RESUMO
A 32-year-old man presented with a 2-month history of worsening fever, chills, and cough despite therapy with oral antibiotics. Chest radiographs demonstrated migrating, peripheral upper lobe infiltrates. A CBC count demonstrated significant eosinophilia. At bronchoscopy, eosinophil-rich mucus was seen impacted throughout his bronchi. A transbronchial biopsy confirmed the diagnosis of eosinophilic pneumonia. Symptoms, eosinophilia, and radiographic abnormalities were reversed with cessation of duloxetine. This case report briefly reviews the diagnosis of drug-induced pulmonary infiltrates with eosinophilia (PIEs) and eosinophilic pneumonia. To our knowledge, this is the first reported case of PIEs due to duloxetine.
Assuntos
Antidepressivos/efeitos adversos , Eosinofilia Pulmonar/induzido quimicamente , Tiofenos/efeitos adversos , Adulto , Antidepressivos/uso terapêutico , Biópsia , Broncoscopia , Pneumonia em Organização Criptogênica/induzido quimicamente , Pneumonia em Organização Criptogênica/diagnóstico , Pneumonia em Organização Criptogênica/patologia , Diagnóstico Diferencial , Cloridrato de Duloxetina , Humanos , Pulmão/efeitos dos fármacos , Pulmão/patologia , Masculino , Eosinofilia Pulmonar/diagnóstico , Eosinofilia Pulmonar/patologia , Tiofenos/uso terapêutico , Tomografia Computadorizada por Raios XRESUMO
Varicose veins in the vulvar and perivulvar area are seen in 4% of women. Most of them are secondary to pregnancy and usually regress spontaneously. Vulvar varicose veins are rare in nonpregnant women. When present, they can be seen alone, associated with leg varices or associated with venous malformations of the labia, clitoral area, or vagina with or without arteriovenous malformations on the limbs or trunk (Klippel-Trenaunay-Weber syndrome and Parkes-Weber syndrome). In some cases, vulvar varices are seen as part of the so-called "pelvic congestion syndrome." Clinically, vulvar varices may present as small isolated protrusions, mainly in the labia majora, or as large masses, involving the vulva and even the perivulvar area. The treatment of choice of vulvar varices seen during pregnancy is conservative and symptomatic. Surgical pathologists need to be aware of the existence of vulvar varicose veins and its possible presence in biopsy specimens. Vulvar varicose veins can be misdiagnosed clinically as cysts or masses mainly in the Bartholin gland area. Correct diagnosis of the lesion is important to determine appropriate therapy and to recognize the possibility of associated anatomical or pathological problems.