A case of juvenile cutaneous polyarteritis nodosa (cutaneous PAN) is presented. Since early infancy the child underwent attacks of fever and cutaneous rash that occasionally progressed to gangrene and amputations of distal portions of toes and fingers. Although occasional episodes of high blood pressure and persistence of moderate eosinophilia were present, the clinical pattern was mostly restricted to the musculoskeletal system and skin. The authors discuss the definition of the disease and its present therapeutic possibilities, calling attention to a feature not referred in previous reports: the unique co-existence of cutaneous PAN plus antiphospholipid antibodies (aPL) and perinuclear antineutrophil cytoplasmic antibodies (p-ANCA).
Many extrahepatic manifestations, including rheumatic diseases, have been reported to be associated with hepatitis C virus (HCV) infection. In order to investigate the prevalence of HCV infection among patients with rheumatic diseases, in the present study we interviewed 367 patients and tested their blood samples for HCV antibodies (anti-HCV) by an enzyme-linked immunosorbent assay. Anti-HCV-reactive samples were retested for confirmation by a line immunoassay and also for HCV RNA detection by the polymerase chain reaction. HCV RNA-positive samples were genotyped by INNO-LIPA. An overall HCV infection prevalence of 1.9% (7/367) was found. Of the 7 HCV-infected patients, 4 had systemic lupus erythematosus and 3 rheumatoid arthritis, resulting in positivity rates of 2.3 and 3.4%, respectively. HCV RNA genotyping revealed the presence of subtypes 1a (57.1%), 1b (28.6%) and 3a (14.3%). The clinical course was favorable for all HCV-infected patients, except one, who died due to renal insufficiency related to lupus nephritis. These results demonstrate a low HCV infection prevalence among the population studied. In the few positive cases, we observed no adverse influence of this infection on the clinical evolution of the rheumatic disease.
Introdução: A polineuropatia simétrica distal (PNSD) é umacomplicação frequente e catastrófica da diabetes mellitus, massubdiagnosticada. Os autores colocam a hipótese de o internamento ser uma oportunidade de rastreio da PNSD e pretendemcomparar dois métodos de diagnóstico.Material e Métodos: Estudo prospetivo e multicêntrico,que incluiu doentes diabéticos internados nos serviços de medicina interna de dois hospitais, entre maio e outubro de 2015.Foi aplicada a escala MNSI (Michigan Neuropathy Screening Instrument) e o teste SWME (Monofilamento de 10 g-SemmesWeinstein exam) para despiste de PNSD. Uma pontuação > 2no exame clínico da MNSI ou ≤ 7 respostas positivas em 10 noteste SWME, foram consideradas diagnósticas de DSPN.Resultados: Foram incluídos 88 pacientes com idade mediana de 77 (13) anos e 45% homens; a maioria com diabetestipo 2 e 7% tinham diagnóstico prévio de PNSD. A prevalênciade PNSD foi de 75% utilizando o MNSI; o teste SWME foi anormal em 38% destes pacientes. A taxa de concordância entre ostestes foi de 44,3%. Dos pacientes, 92,4% com diagnóstico dePNSD no estudo não tinham diagnóstico prévio.Discussão: O número de subdiagnósticos de PNSD nesteestudo é alarmante. A percentagem de casos subdiagnosticadapode representar um problema de registo ou de escassez derastreio.Conclusão: Neste estudo concluímos que a PNSD é altamente prevalente entre os pacientes hospitalizados, mas profundamente subdiagnosticada. A escala MNSI poderá ser uminstrumento adequado para o rastreio, enquanto o teste SWMEnão deve ser utilizada isoladamente para este propósito.
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