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1.
Eur J Neurol ; 28(1): 358-360, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32997868

RESUMO

COVID-19 can occasionally be associated with cranial nerve involvement, but facial palsy, particularly if bilateral, is exceptional. We here report a patient who presented with severe bilateral facial palsy and evidence of SARS-CoV-2 infection preceded by upper respiratory symptoms. He also had serological evidence of coinfection with Epstein-Barr virus, which could have also played a role in his neurological manifestations. PCR in the cerebrospinal fluid was negative for both EBV and SARS-CoV-2, which suggests an indirect, immune-mediated mechanism rather than direct, viral-induced damage. The patient was treated with prednisone 60 mg/24h with a tapering schedule and had a favorable outcome, with an almost complete recovery in 3 weeks. SARS-CoV-2 adds to the list of infectious agents causative of bilateral facial palsy. Coinfection with SARS-CoV-2 is not rare and should be considered in the differential diagnosis.


Assuntos
/complicações , Infecções por Vírus Epstein-Barr/complicações , Paralisia Facial/etiologia , Anti-Inflamatórios/uso terapêutico , Paralisia Facial/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Prednisona/uso terapêutico , Recuperação de Função Fisiológica , Infecções Respiratórias/etiologia , Infecções Respiratórias/fisiopatologia , Resultado do Tratamento , Adulto Jovem
3.
Leukemia ; 35(1): 143-155, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32382083

RESUMO

PTCL patients exhibit poor survival with existing treatments. We investigated the efficacy of CHOP combined with alemtuzumab in 116 PTCL patients age 61-80 in an open-label, randomized phase 3 trial. Alemtuzumab was given on day 1, to a total of 360 mg in 21 patients, or 120 mg in 37. Hematotoxicity was increased with A-CHOP resulting in more grade ≥3 infections (40% versus 21%) and 4 versus 1 death due to infections, respectively. CR/CRu rate was 60% for A-CHOP and 43% for CHOP, and OR rate was 72% and 66%, respectively. Three-year-EFS, PFS and OS were 27% [15%-39%], 28% [15%-40%], and 37% ([23%-50%] for A-CHOP, and 24% [12%-35%], 29% [17%-41%], and 56% [44%-69%] for CHOP, respectively, showing no significant differences. Multivariate analyses, adjusted for strata and sex confirmed these results (hazard ratio HREFS: 0.7 ([95% CI: 0.5-1.1]; p = 0.094), HRPFS: 0.8 ([95% CI: 0.5-1.2]; p = 0.271), HROS: 1.4 ([95% CI: 0.9-2.4]; p = 0.154). The IPI score was validated, and male sex (HREFS 2.5) and bulky disease (HREFS 2.2) were significant risk factors for EFS, PFS, and OS. Alemtuzumab added to CHOP increased response rates, but did not improve survival due to treatment-related toxicity.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Linfoma de Células T Periférico/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Alemtuzumab/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Causas de Morte , Ciclofosfamida/efeitos adversos , Ciclofosfamida/uso terapêutico , Doxorrubicina/efeitos adversos , Doxorrubicina/uso terapêutico , Feminino , Humanos , Linfoma de Células T Periférico/diagnóstico , Linfoma de Células T Periférico/mortalidade , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Prednisona/efeitos adversos , Prednisona/uso terapêutico , Prognóstico , Análise de Sobrevida , Resultado do Tratamento , Vincristina/efeitos adversos , Vincristina/uso terapêutico
4.
Int J Dermatol ; 60(1): 88-92, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33017043

