RESUMEN
An asymptomatic, homosexual, white man was found to have an abnormal chest x ray. A presumptive diagnosis of sarcoidosis was made, but pulmonary function tests and a transbronchial biopsy were normal. He then remained asymptomatic for 10 years until he developed a progressive spastic paraparesis. At this point, antibodies to human T cell lymphotropic virus type 1 (HTLV-1) were identified in the serum and cerebrospinal fluid, and the diagnosis of HTLV-1 associated myelopathy was made, the history suggesting sexual exposure to HTLV-1 many years previously. HTLV-1 is associated with a spectrum of immune related disorders, including a pulmonary sarcoid-like syndrome. Infection with this chronic proinflammatory retrovirus should be considered in the differential diagnosis of all immune disorders in at risk individuals.
Asunto(s)
Infecciones por HTLV-I/complicaciones , Sarcoidosis Pulmonar/virología , Infecciones por HTLV-I/diagnóstico , Infecciones por HTLV-I/transmisión , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Sarcoidosis Pulmonar/diagnóstico por imagenRESUMEN
We report the case of a young man who presented with a severe acute akinetic-rigid disorder 2 weeks after complete recovery from an episode of pharyngitis. Magnetic resonance imaging scan abnormalities strikingly localized to the basal ganglia were accompanied by serological evidence of recent streptococcal infection and the presence of anti-basal ganglia antibodies in the serum. The case represents an unusually clear example in the spectrum of inflammatory neurological disorders associated with streptococcal infection, an etiology that should be considered in the differential diagnosis of all acute onset movement disorders.
Asunto(s)
Ganglios/inmunología , Enfermedad de Parkinson/inmunología , Infecciones Estreptocócicas/inmunología , Enfermedad Aguda , Adolescente , Anticuerpos/sangre , Creatina Quinasa/metabolismo , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Enfermedad de Parkinson/complicaciones , Enfermedad de Parkinson/microbiología , Enfermedad de Parkinson/patología , Infecciones Estreptocócicas/complicaciones , Infecciones Estreptocócicas/microbiología , Infecciones Estreptocócicas/patologíaRESUMEN
Invasive infection with the opportunistic fungus Aspergillus fumigatus predominantly affects people with impaired cell mediated immunity. The case of a 31 year old woman with no identified cause for immunosuppression who presented with severe refractory aspergillosis of the paranasal sinuses is reported. She subsequently developed clinical and molecular evidence of mitochondrial encephalomyopathy with lactic acidosis and stroke-like events (MELAS) syndrome. It is proposed that MELAS syndrome may represent an unusual risk factor for the development of invasive aspergillosis and mechanisms are supported by which mitochondrial dysfunction may predispose to this.