RESUMO
Damage of skeletal muscle in association with graft-versus-host disease (GvHD) has been referenced exceptionally. Eighteen months after bone marrow transplantation, a 22-year-old man developed polymyositis associated with manifestations of chronic GvHD, such as peripheral eosinophilia and localized morphea. Diagnosis of polymyositis was established by clinical, electromyographic, and histopathologic findings. His clinical condition improved with immunosuppressive therapy. At electronmicroscopy, some close and broad contacts between lymphocytes with activated appearance and degenerated muscle fibers were observed, suggesting a lymphocytotoxic mechanism. The findings support the idea that polymyositis can be considered a manifestation of chronic GvHD.
Assuntos
Doença Enxerto-Hospedeiro/patologia , Miosite/patologia , Adulto , Transplante de Medula Óssea , Doença Crônica , Doença Enxerto-Hospedeiro/etiologia , Humanos , Linfócitos/ultraestrutura , Masculino , Complicações Pós-Operatórias/patologiaRESUMO
For evaluating the therapeutic approaches in the follow-up and complications of patients treated with bone marrow transplantation (BMT), the histopathology is important on many occasions. The authors describe the different morphological changes that have an important role for treatment of these patients, classified according to their target organs of localization: skin, digestive tract, liver, and bone marrow. Graft-versus-host disease (GVHD) mainly affects the skin, gastrointestinal tract, and liver, and is sometimes difficult to differentiate from radiochemotherapy or infectious diseases. In the liver, the most frequent complications are GVHD, veno-occlusive disease, and infections. In the bone marrow, it is most important to evaluate the elimination of hemopathy and the reconstitution of normal hematopoiesis.
Assuntos
Transplante de Medula Óssea/patologia , Transplante de Medula Óssea/efeitos adversos , Gastroenteropatias/etiologia , Gastroenteropatias/patologia , Doença Enxerto-Hospedeiro/etiologia , Doença Enxerto-Hospedeiro/patologia , Humanos , Hepatopatias/etiologia , Hepatopatias/patologia , Dermatopatias/etiologia , Dermatopatias/patologiaRESUMO
The aim of the present study was to analyze the main clinical and evolutive characteristics of a series of 10 patients diagnosed with sepsis by Candida tropicalis over a 5-year period in a Hematology Unit. The mean age of the 10 patients was 23 years (range 13-66 years) with 6 males and 4 females. Eight patients had acute leukemia, 1 non-Hodgkin's lymphoma and another patient had severe bone marrow aplasia. All the patients presented intense granulocytopenia (< 0.5 x 10(9)/L), had intravenous catheters and were receiving wide spectrum antibiotics as treatment for bacterial infection. The diagnosis of the fungal infection was based on the growth of C. tropicalis in blood cultures together with the evidence of tissue involvement by the fungus. Fever (> 38 degrees C) was the initial symptom of the infection in all the patients, being accompanied by myalgia in 5 cases, pleuritic pain in 2 and septic shock in 1. Violaceous erthymatomous pustules disseminated over the trunk and limbs, the histologic study of which demonstrated the presence of C. tropicalis were observed in 9 patients. Septic metastasis were found in the liver (2 cases), serosae (2 cases), the psoas muscle and the brain (1 case), respectively. Eight patients underwent treatment with amphotericin B which was complemented with 5-fluorocytosin in 6, with death occurring in the remaining 2 patients prior to the start of treatment. Three patients died with active fungal infection (2 by cerebral hemorrhage and 1 by septic shock). In 2 patients the infection evolved to chronic systemic candidiasis and in the remaining 5 patients infection was resolved with hemoperipheral values returning to normal. Sepsis by Candida tropicalis is a severe complication in patients with granulocytopenia, being mainly characterized by fever, cutaneous papulae and, to a lesser extent, muscle pain. Amphotericin B alone, or in combination with 5-fluorocytosin constitute a treatment of choice in this infection, which nonetheless is associated with an undisdainful mortality.
Assuntos
Agranulocitose/complicações , Candidíase/complicações , Sepse/complicações , Adolescente , Adulto , Agranulocitose/fisiopatologia , Candidíase/tratamento farmacológico , Candidíase/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sepse/tratamento farmacológico , Sepse/fisiopatologiaRESUMO
We report a case of acne secondary to amineptine (Survector) in a 54-year-old woman. Clinical picture and relationship with excessive drug intake of this drug define this new iatrogenic acne. To our knowledge, this is the first case described in Spain.
Assuntos
Acne Vulgar/induzido quimicamente , Antidepressivos Tricíclicos/efeitos adversos , Dibenzocicloeptenos/efeitos adversos , Dermatoses Faciais/induzido quimicamente , Dorso , Feminino , Humanos , Pessoa de Meia-IdadeAssuntos
Transplante de Medula Óssea/efeitos adversos , Doença Enxerto-Hospedeiro/complicações , Dermatopatias/etiologia , Diagnóstico Diferencial , Doença Enxerto-Hospedeiro/diagnóstico , Doença Enxerto-Hospedeiro/imunologia , Humanos , Dermatopatias/diagnóstico , Dermatopatias/imunologia , Imunologia de TransplantesAssuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Eritema/induzido quimicamente , Dermatopatias/induzido quimicamente , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Edema/induzido quimicamente , Humanos , Leucemia Mieloide Aguda/tratamento farmacológico , MasculinoAssuntos
Tumor Carcinoide/secundário , Neoplasias do Ceco , Neoplasias Cutâneas/secundário , Umbigo , Tumor Carcinoide/tratamento farmacológico , Tumor Carcinoide/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/patologia , Estreptozocina/uso terapêuticoAssuntos
Mãos , Neurofibroma/patologia , Neoplasias Cutâneas/patologia , Adulto , Diagnóstico Diferencial , Feminino , HumanosRESUMO
A 60-year-old man receiving chemotherapy for an intermediate-grade non-Hodgkin's lymphoma developed multiple papuloerythematous cutaneous lesions. Alternaria alternata was cultured from the lesions, and hyphae were seen in biopsy specimens. This is an unusual infection, without a well-established treatment, in patients with lymphoma. The use of amphotericin B resulted in cure.