SUMMARYPurpose: To evaluate the frequency and the consequences of the co-infection of hepatitis B and C viruses in patients with hepatosplenic schistosomiasis (HSS).Methods: B and C serologic markers, exposure to risk factors, biochemical assays, upper gastrointestinal endoscopies, and abdominal ultrasonograms were evaluated in 101 patients with HSS from 1994 to 1997. Whenever possible, PCR was tested and histopathological studies were reviewed.Results: At least one HBV virus marker was found in 15.8%, and anti-HCV was detected in 12.9% of the subjects. The seropositive subjects tended to be older than the seronegative ones. A history of blood transfusion was significantly related to the presence of anti-HCV. Three (18.75%) out of 16 subjects exposed to B virus were HBsAg positive. Eleven (84.6%) out of thirteen patients who were anti-HCV positive demonstrated viral activity. Patients with ongoing viral infection presented a higher average level of liver aminotransferases, a higher frequency of cell decompensation and a higher rate of chronic hepatitis. Portal hypertension parameters were not influenced by viral exposure. Conclusions:The rate of hepatitis B and C viruses serologic markers observed in the patients with HSS was higher than the control group. The co-infection was responsible for a higher frequency of cell decompensation.

SUMMARYToxocara canis is a common canine nematode parasite and one of its possible transmission mechanisms is the predation of infected rodents by canids. Fifty Rattus norvegicus were used to study behavioral alterations in rodents infected by T. canis larvae. The rats were divided into three groups: G1, 20 rats infected with 300 T. canis eggs; G2, 20 rats infected with 2,000 T. canis eggs; and G3, 10 non-infected rats. Thirty and 60 days post-infection, rats from all the groups were submitted to an open-field apparatus for five min and subsequently, to an elevated plus-maze apparatus, again for five min. The data obtained indicated improvement in mobility (total locomotion time and rearing frequency) and exploratory behavior in infected rats, principally in G2, which provides some support for the hypothesis that behavioral alterations in rodents infected by Toxocara canis larvae enhance the transmission rate of this ascarid to dogs.

suMMARYThe muscular strength of experimental infected Rattus norvegicus with 3 rd. stage Toxocara canis larvae was investigated. Fifty Wistar rats, divided in three groups (G1 -20 rats infected by 300 eggs of T. canis; G2 -20 rats infected by 2,000 eggs of T. canis and G3 -10 rats without infection) had been used. Ten and 30 days after infection the muscular strength in the fore-feet of the rats was checked; at the same time, the body weight was determined. No significative differences in the body weight were noted among the infected and control rats in both occasions. Otherwise, an impairment on the muscular strength was observed in rats infected with T. canis 30 days after inoculation.

CONTEXT: DRESS syndrome (Drug Rash with Eosinophilia and Systemic Symptoms) is a type of drug reaction commonly mistaken for a viral infection. It must be recognized promptly due to its high morbidity and 10% mortality rate. Few cases of DRESS syndrome induced by sulfasalazine have been reported in the literature. CASE REPORT: The case of a 47-year-old white Brazilian woman who developed DRESS syndrome eight weeks after starting a course of sulfasalazine for treatment of seronegative arthritis is reported. She presented a skin rash, fever, hepatitis, lymphadenopathy, eosinophilia and atypical lymphocytes. The causative drug was discontinued immediately, but she only improved after treatment with prednisone.

