BackgroundCardiac complications constitute a rare clinical manifestation of cytomegalovirus (CMV) infection. This virus is usually asymptomatic in immunocompetent individuals. We report a case of myocarditis and cardiac insufficiency due to primary CMV infection. Serological tests by using ELISA method showed positive results for the virus.Case presentationA 41-year-old man with no prior comorbidities presenting with dyspnoea, fever, and oedema was admitted to the cardiac emergency service. He had fever and dry cough, which aggravated into progressive respiratory distress, lower limb oedema, and orthopnoea 30 days prior to hospitalisation. The electrocardiogram revealed sinus tachycardia, first-degree right bundle branch block, and ventricular and left atrial overload as well as diffuse and nonspecific disturbances of ventricular repolarization. Serological tests were conducted, and IgM (1.54 UI/mL) and IgG (2.5 UI/mL) were found positive only for CMV by using ELISA. The patient was diagnosed with cardiac insufficiency due to CMV myocarditis. He was treated with ganciclovir for 10 days and received supportive medication.ConclusionThis case reaffirms the possibility of cardiac involvement in CMV infection and emphasises the importance of viral aetiologies as differential diagnoses for acute myocarditis.

BackgroundAcute aortic dissection (AAD) is a highly lethal and prevalent cardiovascular emergency. AAD can develop into atrioventricular conductivity disorders caused by coronary artery dissection, with acute myocardial infarction (AMI) being the most frequent clinical sign. In many deceased patients, the diagnosis is not confirmed until autopsy, and 85 % receive the wrong therapy as a result of misdiagnosis.Case presentationA 49-year-old male patient presenting with prolonged, intense and sharp precordial pain radiating to his back, as well as cold sweats, nausea and vomiting, was admitted to the cardiac emergency service. Thorax examination revealed normal bilateral breath sounds and a respiratory frequency of 24 incursions/min (SpO2 97 %). Cardiac auscultation revealed a heartbeat that was rhythmic, regular, and bradycardic. There was a visible high-intensity pulsation in the suprasternal notch, a diastolic murmur audible at the aortic focus, and a fourth heart sound on auscultation. The patient was diagnosed with Stanford type A AAD, concomitant complete atrioventricular block, and impairment of the right coronary artery, progressing to acute coronary syndrome (ACS) and spontaneous rupture of the aortic aneurysm. After a hemodynamic study, the patient was transferred for urgent surgical treatment and passed away during the procedure.ConclusionPhysical examination is essential to be able to disregard AAD as the main cause of AMI. The consequences of a misdiagnosis can be fatal if thrombolytic or anticoagulant therapy is chosen as the initial treatment; therefore, surgery is the best treatment for aortic dissection.

BackgroundPoncet’s disease is a rare syndrome characterized by articular impairment in a form of rare tuberculid. One of the theories of its cause involves an autoimmune response induced by the intravesical administration of the Calmette–Guerin Bacillus or the treatment of bladder carcinoma. Furthermore, there may be an appearance of oligoarticular or polyarticular arthritis, beginning 1–3 months after the start of therapy. Few physicians know the disease and the literature related to that syndrome is scarce and restricted to case reports, which contributes to its under diagnosis.Case presentationFemale patient, 64 years old, Caucasian, in whom was noticed firstly dark urine, without haematuria or dysuria. Later felt also colic pain in the hypogastric region. Microscopically, the conclusive diagnosis was a high grade non-invasive papillary urothelial carcinoma. Thereupon, the treatment of the tumour began with transurethral resection technique and intravesical instillation of Calmette–Guérin Bacillus as adjuvant treatment. Eight months after the beginning of treatment, the lingering presence of the carcinoma was identified. Nevertheless, arthritis was identified through radiographs, after an increase in the clavicle capitation, right knee and left ankle in bone scintigraphy. Coinciding with the joint manifestations, the patient developed fever and purulent urethral discharge (culture was negative). Therefore, trying to investigate the cause of the arthritis, Purified Protein Derivate was taken, with reactive results. An increase of acute phase reactants was found, with other tests resulting normal: blood chemistry, Complete Blood Count, immunology and serology. Human Leukocyte Antigen typing by polymerase chain reaction revealed the presence of A24/AX, B44, B27, BW4/BW4, DQ7 and DQ5. Consequently, Poncet’s disease was the diagnostic conclusion. The treatment with intravesical Calmette–Guérin Bacillus was immediately discontinued. The patient received corticosteroids associated with etoricoxib and isoniazid for 4 months, achieving disappearance of the inflammatory joint signs in 3 months. After 6 months, no joint pain recurrence or other manifestations suggesting active disease had been seen.ConclusionsTherefore, such diagnosis should be considered when confronted with an osteoarticular clinical picture in patients treated with intravesical Calmette–Guérin Bacillus, especially patients with HLA-B27 (+) and B7 (+), as Poncet’s disease is a reactive arthritis.