RESUMO

BACKGROUND: In approximately 13% of systemic lupus erythematosus (SLE) patients, a hallmark of primary biliary cirrhosis (PBC) can be detected: antimitochondrial M2 antibodies (AMA-M2). It has not been determined if the presence of AMA-M2 in SLE patients results in a higher risk of PBC in comparison to those with AMA but no SLE. Until now, there have been no such analyses among individuals with subacute cutaneous lupus erythematosus (SCLE). METHODS: To assess the seropositivity rates for AMA-M2 and autoantibodies associated with autoimmune hepatitis in patients with newly diagnosed SCLE and to determine the coexistence and risk of development of autoimmune liver disease in these patients within 1 year of follow-up, data from 33 patients with newly diagnosed SCLE were analyzed. RESULTS: AMA-M2 was found in 20% of SCLE patients. Patients from the AMA-M2-positive group were characterized by significantly higher levels of cholestatic liver enzymes when compared to those without AMA-M2 (P < 0.05). After introducing therapy with hydroxychloroquine and prednisone, the levels of hepatocellular enzymes increased significantly only in AMA-M2 positive patients (P < 0.05). CONCLUSIONS: A high prevalence of AMA-M2 was found in patients with SCLE. Patients with SCLE and AMA-M2 had significantly higher values of cholestatic enzymes than patients without AMA. Newly diagnosed patients with SCLE should be screened for the presence of AMA and should be clinically followed up. Avoiding drugs with potential liver toxicity should be recommended in patients with SCLE and AMA.


Assuntos
Autoanticorpos/sangue , Hepatite Autoimune/epidemiologia , Cirrose Hepática Biliar/epidemiologia , Lúpus Eritematoso Cutâneo/sangue , Lúpus Eritematoso Cutâneo/epidemiologia , Mitocôndrias/imunologia , Adulto , Idoso , Alanina Transaminase/sangue , Fosfatase Alcalina/sangue , Anti-Inflamatórios/uso terapêutico , Antirreumáticos/uso terapêutico , Aspartato Aminotransferases/sangue , Comorbidade , Progressão da Doença , Quimioterapia Combinada , Feminino , Hepatite Autoimune/sangue , Humanos , Hidroxicloroquina/uso terapêutico , Cirrose Hepática Biliar/sangue , Lúpus Eritematoso Cutâneo/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Músculo Liso/imunologia , Polônia/epidemiologia , Prednisona/uso terapêutico , Prevalência , Fatores de Risco , Estudos Soroepidemiológicos , gama-Glutamiltransferase/sangue
5.
Otol Neurotol ; 42(1): e10-e14, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33301283

RESUMO

OBJECTIVE: To describe a case of bilateral sudden sensorineural hearing loss (SSNHL) and intralabyrinthine hemorrhage in a patient with COVID-19. STUDY DESIGN: Clinical capsule report. SETTING: Tertiary academic referral center. PATIENT: An adult woman with bilateral SSNHL, aural fullness, and vertigo with documented SARS-CoV-2 infection (IgG serology testing). INTERVENTIONS: High-dose oral prednisone with taper, intratympanic dexamethasone. MAIN OUTCOME MEASURES: Audiometric testing, MRI of the internal auditory canal with and without contrast. RESULTS: A patient presented with bilateral SSNHL, bilateral aural fullness, and vertigo. Serology testing performed several weeks after onset of symptoms was positive for IgG COVID-19 antibodies. MRI showed bilateral intralabyrinthine hemorrhage (left worse than right) and no tumor. The patient was treated with two courses of high-dose oral prednisone with taper and a left intratympanic dexamethasone injection, resulting in near-resolution of vestibular symptoms, a fluctuating sensorineural hearing loss in the right ear, and a severe to profound mixed hearing loss in the left ear. CONCLUSIONS: COVID-19 may have otologic manifestations including sudden SSNHL, aural fullness, vertigo, and intralabyrinthine hemorrhage.


Assuntos
/complicações , Perda Auditiva Neurossensorial/virologia , Hemorragia/virologia , Doenças do Labirinto/virologia , Adolescente , Anti-Inflamatórios/uso terapêutico , Dexametasona/administração & dosagem , Feminino , Perda Auditiva Bilateral/virologia , Perda Auditiva Súbita/virologia , Humanos , Injeção Intratimpânica , Prednisona/uso terapêutico
6.
Medicine (Baltimore) ; 99(50): e23491, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327284

