We present the case of a patient who sought treatment for fever and a maculopapular rash involving the trunk, limbs, palms and soles. The patient also presented with hepatomegaly and elevated levels of liver enzymes (with a higher increase of alkaline phosphatase). With the proposal of early syphilitic hepatitis, during the stage of secondary syphilis, a venereal disease research laboratory and Treponema pallidum haemagglutination tests were requested, which confirmed the diagnosis. All altered parameters improved with antibiotic treatment for secondary syphilis. Syphilitic hepatitis is an often overlooked presentation of syphilis and should be considered as a differential diagnosis in patients with elevated levels of liver enzymes and risk factors for syphilis.
Etiology of renal infarction. A systematic review Background: Renal infarction is a rare and usually underdiagnosed entity. Aim: To study the etiology of renal infarction in published series. Material and Methods: A systematic review was carried out selecting 28 series that included 1582 patients. Results: The proposed cause was cardiac or aortic embolism in 718 cases (45%), an arterial injury in 253 (16%), prothrombotic factors in 146 (9%) and other causes in 79 (5%). 291 cases were classified as idiopathic (18.4%). Atrial fibrillation was present in 542 of the 718 patients with cardiac or aortic embolism. Conclusions: The main cause of renal infarction is cardiac or aortic embolism and among this group, most cases are due to atrial fibrillation. One out of five cases is labeled as idiopathic.
Hypoxic hepatitis is a rather common complication of heart, circulatory or respiratory failure. We present the case of a patient with hypoxic hepatitis in the setting of heart failure and dehydration from furosemide as a reminder of an important clinical lesson. The pathogenesis of hypoxia (especially in the case of heart failure) is explained by a two-hit mechanism in which the liver at risk of hypoxic injury by passive hepatic congestion (right heart failure) is subsequently exposed to systemic hypoperfusion, which leads to a marked and transient elevation of aminotransferases. In the case presented, the use of furosemide (at least partially) promoted the second hit because it helped to generate hypotension and splanchnic hypovolaemia and favoured hepatic hypoxia.
Renal infarction: systematic review of symptoms of clinical suspicion and repercussion on renal function Infarto renal: revisão sistemática dos sintomas de suspeita clínica e repercussão na função renal Resumen: El infarto renal es una entidad poco frecuente y está sub-diagnosticada por lo que para su diagnóstico se necesita un alto índice de sospecha clínica. Objetivo: Determinar las características clínicas y paraclínicas más frecuentes en el infarto renal, destacando la repercusión en la función renal. Metodología: Se realizó una revisión sistemática de serie de casos en PUBMED y SciELO con los términos: "renal infarction" y "renal infarct". Se estudiaron variables: demográficas, clínicas y paraclínicas. En el caso de las variables paraclínicas se analizó el porcentaje de pacientes con valores elevados de cada una de las mismas. El análisis estadístico fue realizado con EPI INFO 7. 2. Resultados: Los síntomas y signos más frecuentes fueron oliguria, dolor en flanco y abdominal, nauseas, fiebre y vómitos. Los parámetros paraclínicos alterados fueron: LDH, PCR y glóbulos blancos. Se constató injuria renal aguda en 30.8% de los pacientes, la progresión a enfermedad renal crónica se observó en 17.3% y la progresión a enfermedad renal terminal se observó en 5.2% de los pacientes. Discusión y conclusiones: La determinación de las características clínicas y paraclínicas más frecuentes del infarto renal, se pueden utilizar para disminuir el retraso diagnóstico, lo que tiene consecuencias terapéuticas.
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