Hepatitis E virus (HEV) infection can be responsible for chronic hepatitis in immunocompromised patients, and can rapidly evolve into fibrosis and/or hepatic cirrhosis. We present two cases of chronic hepatitis E, emphasizing the need to be aware of this entity as a growing etiology of hepatitis in transplant and immunocompromised patients.
Polymyositis (PM) is usually associated to other autoimmune or connective tissue diseases. The authors report the case of a 59-year-old man with pulmonary fibrosis, who presented with constitutional symptoms and gradually developed proximal muscle weakness, Raynaud phenomenon, and dysphagia. Besides creatine kinase (CK) elevation, he had positive anti-Polymyositis-Scleromyositis (PM-Scl) and anti-Sjögren’s-syndrome A (SSA) antibodies. Nailfold capillaroscopy showed a scleroderma pattern and muscle biopsy revealed necrosis, regeneration of muscle fibers, and inflammatory infiltrate. Prednisolone was started, with great improvement. Taking into account the overlap features between PM and systemic sclerosis sine scleroderma, it is important to closely monitor the patient for signs of pulmonary and cardiac decompensation.
LEARNING POINTS
Polymyositis (PM) may be associated with connective tissue diseases such as systemic sclerosis, including its variant without skin involvement.
Necrotizing muscle fibers are typically found in patients with overlap syndrome, in opposition to patients only with polymyositis.
PM-Scl antibodies are associated to a good response to corticoids.
International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations.
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O eritema nodoso (EN), paniculite que se apresenta com lesões nodulares eritematosas dolorosas, lo- calizadas preferencialmente à face extensora das pernas, é geralmente autolimitado e a cronicidade ou recorrência das lesões é rara. A sua etiologia é variada, sendo as causas mais comuns a faringite estreptocócica, a sarcoidose, a doença inflamatória intestinal e a tuberculose. Uma mulher de 73 anos apresentou-se na consulta de Medicina Interna com quadro de EN recorrente com um ano de evolução, tendo a investigação etiológica excluído as causas mais frequentes. Por queixas de epigastralgias realizou endoscopia digestiva que detetou um processo infiltrativo gástrico. A biopsia revelou um linfoma B difuso de grandes células. Apesar de rara, está descrita na literatura a associação entre linfoma e EN recorrente, podendo estas lesões cutâneas preceder em meses o diagnóstico daquela neoplasia. O linfoma não-Hodgkin deve portanto ser considerado como hipótese etiológica, principalmente nos casos de EN persistente ou recorrente. PALAVRAS-CHAVE – Eritema nodoso; Linfoma não-Hodgkin.
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