RESUMO

RATIONALE: The rarity of adult T cell leukemia/lymphoma (ATLL) in China, coupled with its clinicopathologic mimicry of primary skin disease, poses a diagnostic challenge. The method of diagnosis and mechanism of immune regulation in ATLL are discussed in the present report. PATIENT CONCERNS: A 51-year-old Chinese man was admitted to the hospital with 2-years history of systemic plaque lesions and 1-year history of left ankle joint pain. DIAGNOSES: The patient was diagnosed with ATLL based on the results of flow cytometry immunophenotype and human T-cell lymphotropic virus type 1 (HTLV-1) serology. INTERVENTIONS: The patient received 3 cycles of cyclophosphamide, epirubicin/ vinorelbine, and dexamethasone (CHOP) chemotherapy. However, he relapsed and did not respond to epirubicin, vindesine, etoposide, dexamethasone (EPOCH) chemotherapy. OUTCOMES: His family discontinued the treatment and opted for hospice care. LESSONS: Patch and plaque ATLL types exhibits a better survival rate, but atypical skin patches delays the diagnosis of ATLL and negatively affects the patient survival. Based on the present findings, we suggest that patients with petal-like nuclear lymphocytes in blood smears, a high CD4: CD8 ratio, and strong CD25 expression should undergo HTLV-1 serology testing.


Assuntos
Leucemia-Linfoma de Células T do Adulto/diagnóstico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Ciclofosfamida/uso terapêutico , Diagnóstico Diferencial , Doxorrubicina/uso terapêutico , Etoposídeo/uso terapêutico , Citometria de Fluxo , Vírus Linfotrópico T Tipo 1 Humano/genética , Humanos , Leucemia-Linfoma de Células T do Adulto/sangue , Leucemia-Linfoma de Células T do Adulto/complicações , Leucemia-Linfoma de Células T do Adulto/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Prednisolona/uso terapêutico , Prednisona/uso terapêutico , Dermatopatias/etiologia , Vincristina/uso terapêutico
7.
Medicine (Baltimore) ; 99(50): e23501, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327289

RESUMO

INTRODUCTION: Primary pulmonary lymphoma (PPL) is a rare extranodal lymphoma. Only 5% to 20% of patients suffering from PPL have diffuse large ß-cell lymphoma (DLBCL), and their chest computed tomography (CT) findings show single- or double-lung patchy or flocculated shadows, isolated or multifocal nodules, or masses. In this research paper, we report an older woman having multiple ground-glass nodules, who was eventually diagnosed with primary pulmonary diffuse large ß-cell lymphoma (PPDLBCL). PATIENT CONCERNS: A 69-year-old woman suffering from cough was admitted to the Second Hospital of Jilin University. DIAGNOSES: A chest CT scan showed multiple ground-glass nodules. She had received 2 weeks of antibiotic treatment, but the multiple ground-glass nodules were still present. Lung biopsy was performed by tracheoscopy, which showed non-Hodgkin diffuse large ß-cell lymphoma. INTERVENTIONS: The patient received R-CHOP-21 chemotherapy. OUTCOMES: The multiple ground-glass nodules were absorbed. CONCLUSION: The current study shows that spotting multiple ground-glass nodules in the lungs is a clear indication of the presence of PPDLBCL. It is important to spread awareness of PPDLBCL, which needs timely diagnosis and management.


Assuntos
Neoplasias Pulmonares/diagnóstico , Linfoma Difuso de Grandes Células B/diagnóstico , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Tosse/etiologia , Ciclofosfamida/uso terapêutico , Diagnóstico Diferencial , Doxorrubicina/uso terapêutico , Feminino , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/tratamento farmacológico , Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Prednisona/uso terapêutico , Rituximab/uso terapêutico , Tomografia Computadorizada por Raios X , Vincristina/uso terapêutico
8.
Artigo em Inglês | MEDLINE | ID: mdl-33331521

RESUMO

COVID-19 is a viral disease caused by SARS-CoV-2 that compromises the host immune response in severe cases, promoting a hyperinflammation that results in acute lung injury and multiple organs failure. In this context, patients presenting with immune-related diseases, such as Crohn's disease, affected by COVID-19, may have an uncertain prognosis. We report on a case of a young female patient with a severe Crohn's disease that presented with COVID-19 pneumonia and a favorable outcome even maintaining the use of adalimumab, TNF - alpha inhibitor and prednisone. This case raises the hypothesis that aside from prednisone, TNF-α inhibitors such as adalimumab could be used to stop the progression to COVID-19 complications by blocking the TNF-alpha-driven inflammatory process that occurs in severe COVID-19.


