLRs and CRP regardless of the presence or absence of an LRT infection. The PBE percentage showed moderate inverse correlations with NLR ( r = -0.34) and CRP ( r = -0.20). CONCLUSION: The presence of PBE was significantly associated with lower NLR and CRP regardless of the presence or absence of an infectious condition.


Assuntos
Asma/diagnóstico , Biomarcadores/metabolismo , Eosinofilia/complicações , Mediadores da Inflamação/metabolismo , Inflamação/complicações , Infecções Respiratórias/diagnóstico , Asma/etiologia , Asma/metabolismo , Proteína C-Reativa/metabolismo , Estudos Transversais , Progressão da Doença , Feminino , Seguimentos , Humanos , Linfócitos/patologia , Masculino , Neutrófilos/patologia , Valor Preditivo dos Testes , Infecções Respiratórias/etiologia , Infecções Respiratórias/metabolismo , Estudos Retrospectivos
19.
An. sist. sanit. Navar ; 42(1): 89-92, ene.-abr. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-183052

RESUMO

El síndrome de DRESS (reacción de sensibilidad a medicamentos con eosinofilia y síntomas sistémicos) es una farmacodermia grave que debe ser conocida para instaurar un tratamiento óptimo precoz, evitando así una evolución sistémica y potencialmente letal. Las farmacodermias son la tercera causa de efectos adversos en las plantas de hospitalización quirúrgica, precedida por las infecciones nosocomiales y las complicaciones intraoperatorias. La mayoría de los casos suponen un reto diagnóstico para el cirujano, ya que su debut es inespecífico y, por tanto, son fácilmente confundibles con una complicación derivada de una cirugía reciente. Presentamos el caso de un varón de 54 años, sano y sin antecedentes personales, intervenido en dos ocasiones por sangrado abdominal espontáneo que tres semanas después de la última cirugía, y coincidiendo con la toma de metamizol oral, desarrolló un síndrome de DRESS. El deterioro inicial inespecífico, característico de este síndrome, motivó el retraso diagnóstico y terapéutico del paciente, y la consecuente evolución hacia la afectación sistémica


The DRESS syndrome (drug rash with eosinophilia and systemic symptoms) is a serious pharmacodermia which must be taken into account when establishing an optimal early treatment to prevent a systemic and potentially lethal evolution. Pharmacodermias are the third most frequent cause of adverse effects during surgical hospitalization, after nosocomial infections and intraoperative complications. In most cases, they pose a challenge to the surgeon, since their onset is nonspecific and, therefore, can be easily mistaken for a surgery complication. We present the case of a 54-year-old man, healthy and without relevant background, who was operated on two times due to spontaneous abdominal bleeding. Three weeks after the last surgery, and coinciding with the administration of oral metamizole, the patient developed a DRESS syndrome. The initial unspecific deterioration, characteristic of this syndrome, is the main cause of the delay in diagnosis and correct treatment, causing the resulting evolution to systemic affectation


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Eosinofilia/complicações , Hipersensibilidade a Drogas/complicações , Dipirona/efeitos adversos , Nefrite Intersticial/complicações , Diagnóstico Diferencial , Complicações Pós-Operatórias/diagnóstico , Nefrite Intersticial/diagnóstico
20.
Leg Med (Tokyo) ; 38: 1-4, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30861484

RESUMO

Acute myocarditis is related to a significant number of sudden deaths among young adults and its diagnosis is often demanded to post-mortem investigations performed on a forensic setting. Eosinophilic myocarditis (EM) is a rare form of myocarditis that is pathologically characterized by myocardial inflammation with eosinophils, often in association with elevated levels of circulating blood eosinophils. The sudden death of a 19-year-old boy with no past medical history is reported. Diagnosis of fatal acute EM was performed after a comprehensive investigation including an in-depth analysis of anamnestic and circumstantial data, and complete autopsy followed by toxicologic and cardio-pathological investigations. Discussion focuses on the forensic issues related to diagnosis and therapy of this rare form of acute myocarditis. As acute EM may be patchy, extensive myocardial sampling is mandatory in order to recognize the extent and the phase of the disease. An early diagnosis is the basis for a timely therapy, which is the key-point for prevent extensive myocardial damage, allowing a better outcome, especially when EM is acute and necrotizing. However, as demonstrated from the case herein reported, the course of EM is sometimes fulminant and does not allow any therapy nor even clinical diagnosis. Finally, this paper serves as reminder to consider this infrequent disease in differential diagnosis when facing with a sudden death, even in a young subject and in the absence of any prodrome.


Assuntos
Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/patologia , Eosinofilia/complicações , Eosinofilia/patologia , Patologia Legal , Miocardite/complicações , Miocardite/patologia , Miocárdio/patologia , Doença Aguda , Adulto , Autopsia , Diagnóstico Diferencial , Eosinofilia/diagnóstico , Humanos , Masculino , Miocardite/diagnóstico , Necrose , Adulto Jovem
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