[Severe Thrombocitopenia Induced by Fenofibrate]. / Trombocitopenia Grave Induzida por Fenofibrato.

Drug-induced thrombocytopenia is a common entity in clinical practice. However, having in consideration the severity of the case, it becomes imperative to distinguish non-immune thrombocytopenia from the po-tentially life-threatening immune-mediated forms. The authors report a rare clinical case of a 79-year-old man presenting with purpuric rash and gingival hemorrhage while on fenofibrate treatment (sixth day). The evolu-tion was favorable after drug removal and corticosteroid administration. Drug-associated thrombocytopenia is reported by manufacturers as an extremely rare event. This is the second case report of immune throm-bocytopenia to fenofibrate. The first event was reported for publication in 2015.

A trombocitopenia induzida por fármacos é uma entidade frequente na prática clínica. No entanto, pela sua gravidade torna-se imperativo distinguir a trombocitopenia não-imune das formas imunomediadas potenci-almente ameaçadoras da vida. Os autores descrevem o caso clínico raro de um homem de 79 anos que se apresentou com púrpura trombocitopénica grave não-trombótica e gengivorragia ao sexto dia de introdu-ção diária de fenofibrato na sua medicação habitual. Foi feita exclusão do fármaco e administrada metilprednisolona 125 mg endovenoso durante três dias com resolução completa do quadro estabelecendo uma probabilidade elevada de diagnóstico. A trombocitopenia associada ao fármaco é reportada pelos fabricantes como um evento extremamente raro. Este é o segundo caso reportado de trombocitopenia imune ao fenofibrato, tendo o primeiro caso sido publicado em 2015.

Unstable angina as initial manifestation of Wegener granulomatosis: case report.

Wegener granulomatosis (WG) is a necrotizing vasculitis that usually affects the respiratory tract, in association with kidney disease. Cardiac involvement is rare and silent in most cases, only becoming evident in necropsy studies. The authors report the case of a patient with WG, whose unstable angina was the first clinical manifestation, although the patient had suffered a previous unrecognized myocardial infarction. In most cases cardiovascular disease is clinically silent, but there may be symptoms indicating involvement of the coronary arteries, pericardium, myocardium, endocardium, cardiac valves, conduction system or thoracic great vessels. In most cases cardiac manifestations appear late in the natural history of GW. In the case reported, cardiac symptoms appeared as the first manifestation of the disease, a situation which we were unable to find described in the literature. The authors review the literature on cardiac manifestations of WG, together with recommendations for diagnosis and follow-up of this disease.

Gaucher disease and Lupus: A rare association? / Gaucher y lupus: ¿una rara asociación?

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