Assuntos
Adalimumab/uso terapêutico , Doença de Crohn/tratamento farmacológico , Prednisona/uso terapêutico , Doença de Crohn/virologia , Feminino , Humanos , Inibidores do Fator de Necrose Tumoral/uso terapêutico
10.
Zhongguo Shi Yan Xue Ye Xue Za Zhi ; 28(6): 1912-1918, 2020 Dec.
Artigo em Chinês | MEDLINE | ID: mdl-33283719

RESUMO

OBJECTIVE: To analyze the efficacy of rituximab combined with CHOP/EPOCH regimen for treatment of diffuse large B-cell lymphoma(DLBCL) patients, and to explore the high risk factors of refractory and relapsed patients. METHODS: The clinical data of 72 patients with de novo DLBCL from December 2012 to December 2018 in the Department of Hematology, Zhongda Hospital Affiliated to Southeast University were retrospectively analyzed. The remission rate of DLBCL patients treated by rituximab combined with CHOP/EPOCH was analyzed, and survival analysis was conducted to explore the risk factors influencing refractory recurrence. RESULTS: 45 cases among 72 patients achieved complete remission (CR), 11 cases achieved partial remission (PR), the total remission rate was 77.78%. 25 cases (34.2%) refractory and relapsed. Single factor analysis showed that the B symptoms, low Hb, high NLR, low MLR, high ß2-MG, high ESR, high hs-CRP, high LDH, low ALB, low HDL were high risk factors of refractory and relapsed DLBCL. Multivariate Logistic analysis showed B symptoms, low Hb, high ß2-MG, high ESR, and high hs-CRP were significantly related with refractory relapse. Survival analysis showed that OS of refractory and relapsed group was significantly worse than that in remission group. In addition, OS of patients with B symptoms, anemia, low LMR, high ß2-MG, high hs-CRP, high LDH, low ALB and low HDL was significantly worse than that of control group. CONCLUSION: The remission rate of DLBCL patients treated by rituximab combined with CHOP/EPOCH regimen is high, but about one third of the patients still show refractory and relapsed. B Symptoms, anemia, high ß2-MG, ESR and hs-CRP are the independent prognostic factors.


Assuntos
Linfoma Difuso de Grandes Células B , Recidiva Local de Neoplasia , Protocolos de Quimioterapia Combinada Antineoplásica , Ciclofosfamida/uso terapêutico , Doxorrubicina/uso terapêutico , Etoposídeo , Humanos , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Prednisona/uso terapêutico , Prognóstico , Estudos Retrospectivos , Rituximab/uso terapêutico , Resultado do Tratamento , Vincristina
11.
Travel Med Infect Dis ; 38: 101906, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33137493

RESUMO

BACKGROUND: For the past few months, HMOs have faced crowded emergency rooms and insufficient hospital and intensive-care-unit beds, all from the worst pandemic of this century, COVID-19. METHODS: In a large HMO in Brazil, our approach was to allow treating physicians to prescribe antiviral medications immediately at presentation, and prednisone starting on day-6 of symptoms to treat pulmonary inflammation. We implemented this COVID-19 protocol for outpatients and studied 717 consecutive SARS-CoV-2-positive patients age 40 years or older presenting at our emergency rooms. RESULTS: Use of hydroxychloroquine (HCQ), prednisone or both significantly reduced hospitalization risk by 50-60%. Ivermectin, azithromycin and oseltamivir did not substantially reduce risk further. Hospitalization risk was doubled for people with type-2 diabetes or obesity, increased by two-thirds for people with heart disease, and by 75% for each decade of age over age 40. Similar magnitudes of reduced risk with HCQ and prednisone use were seen for mortality risk, though were not significant because of only 11 deaths among the 717 patients. No cardiac arrhythmias requiring medication termination were observed for any of the medications. CONCLUSIONS: This work adds to the growing literature of studies that have found substantial benefit for use of HCQ combined with other agents in the early outpatient treatment of COVID-19, and adds the possibility of steroid use to enhance treatment efficacy.


