Morphoea, also known as localized scleroderma, is a disorder characterized by excessive collagen deposition leading to thickening of the dermis and/or subcutaneous tissues. Intravenous IgG therapy has induced improvement in some fibrotic conditions. The primary indication for subcutaneous IgG (SCIG) is in primary immunodeficiency disorders as replacement therapy; however, recently there has been considerable interest in SCIG as an immunomodulatory agent. We report an 11-year-old girl with deep morphoea who was successfully treated with SCIG.
La medicina es uno de los campos del conocimiento que más podrían beneficiarse de una interacción cercana con la computación y las matemáticas, mediante la cual se optimizarían procesos complejos e imperfectos como el diagnóstico diferencial. De esto se ocupa el aprendizaje automático, rama de la inteligencia artificial que construye y estudia sistemas capaces de aprender a partir de un conjunto de datos de adiestramiento y de mejorar procesos de clasificación y predicción. En México, en los últimos años se ha avanzado en la implantación del expediente electrónico y los Institutos Nacionales de Salud cuentan con una riqueza de datos clínicos almacenada. Para que esos datos se conviertan en conocimiento, necesitan ser procesados y analizados a través de métodos estadísticos complejos, como ya se hace en otros países, usando: razonamiento basado en casos, redes neuronales artificiales, clasificadores bayesianos, regresión logística multivariante o máquinas de soporte vectorial, entre otros. Esto facilitará el diagnóstico clínico de padecimientos como: apendicitis aguda, cáncer de mama o hepatopatía crónica. En esta revisión se repasan conceptos, antecedentes, ejemplos y métodos de aprendizaje automático en diagnóstico clínico.
Langerhans cell histiocytosis presents most frequently in pediatric patients with cutaneous manifestations such as erythematous and scaly papules in the trunk or scalp and macerated plaques in intertriginous sites. We present a case of a seven-month-old patient who was brought with complaints of persistent diaper rash. The patient presented with skin fissures in intertriginous areas and pink color papules dispersed widely in the trunk and perineum. The skin biopsy revealed infiltration of abundant histiocytes, eosinophils, lymphocytes, and plasma cells, being CD207, CD1a, and S-100 positive by immunohistochemistry. Due to the diversified presentations of Langerhans cell histiocytosis and its propensity to mimic other dermatological conditions, physicians should have a clinical suspicion of this disease and consider it as a differential diagnosis among common skin diseases in pediatric patients.
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