RESUMO
Although several associations of autoimmune disorders with ulcerative colitis have been reported, autoimmune hemolytic anemia is extremely rare. We report a case of a 35 year-old white woman with a twelve-year history of mild ulcerative colitis treated in the last 5 years with 5-amino-salycilic acid who developed a severe autoimmune hemolytic anemia. We discuss some particular aspects of the association of these two immunologically mediated disorders as well as the controversial aspects of autoimmune hemolytic anemia therapy in this context.
Assuntos
Ácidos Aminossalicílicos/uso terapêutico , Anemia Hemolítica Autoimune/complicações , Anti-Inflamatórios não Esteroides/uso terapêutico , Colite Ulcerativa/complicações , Adulto , Anemia Hemolítica Autoimune/tratamento farmacológico , Anemia Hemolítica Autoimune/imunologia , Anti-Inflamatórios/uso terapêutico , Colite Ulcerativa/tratamento farmacológico , Colite Ulcerativa/imunologia , Feminino , Humanos , Mesalamina , Prednisona/uso terapêuticoRESUMO
Perianal fistula is a frequent complication of Crohn's disease. The diagnosis of the later may be difficult if cutaneous disease is dominant, and sometimes an important clinical challenge. The authors report a case of a 34 year old male complaining of painful perianal nodules for the three last years. Cutaneous histopathological examination was inespecific and colonoscopy normal. Pelvic CT scan and fistulography showed an intercommunicated fistular system invading both isquiorectal fossae, without intestinal communication. Repetition of colonoscopy showed normal mucosa, but in two of the biopsy samples noncaseous granulomas were found at the submucosa. The authors explain their main difficulties to reach the diagnosis of Crohn's disease and discuss the investigation and the evolution of the patient.
Assuntos
Doenças do Ânus/etiologia , Doença de Crohn/complicações , Dermatopatias/etiologia , Adulto , Humanos , MasculinoRESUMO
We present the case of an HIV-seropositive drug addict patient whose seropositivity was unknown until admission to hospital, where he presented with a clinical picture of fever splenomegaly and weight loss. A diagnosis of visceral leishmaniasis was established. We stress the diagnostic difficulties well expressed in the need to repeat the bone marrow aspirate to detect the presence of leishmanias. The lack of response to conventional antimonial therapy is discussed as well as the role of pentamidine as an alternative therapy.