Assuntos
/tratamento farmacológico , Hospitalização , Adulto , Idoso , Brasil , Quimioterapia Combinada , Feminino , Humanos , Hidroxicloroquina/uso terapêutico , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Prednisona/uso terapêutico
12.
Rinsho Ketsueki ; 61(9): 1244-1251, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-33162522

RESUMO

Interim positron emission tomography (iPET-2)-guided therapy following two cycles of ABVD chemotherapy has been developed for newly diagnosed classical Hodgkin lymphoma (cHL) patients in several prospective trials. In localized-stage cHL, radiotherapy cannot be omitted, even in iPET-negative patients after two or three cycles of ABVD, whereas two cycles of escalated BEACOPP regimens followed by involved nodular radiotherapy (30 Gy) is a useful treatment option for iPET-2 positive patients after two cycles of ABVD. In advanced-stage cHL, approximately 20% of cases were iPET-2 positive, and the switch to BEACOPP-based regimens was reported as a useful treatment option, with 3-year progression-free survival of approximately 60-65%, in iPET-2-positive patients in three clinical trials. Furthermore, the switch to AVD (omission of bleomycin after two cycles of ABVD) is a reasonable treatment option in iPET-2-negative patients, particularly those at risk for bleomycin lung toxicity in advanced-stage cHL. This review summarizes the current evidence regarding interim PET-guided therapy for newly diagnosed cHL patients.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica , Doença de Hodgkin , Tomografia por Emissão de Pósitrons , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bleomicina/uso terapêutico , Dacarbazina/uso terapêutico , Doxorrubicina/uso terapêutico , Doença de Hodgkin/diagnóstico por imagem , Doença de Hodgkin/tratamento farmacológico , Humanos , Estadiamento de Neoplasias , Prednisona/uso terapêutico , Estudos Prospectivos , Vimblastina/uso terapêutico
13.
Zhonghua Yi Xue Za Zhi ; 100(42): 3296-3302, 2020 Nov 17.
Artigo em Chinês | MEDLINE | ID: mdl-33202490

RESUMO

Objective: To analyze the clinical feature,treatment and survival outcome of elderly patients older than 80 years with large diffuse B-cell lymphoma. Methods: A total of 46 patients aged over 80 years with large diffuse B-cell lymphoma who were treated in Third Hospital of Peking University during the period from 2002 to 2018 were retrospectively analyzed, and the clinical features, laboratory data, survival and prognostic factors were included in Kaplan-Meier and prognostic analysis. Results: Patients older than 80 years old accounted for 15.7% (46/293) in all elderly patients, and the median age was 83 years old. There were 78.3% (36/46)patients who belonged to stage Ⅲ or Ⅳ, 63%(29/46) who had more than two extranodal organ involvement, and the higher proliferation index(Ki-67≥80%) was present in 53.7%(22/41) patients. Immunohistochemistry showed that 37% patients in 27 cases were double-expressed DLBCL. With a median follow-up of 25 months, the overall response rate (ORR) for the whole group was 63.0%, the complete response (CR) rate was 36.4%, the 2, 3-year progression-free survival (PFS) rate was 49.9% and 41.7%, the 2, 3-year overall survival (OS) rate was 54.6% and 43.6% respectively. The ORR for patients who received anthracycline-based therapies and non-anthracycline-based therapies were 81.8% and 55.0%, and the 3-year OS rate were 50.0% and 39.0%, respectively, but the difference was not statistically significant (P>0.05). 45.5% patients had hematologic toxicity of Grade Ⅲ or above, and 56.8% patients experienced infections during the treatment. Among the patients who died, the treatment-related mortality rate in group with high score of Charlson comorbidity index(CCI) was higher (43.8% vs 16.7%, P=0.03) . The National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) score, nodal involvement area ≥3, 6 cycles of chemotherapy, CCI score, initial treatment outcome and refractory-relapsed were predictive of overall survival. Multivariate analysis indicated the CCI score (HR=6.463, P=0.008) and initial treatment outcome (HR=0.086, P=0.001) were independent prognostic risk factors. Conclusions: The clinical and pathological features of patients older than 80 years were highly aggressive with poor chemotherapy tolerance and high adverse reaction rate. Anthracycline-based therapies may be less important in the treatment of DLBCL patients aged over 80 years. Patients with high CCI score have higher treatment-related mortality and CCI can help identify elderly patients who are suitable for larger chemotherapy dose.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica , Linfoma Difuso de Grandes Células B , Idoso de 80 Anos ou mais , Ciclofosfamida/uso terapêutico , Doxorrubicina , Humanos , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Prednisona/uso terapêutico , Prognóstico , Estudos Retrospectivos , Rituximab/uso terapêutico , Resultado do Tratamento
16.
J Neurovirol ; 26(6): 941-944, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33006717