BACKGROUND: describes clinical aspects of patients with chromoblastomycosis treated at the dermatology department of the Para State University. The  present  study  aimed  to  describe  clinical  and therapeutic   aspects   of   patients   with   chromoblastomycosis   treated   at the   dermatology department  of  Para  State  University. METHODS: An  observational,  descriptive,  case  series  study  was performed,  comprising  12  patients  with  the  diagnosis  of  chromoblastomycosis.  A  clinical interview and a dermatological protocole were applied, classifing these patients in variables as gender, age, time of illness, type of lesion (size, shape, appearance,  location  and  evolution),  treatment and complications.  Those unable to attend the clinic in person or unable to be represented by someone legally, a Term of Consent for Data Use was applied. CONCLUSIONS: most of the patients were male, rural workers, with vegetative lesions according to the classification of Carrión, graduated as moderate, with less than 10 years of evolution.

Background: Glioblastoma with oligodendroglioma component (GBMO) is a recently classified subtype of glioblastoma, which carries different clinical and prognostic outcomes, being frequently misdiagnosed. Both glioblastoma and GBMO are mainly seen in older ages, such as the 5th and 6th decades of life, being an extremely rare occurrence in children or adolescents and more frequent in male patients. Case report:A 15-year-old female patient, presented with history of daily headache, not relieved by painkillers, vomiting, blurred vision and strabismus. Magnetic resonance imaging of the brain revealed expansive tumour on left temporo-occipital lobe. Patient was submitted to intracranial exeresis, along with histopathological examination: glial neoplasm with areas of pleomorphism, hyperchromatism, anaplasia, foci of oligodendroglial component, perinuclear halo and ramified capillaries, resembling oligodendroglioma, necrosis and intense mitotic activity. The immunohistochemical analysis revealed positive Glial Fibrillary Acidic Protein (GFAP), synaptophysin, Ki-67 (MindBomb E3 ubiquitin protein ligase 1 -MIB-1) and hyperexpression of Epidermal Growth Factor Receptor (EGFR), indicating GBMO. Subsequently, Fluorescence in situ Hybridization (FISH) showed positive for 19q deletion, negative for 1p deletion and also positive for Isocitrate Dehydrogenase 1 (IDH 1) mutation, suggesting an oligodendroglioma component. Tumour resection was total and symptoms disappeared. Afterwards, she started adjuvant oral chemotherapy with temozolomide. Treatment was completed after 12 cycles adjuvant temozolomide, with no greater symptoms or complications and complete remission. Furthermore, according to the most recent WHO classification, in 2016, a new addition was made to this diagnosis: the evidence of isocitrate dehydrogenase (IDH) mutation, which is present on about 10% of gliobastomas [2]. This genetic marker has been shown as an important predictor of prognostic and longer survival rate [3,4,5].Moreover, the overall median survival of GBMO and GBM are still controversial, since it has shown a longer survival [4] in GBMO while others did not identify differences whatsoever [5].Regarding age, although GBMO has been said to have a younger onset than GBM, both are mainly seen on older ages, such as the 5th and 6th decades of life, being an extremely rare occurrence on children or adolescents [3,5,6].About gender, GBMO has been said as more prevalent in men at a 3,25:1 rate [3], but this prevalence is controversial, since many time GBMO is still misdiagnosed as a regular GBM or as anaplastic oligoastrocytoma (AOA). However, Karsy et al showed the rarity of this subtype of GBM and, moreover, how rare is its occurrence in children and adolescents [6].In Brazil, literature about GBMO is scarce, although some cases of GBMs have been reported, most of it was in adults and located in the cerebellum [7]. Furthermore, cases related regarding specifically pediatric patients include a cerebral case, located in the right hemisphere [8].How...