The present report shows the occurrence of thrombotic thrombocytopenic purpura (TTP) associated with acute dengue and chikungunya virus coinfection, manifesting as a severe disease with high mortality potential. The patient was a 28 year-old man with clinical and epidemiological diagnosis of arboviruses infections who developed thrombocytopenia and anemia, after which oral corticosteroid therapy was started. On the third day of hospitalization, he showed neurological alterations that simulated a cerebral vascular accident, but the imaging examination did not identify ischemic or hemorrhagic alterations. At that moment, the TTP hypothesis was raised so that plasmapheresis and corticosteroid pulse therapy were started, have been essential for the favorable evolution of the case.

Introduction: ALL is known to have a lower survival rate in adults and this can be attributed, among other aspects, to intolerance to intensive regimens. As the treatment of ALL is very complex, with many protocols available, this study proposes an analysis regarding the CALGB 8811 protocol in a tertiary health unit in Ceará Methods: In this retrospective study, 50 patients with a recent diagnosis of ALL who underwent the CALGB8811 protocol were evaluated. Disease risk criteria were based on the CALGB8811 protocol. Results: CR was obtained in 86% of patients. 12% of patients died during induction due to infectious complications. 30% of patients underwent alloSCT, 60% were on CR1. The median overall survival (OS) was 21.5 months (8.1-38.7). The 5 years OS was 25% in the transplanted patients versus 60% in the transplanted group. Achieving complete remission after induction chemotherapy and allogeneic hematopoietic stem cell transplantation were the factors associated with better long-term survival rates in uni and multivariate analysis. Conclusion: Risk factors classically associated with worse adult ALL outcome and post-induction MRD status were not outcome predictors, in addition, post-induction remission and alloSCT were factors associated with a favorable outcome.

Fournier's Gangrene is a rapidly evolving polymicrobial necrotizing fasciitis of the perineal, perianal, and genital region, extending to the thigh root, abdominal wall and retroperitoneum, which rarely affects women and children, with an overall incidence rate of 1,6 cases per 100,000 men / year and a peak incidence after the age of 50. Incomplete hygiene, exacerbated skin folds, mechanical trauma, prolonged catheterization and invasive procedures, as well as comorbidities such as diabetes mellitus, smoking, obesity, chronic alcoholism, hypertension, immunosuppression, HIV, cancer patients, and chronic diseases are factors that predispose to the appearance of the lesion.The objective of the study is to report the case of a female patient, 43 years old, without comorbidities, with a picture of Fournier's gangrene in the perineal region and genitalia, accompanied by the General Surgery Service of the General Public Hospital of Palmas - TO, and submitted to colostomy in a descending loop as a protective measure of choice for the spread of the infection to the abdominal cavity, interrupting the progression of the disease.

Multiple myeloma (MM) is a blood cell neoplasm characterized by excessive production of malignant monoclonal plasma cells (activated B lymphocytes) by the bone marrow, which end up synthesizing antibodies or antibody fragments, called M proteins, in excess. The accumulation of this production, both cells themselves and of the immunoglobulins, causes a series of problems for the patient, of a systemic and local nature, such as blood hyperviscosity, renal failure, anemia, bone lesions, and infections due to compromised immunity. MM is the third most common hematological neoplasm, constituting 1% of all cancer cases, and is a disease that is difficult to treat, still being considered an incurable disease. The treatments currently available cannot cure the patient, but only extend their lifespan, and the main and most effective alternative is autologous hematopoietic stem cell transplantation, but not every patient is eligible, often due to age and pre-existing comorbidities. In this context, the search for new therapies that can bring better results to patients is of utmost importance. Protein tyrosine kinases (PTKs) are involved in several biological processes, such as cell growth regulation and proliferation, thus, mutations that affect their functionality can have a great impact on crucial molecular pathways in the cells, leading to tumorigenesis. In the past couple of decades, the use of small-molecule inhibitors, which include tyrosine kinase inhibitors (TKIs), has been a hallmark in the treatment of hematological malignancies, and MM patients may also benefit from TKI-based treatment strategies. In this review, we seek to understand the applicability of TKIs used in MM clinical trials in the last 10 years.

Acute myeloid leukemia (AML) is a hematologic malignancy that occurs due to alterations such as genetic mutations, chromosomal translocations, or changes in molecular levels. These alterations can accumulate in stem cells and hematopoietic progenitors, leading to the development of AML, which has a prevalence of 80% of acute leukemias in the adult population. Recurrent cytogenetic abnormalities, in addition to mediating leukemogenesis onset, participate in its evolution and can be used as established diagnostic and prognostic markers. Most of these mutations confer resistance to the traditionally used treatments and, therefore, the aberrant protein products are also considered therapeutic targets. The surface antigens of a cell are characterized through immunophenotyping, which has the ability to identify and differentiate the degrees of maturation and the lineage of the target cell, whether benign or malignant. With this, we seek to establish a relationship according to the molecular aberrations and immunophenotypic alterations that cells with AML present.

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Tuberculosis, despite all the research and technological inputs developed in recent years, remains one of the most frequent causes of pleural effusion, especially in developing countries such as Brazil. In immunocompetent individuals, pleural tuberculosis is the most common form of extrapulmonary tuberculosis. The diagnosis of this form of the disease continues to be the detection of Mycobacterium tuberculosis in pleural fluid, or in pleural biopsy samples, either by microscopy and / or culture, and the histological existence of granulomas in the pleura, a valid instrument for the determination of the disease , although the agent is not isolated. We present in this paper the report of a male patient, 76 years old, referred to the Public General Hospital of Palmas (HGPP) in december 2018, with clinic suggestive of Tuberculosis and absence of isolation of M. tuberculosis in a classical research – acid fast bacilli (AFB) and cultures. The visualization of the granulomatous reaction in the pleura, in association with the clinic, proved to be safe for establishing the diagnosis and conduct. Keywords: tuberculosis; pleural tuberculosis; Mycobacterium tuberculosis; tuberculosis diagnosis. RESUMO A tuberculose, apesar de todas as pesquisas e insumos tecnológicos desenvolvidos nos últimos anos, continua sendo uma das causas mais frequentes de derrame pleural, especialmente em países em desenvolvimento como o Brasil. Em indivíduos imunocompetentes, a tuberculose pleural é a forma mais comum de tuberculose extrapulmonar. O diagnóstico desta forma da doença continua sendo a detecção de Mycobacterium tuberculosis em líquido pleural, ou em amostras de biópsia pleural, seja por microscopia e / ou cultura, tendo-se demonstrado a existência histológica de granulomas na pleura, instrumento válido para determinação da doença, ainda que não isolado o agente. Apresentamos neste trabalho o relato de um paciente, masculino, 76 anos, encaminhado ao Hospital Geral Público de Palmas (HGPP) em dezembro de 2018, com clínica sugestiva de Tuberculose e ausência de isolamento de M. tuberculosis em algoritmo clássico de investigação – pesquisa de bacilo álcool- ácido resistente (BAAR) e culturas. A visualização de reação granulomatosa em pleura, em associação com a clínica, se revelou segura para estabelecimento do diagnóstico e conduta.   Palavras-chave: tuberculose; tuberculose pleural; Mycobacterium tuberculosis; diagnóstico de tuberculose.

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