RESUMO
We report the seventh published case of thrombotic thrombocytopenic purpura (TTP) associated to a Still's disease. We confirmed the secondary character of TTP using the measurement of ADAMTS 13 protease. Because of clinical and biological improvement, daily plasmapheresis was stopped after eight days of ICU treatment. Unfortunately, early (24 hours) relapse occurred resulting in daily plasmapheresis resumption for 11 more days. Main therapeutic goals and aggressive treatment duration of PTT associated with a Still's disease remain to be determined.
Assuntos
Artrite Juvenil/complicações , Troca Plasmática , Púrpura Trombocitopênica Trombótica/terapia , Proteínas ADAM/análise , Proteína ADAMTS13 , Injúria Renal Aguda/etiologia , Adolescente , Anti-Inflamatórios não Esteroides/uso terapêutico , Anticonvulsivantes/uso terapêutico , Artrite Juvenil/tratamento farmacológico , Terapia Combinada , Diagnóstico Diferencial , Feminino , Humanos , Púrpura Trombocitopênica Trombótica/diagnóstico , Púrpura Trombocitopênica Trombótica/tratamento farmacológico , Púrpura Trombocitopênica Trombótica/enzimologia , Púrpura Trombocitopênica Trombótica/etiologia , Recidiva , Convulsões/tratamento farmacológico , Convulsões/etiologiaRESUMO
The authors report two cases of bone marrow aplasia observed 2 months after initiation of a treatment with ticlopidine. The outcome was favorable after discontinuation of therapy. The frequency of this severe drug-induced complication seems to have been underestimated. The absolute necessity of a careful haematological survey during the first 3 months of therapy is pointed out.
Assuntos
Doenças da Medula Óssea/induzido quimicamente , Inibidores da Agregação Plaquetária/efeitos adversos , Ticlopidina/efeitos adversos , Idoso , Doenças da Medula Óssea/fisiopatologia , Doenças Hematológicas/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Five adults had inflammatory rheumatic disorders 6 to 20 years before the diagnosis of coeliac disease. It is known that joint inflammation occurs in certain patients with adult coeliac sprue who develop either a specific inflammatory rheumatic disease or an atypical progressive polyarthropathy, sometimes as the first manifestation of the intestinal disorder. The diagnosis of adult coeliac sprue should be entertained in these cases even in absence of major digestive disorders or malabsorption. IgA anti-reticulin antibodies and atrophy of the duodenojejunal villosities are the best indicators for diagnosis. There are two important reasons for making the diagnosis of "asymptomatic adult coeliac sprue". First a gluten-free diet can improve or even cure the inflammatory joint disease, a rare situation which emphasizes the causal relationship between these two diseases. Second, the risk of developing lymphoma (especially in the small bowel) is apparently lower in patients on gluten-free diet. Pathogenesis is unclear. Frequently the two autoimmune disorders simply appear to coincide in the same patient; more rarely, arthritis is a symptom of coeliac disease. The immunological mechanisms probably begin when antigens cross an excessively permeable intestinal mucosa.
Assuntos
Doença Celíaca/complicações , Síndrome de Felty/etiologia , Doenças Reumáticas/etiologia , Síndrome de Sjogren/etiologia , Corticosteroides/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Celíaca/dietoterapia , Síndrome de Felty/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Reumáticas/tratamento farmacológico , Síndrome de Sjogren/tratamento farmacológico , Ácido Ursodesoxicólico/uso terapêuticoRESUMO
BACKGROUND: We report two cases of rheumatism associated with hyperthyroidism. In both cases, arthralgia totally regressed after thyroid treatment. CASE REPORTS: Two 79-year-old and 59-year-old women developed manifestations of polymyalgia rheumatica and psoriasis arthritis respectively. Corticosteroid therapy was ineffective and followed by manifestations of hyperthyroidism. The first patient was treated with carbimazole and the second with thyroidectomy. Once the hyperthyroidism was controlled, both patients experienced a dramatically rapid cure of their arthralgias. DISCUSSION: Scalpulo-humeral periarthritis is the main articular complication of hyperthyroidism. True manifestations of "thyrotoxicosis rheumatism" are unusual and may be linked with a direct toxicity of the thyroid hormones on joint cartilage or with an autoimmune manifestation of hyperthyroidism.
Assuntos
Artralgia/etiologia , Hipertireoidismo/diagnóstico , Psoríase/etiologia , Doenças Reumáticas/etiologia , Corticosteroides/uso terapêutico , Idoso , Antitireóideos/uso terapêutico , Carbimazol/uso terapêutico , Feminino , Humanos , Hipertireoidismo/complicações , Hipertireoidismo/terapia , Pessoa de Meia-Idade , TireoidectomiaAssuntos
Candidíase/induzido quimicamente , Doenças do Esôfago/induzido quimicamente , Hepatite C/terapia , Hepatite Crônica/terapia , Interferon-alfa/efeitos adversos , Candidíase/tratamento farmacológico , Candidíase/microbiologia , Doenças do Esôfago/tratamento farmacológico , Doenças do Esôfago/microbiologia , Feminino , Fluconazol/uso terapêutico , Humanos , Interferon alfa-2 , Interferon-alfa/uso terapêutico , Pessoa de Meia-Idade , Proteínas RecombinantesAssuntos
Tireoidite Autoimune/complicações , Tireotoxicose/etiologia , Idoso , Doença Crônica , Feminino , Humanos , Pessoa de Meia-Idade , RecidivaAssuntos
Artrite/induzido quimicamente , Interferon-alfa/efeitos adversos , Adulto , Idoso , Feminino , Humanos , MasculinoAssuntos
Albendazol/uso terapêutico , Encefalopatias/tratamento farmacológico , Encefalopatias/parasitologia , Cisticercose/tratamento farmacológico , Praziquantel/uso terapêutico , Doenças da Medula Espinal/tratamento farmacológico , Doenças da Medula Espinal/parasitologia , Adulto , Albendazol/administração & dosagem , Esquema de Medicação , Quimioterapia Combinada , Humanos , Masculino , Praziquantel/administração & dosagem , RecidivaRESUMO
Acute nephrotoxicity due to nonsteroidal anti-inflammatory drugs is usually observed in clinical situations in which renal perfusion is compromised as in volume contraction. We report a case of a 20 year-old woman who suffered from acute tubular necrosis after concomitant ingestion of nonsteroidal anti-inflammatory drugs and binge drinking. This acute tubular necrosis is likely to have an hemodynamic origin due to nonsteroidal anti-inflammatory drugs in a patient with volume contraction secondary to binge drinking. The risk appears to be even more important since ethanol has been implicated in tubular necrosis by direct toxicity. This observation underlines the danger in associating nonsteroidal anti-inflammatory drugs and ethanol.