RESUMO

COVID-19 pandemic revealed several neurological syndromes related to this infection. We describe the clinical, laboratory, and radiological features of eight patients with COVID-19 who developed peripheral facial palsy during infection. In three patients, facial palsy was the first symptom. Nerve damage resulted in mild dysfunction in five patients and moderate in three. SARS-Cov-2 was not detected in CSF by PCR in any of the samples. Seven out of eight patients were treated with steroids and all patients have complete or partial recovery of the symptoms. Peripheral facial palsy should be added to the spectrum of neurological manifestations associated with COVID-19.


Assuntos
/complicações , Paralisia Facial/virologia , Adulto , Anti-Inflamatórios/uso terapêutico , Nervo Facial/patologia , Paralisia Facial/tratamento farmacológico , Feminino , Humanos , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Prednisona/uso terapêutico
17.
J Emerg Med ; 59(5): 699-704, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33011038

RESUMO

BACKGROUND: A small subset of pediatric patients develop a rare syndrome associated with Coronavirus Disease 2019 (COVID-19) infection called multisystem inflammatory syndrome in children (MIS-C). This syndrome shares characteristics with Kawasaki disease. CASE REPORT: A 15-year-old girl presented to our Emergency Department (ED) with fevers and malaise. She was diagnosed on her initial visit with an acute viral syndrome and discharged with a COVID polymerase chain reaction test pending, which was subsequently negative. She returned 3 days later with persistent fever, conjunctivitis, and a symmetric targetoid rash over her palms. She had no adenopathy, but her erythrocyte sedimentation rate and C-reactive protein were both significantly elevated at 90 mm/h and 19.61 mg/dL, respectively. The patient was then transferred to the regional children's hospital due to a clinical suspicion for MIS-C, and subsequent COVID-19 immunoglobulin G testing was positive. She had been empirically started on intravenous immunoglobulin in addition to 81 mg aspirin daily. Initial echocardiograms showed mild dilatation of the left main coronary artery, and on repeat echocardiogram, a right coronary artery aneurysm was also identified. Oral prednisone therapy (5 mg) was initiated and the patient was discharged on a continued prednisone taper. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: We present a case of a 15-year-old girl who presented to the ED with MIS-C who developed coronary aneurysms despite early therapy, to increase awareness among emergency physicians of this emerging condition.


Assuntos
/diagnóstico , Aneurisma Coronário/etiologia , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Adolescente , Sedimentação Sanguínea , Proteína C-Reativa/análise , Serviço Hospitalar de Emergência , Feminino , Ferritinas/sangue , Glucocorticoides/uso terapêutico , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Interleucina-6/sangue , Prednisona/uso terapêutico , Síndrome de Resposta Inflamatória Sistêmica/tratamento farmacológico
18.
Am J Trop Med Hyg ; 103(6): 2533-2538, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33025874

RESUMO

Human sporotrichosis is an emerging disease caused by fungi of the genus Sporothrix, distributed worldwide, but mostly in tropical and subtropical regions. This disease is caused by traumatic inoculation of contaminated material (either animal or vegetal in origin) into the skin. Sporotrichosis cases caused by zoonotic transmission through felines have significantly increased over the last 20 years in Brazil. There is a spectrum of clinical outcomes, from classical lymphocutaneous and fixed forms to disseminated manifestations and extracutaneous lesions; however, hypersensitivity reactions related to sporotrichosis, including Sweet syndrome (acute febrile neutrophilic dermatoses), are uncommon. In Brazil, Sporothrix brasiliensis is repeatedly associated with feline infection and has consistently shown higher virulence, tendency to escalate to outbreaks or epidemics, and development of atypical forms. Therefore, the objective of the present study was to report the cases of 10 patients with sporotrichosis infected by S. brasiliensis species who developed Sweet syndrome to alert this association, especially in endemic areas.


