Alcides Greca

Histoplasmosis diseminada y sida en un hospital argentino: manifestaciones clínicas, diagnóstico y tratamiento

diagnosticados en el Hospital Eva Peron de Argentina, desde octubre de 1993 hasta julio de 2000. La histoplasmosis diseminada se observo en el 5,3% de los pacientes infectados por el VIH en el periodo del estudio. El 93,8% presento fiebre, perdida ponderal y hepatosplenomegalia. Otros hallazgos relevantes fueron: compromiso respiratorio (56,3%), digestivo (43,8%), lesiones cutaneomucosas (75%) y poliadenopatias (69%). El tratamiento instituido fue anfotericina B 1 mg/kg/dia hasta una dosis total de 1 g, continuando con itraconazol 400 mg por via oral. La mortalidad en la fase aguda fue del 19%, las recidivas se observaron en el 37,5%.

Systemic infection caused by Trichosporon asahii in a patient with liver transplant

Trichosporon species are emerging pathogens capable of causing severe infections in immunocompromised patients. In this paper, we report a case of systemic infection in a liver transplant patient caused by Trichosporon asahii to show the etiologic agents aggressiveness and poor therapeutic results with the different antifungals employed.

Manifestaciones extraarticulares graves de artritis reumatoide en ausencia de artritis activa, tras remisión espontánea sostenida. Presentación de un caso

Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease occasionally associated with severe extra-articular manifestations, mostly in cases of longstanding highly active disease. We report the case of a 56 year-old woman diagnosed with active RA at the age of 40. After 5 years of high activity, her arthritis subsides spontaneously during pregnancy despite the lack of treatment with disease-modifying anti-rheumatic drugs. She remains without articular symptoms for 7 years, and then she develops a Feltys syndrome requiring steroid treatment and splenectomy. Following steroid withdrawal she develops pericarditis with massive serohematic pericardial effusion, still in absence of articular activity, and responds to immunosuppressive therapy and colchicine. We emphasize the unusual spontaneous and sustained joint remission without specific treatment, and the development of severe extra-articular manifestations of RA in absence of concomitant articular activity, as well as the importance of controlling inflammation.