Hashimoto's encephalitis (HE), encephalitis which responds to steroids and is associated with auto-immune thyroiditis, was described by Brain et al. in 1966 1 . Since then, about 100 cases have been described [2][3][4][5][6][7][8][9][10] . It is probably under diagnosed as it is not well known 5 . It presents with acute or sub-acute encephalopathy, tremor, myoclonus, ataxia, fits, psychosis or stroke like events, progressive or relapsing, high titres of anti-thyroid antibodies but independent of thyroid function 2,4,10 . Its two sub-types can co-exist: multiple stroke like events, and diffuse progressive, with dementia and psychiatric symptoms 3 . Diagnostic criteria are encephalopathy with elevated anti-thyroid antibodies in the absence of infection, tumour or alteration in the cerebral vascular system. A good response to corticoteroids is typical 2,4 . CaSEA 42 years old woman, white, secondary school education, married, from São Paulo, was admitted in Hospital in January 2007 with an acute febrile condition. She has universal alopecia which started when she was 13. There followed a period of three years with difficulties at school. She had three pregnancies with normal gestation, last 9 years ago. Eight years ago she developed hypothyroidism due to Hashimoto's thyroiditis, and has been taking 125 mcg levothyroxine daily.Her mother, 2 sisters and a daughter have Hashitmoto's thyroiditis, one sister also has vitiligo.She had a 2 years history of feeling progressively tired, insomnia, cramps, tremors, arthralgia, paraethesia in her hands and back pain. She had a 6 month history of behavioral changes and agitation, resulting in psychiatric treatment of estazolan 2 mg, bupropion 150 mg, carbamazepine 600 mg and duoxetine 30 mg daily.Over the proceeding 2 months she had lost the nails of her right hand and had lesions on her back and face compatible with excoriation.Five days prior to admission she had a high fever (41 o C), body pain, tremors, cold extremities and pins and needles in her legs.On admission, axillary temperature was 41 o C. Normotensive, pulse 120 bpm, she had universal alopecia, cyanosis and pale alternating in the extremities, growing nails of the right hand and scars on her back and face. She was histrionic with disturbed thought. Ataxia, low amplitude high frequency action and postural tremors and myoclonus were observed in the four limbs. On the second day her temperature fell to 34 o C. She was stable, suggesting a hypothalamic dysfunction.Serology, cultures and diagnostic imaging did not indicate an infectious process. ESR was normal (7 mm) and CRP slightly elevated (2.23 mg/dL). ANCA, anti-DNA and ANA were negative. Biochemical results showed raised aminotransferases (AST >2×; ALT >3×), hypocalcemia and hyperphosphatemia. Anti-thyroperoxidase antibodies (anti-TPO) was 1.100 U/mL with normal TSH and free T4.Cerebral MRI, eletroencephalogram (EEG) and single photon emission computed tomography (SPECT) were all normal. Lumbar puncture was clear, 1 cell/mm 3 , mild hyperproteinorrachia (51 mg/dL...

SUMMARYA case report of a 31 year-old woman from Paraíba State (North-Eastern Brazil) that presented severe involvement of ocular globes, ears and meninges. Diagnosis was established after enucleation of her left eye, when adult worms were seen in the midst of a granulomatous inflammatory process. Her response to the initial treatment with levamisole and cambendazole was good, but there was a relapse after the fifth month of treatment even with maintenance doses of both medications. She later received ivermectin and albendazol and responded well.

CONTEXT: Mucosa-associated lymphoid tissue (MALT) lymphomas are most commonly found in the stomach, lungs, orbital soft tissue, salivary glands and thyroid. Involvement of the trachea is extremely rare. CASE REPORT: This report describes a rare case of MALT lymphoma of the trachea in a 71-year-old woman who presented with a one-year history of coughing, dyspnea, hoarseness and weight loss. There was an infiltrative lesion in the mid-trachea. The anatomopathological diagnosis was only made from the fifth endoscopic biopsy attempt. Immunochemotherapy consisting of rituximab, cyclophosphamide, vincristine and prednisone (R-COP) induced complete remission of the symptoms and endoscopic lesion. CONCLUSIONS: MALT lymphoma of the trachea is extremely rare and indolent disease. It has to be considered in the differential diagnosis of airway lesions. It is crucial to obtain an anatomopathological diagnosis from a specialized pathologist. Immunochemotherapy with R-COP induced complete remission of the disease.

Pemphigus vulgaris is an autoimmune bullous disease whose therapy is based on systemic corticosteroids, with or without immunosuppressants. Rituximab is a chimeric monoclonal antibody of the IgG class, directed at a specific CD20 B cell surface antigen, used in pemphigus vulgaris empirically since 2002, with success in 90% of the cases and long periods of remission. Male patient, 33 years old, diagnosed with pemphigus vulgaris, confirmed by histopathology and direct immunofluorescence. He was treated for seven months with numerous treatments, including immunosuppressive drugs, with an unsatisfactory response, until he had complete remission with the use of rituximab. During a 34-month follow-up period, the patient presented a slight clinical relapse, which was successfully controlled with prednisone in a daily dose of 120mg, soon reduced to 20mg.