Assuntos
Esporotricose/complicações , Síndrome de Sweet/etiologia , Adulto , Idoso , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/uso terapêutico , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Brasil/epidemiologia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prednisona/administração & dosagem , Prednisona/uso terapêutico , Estudos Retrospectivos , Sporothrix
19.
Medicine (Baltimore) ; 99(42): e22802, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080754

RESUMO

The agents used in the treatment of acute lymphoblastic leukaemia (ALL) might affect the oral health of cancer patients.The study aims to assess the changes in the levels of immunoglobulin A (IgA) in saliva and blood, during first 22 days of intensive chemotherapy of ALL in children.Saliva and blood samples were taken from 24 patients, including 13 boys and 11 girls (age range: 4 - 17 years) on days 1, 8 and 22 of treatment. The levels of immunoglobulin A and total protein were estimated in samples at each time-point. The distribution of the quantitative variables was assessed using the Shapiro-Wilk test. Non-parametric statistics were used to compare the levels of repeated measurements and post hoc non-parametric analysis was applied for between time-point comparisons.A constant relationship was found between the levels of Ig A in blood and saliva (r = 0.28; P = .031). No change in salivary IgA level was observed in the prednisone-only prephase, but it dropped significantly on day 22 (10.7+/-4.8 vs 9.6+/-6.4 vs 5.7+/-3.9 ng/mL; P = .04), when chemotherapy was given (anthracycline, vincristine, L-asparaginase).In blood, the total protein level decreased significantly between day 1 and 22 (6.2+/-0.4 vs 5.1+/-0.3 g/dL; P = .001). Lymphocyte count (per microliter) also decreased (2.12+/-0.8 vs 0.41+/-0.1 vs 1.08+/-0.5; P = .002). Four children suffered from oral mucositis graded 1 or higher between days 8 and 22.Chemotherapy given during the treatment of childhood ALL is associated with a reduction in the level of salivary immunoglobulin A. Prevention of the drop of salivary IgA may diminish the risk of occurrence of acute mucosal complications.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Glucocorticoides/uso terapêutico , Imunoglobulina A Secretora/metabolismo , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Saliva/imunologia , Adolescente , Asparaginase/administração & dosagem , Proteínas Sanguíneas/análise , Criança , Pré-Escolar , Daunorrubicina/administração & dosagem , Feminino , Humanos , Contagem de Linfócitos , Masculino , Prednisona/uso terapêutico , Proteínas/análise , Indução de Remissão , Saliva/química , Estomatite/induzido quimicamente , Vincristina/administração & dosagem
20.
Medicine (Baltimore) ; 99(42): e22817, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080759

RESUMO

RATIONALE: Immunoglobulin (Ig) G4-related disease (IgG4-RD) is a newly recognized, systemic disease. Membranous nephropathy is the most common glomerular lesion in IgG4- related kidney disease. However, the lack of relationship with IgG4-related kidney disease and monoclonal gammopathy of undetermined significance (MGUS) warrants investigation of the potential mechanisms. PATIENT CONCERNS: A 62-year-old patient was diagnosed with IgG4-RD, tubulointerstitial nephritis, retroperitoneal fibrosis. After 2 years, she was presented with proteinuria, hypoproteinemia, facial, and bilateral lower limb edema. Furthermore, this patient exhibited deposits of IgG k of monoclonal hyperplasia, and bone marrow plasma cell count was 2.5%. DIAGNOSIS: The patient was diagnosed with nephrotic syndrome, acute kidney injury, and MGUS. The pathological diagnosis was IgG4-related tubulointerstitial nephritis, IgG4-related membranous nephropathy. INTERVENTIONS: The patient was treated with intravenous methylprednisolone (40 mg daily), which was changed to oral prednisone 50 mg/d after 2 months. OUTCOMES: After 1 month, the patient exhibited a rapid response only with corticosteroid, and experienced partial remission of serum albumin and proteinuria. LESSONS: This case may suggest a possible relationship between IgG4-RD and MGUS, provide some guidance for investigating the mechanism between them.


Assuntos
Glomerulonefrite Membranosa/diagnóstico , Doença Relacionada a Imunoglobulina G4/complicações , Anti-Inflamatórios/uso terapêutico , Feminino , Glomerulonefrite Membranosa/tratamento farmacológico , Humanos , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Nefrite Intersticial/diagnóstico , Nefrite Intersticial/tratamento farmacológico , Prednisona/uso terapêutico , Fibrose Retroperitoneal/diagnóstico , Fibrose Retroperitoneal/tratamento farmacológico
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