Gabriel Horta-Baas

Infección del sistema nervioso central por Listeria monocytogenes en pacientes con lupus eritematoso sistémico: análisis de 26 casos, incluyendo el reporte de un caso nuevo

INTRODUCTION Infections in patients with systemic lupus erythematosus cause significant morbidity. Infection due to Listeria monocytogenes (LM) is considered an opportunistic disease, and has been published on rare occasions in patients with SLE. OBJECTIVE To review the presentation of listeria infections in the central nervous system (CNS) in SLE patients. METHODOLOGY We conducted a literature review, selecting cases with central nervous system infection and confirmation of LM infection through culture. RESULTS Twenty six cases are described. The most common presentation was meningitis, with meningoencephalitis and brain abscesses being less frequent. The predisposing factors are: use of glucocorticoids, immunosuppressants, renal replacement therapy and the activity flares. CONCLUSION CNS infection by listeria is rare and sometimes fatal. The atypical presentation may lead to a delay in diagnosis and appropriate treatment. L. monocytogenes should be included in the differential diagnosis of patients with SLE with neurological manifestations.

Intestinal Dysbiosis and Rheumatoid Arthritis: A Link between Gut Microbiota and the Pathogenesis of Rheumatoid Arthritis

Characterization and understanding of gut microbiota has recently increased representing a wide research field, especially in autoimmune diseases. Gut microbiota is the major source of microbes which might exert beneficial as well as pathogenic effects on human health. Intestinal microbiomes role as mediator of inflammation has only recently emerged. Microbiota has been observed to differ in subjects with early rheumatoid arthritis compared to controls, and this finding has commanded this study as a possible autoimmune process. Studies with intestinal microbiota have shown that rheumatoid arthritis is characterized by an expansion and/or decrease of bacterial groups as compared to controls. In this review, we present evidence linking intestinal dysbiosis with the autoimmune mechanisms involved in the development of rheumatoid arthritis.

Estenosis subglótica en granulomatosis con poliangitis (granulomatosis de Wegener): presentación de 4 casos

INTRODUCTION Subglottic stenosis (SGS) in granulomatosis with polyangiitis (GPA) may result from active disease or from chronic recurrent inflammation. The objective of the study was to describe the clinical features and treatment of patients with subglottic stenosis. METHODS We retrospectively reviewed the medical records of all patients with SGS due to GPA diagnosed at Rheumatology deparment between January 2000 and June 2015. RESULTS We present 4 cases of SGS at our department during a period of 15 years. The interval between the presentation of the GPA and SGS varied between 2 and 144 months. The leading symptoms of SGS were dyspnoea on exertion and stridor. Three patients presented SGS without evidence of systemic activity. Two patients presented SGS grade i and received tracheal dilatation; two recurred and three needed a tracheostomy due to severe airway-limiting stenosis. CONCLUSION SGS presents high morbidity. Even though subglottic dilatation provides symptomatic relief, recurrences may present. Severe airway-limiting stenosis often requires tracheostomy.

Multibacillary leprosy mimicking systemic lupus erythematosus: case report and literature review

Leprosy is an infectious chronic disease with a wide range of clinical and serological manifestations. We report a case of a woman presenting with a malar rash, painless oral ulcers, photosensitivity, arthritis, positive antinuclear antibodies test and leuko-lymphopenia. Our case illustrates an unusual presentation of leprosy initially diagnosed as systemic lupus erythematosus (SLE). After the confirmation of multibacillary leprosy and multidrug therapy recommended by the World Health Organization, a good clinical response was observed. Recognition of rheumatic manifestations in leprosy is important as they may be confused with SLE. A literature review is presented to encourage clinicians to consider leprosy as a differential diagnosis. Specifically in patients with unusual rheumatic manifestations and persistent skin lesions, and when neurological symptoms are present. Leprosy has not been eradicated, so misdiagnosis can be frequent. It is necessary to increase medical practitioner awareness in order start proper treatment.

Trasplante renal en lupus eritematoso sistémico: comparación de la supervivencia del injerto con otras causas de enfermedad renal terminal

INTRODUCTION End-stage renal disease (ESRD) due to lupus nephritis (LN) occurs in 10%-30% of patients. Initially systemic lupus erythematosus (SLE) was a contraindication for kidney transplantation (KT). Today, long-term graft survival remains controversial. Our objective was to compare the survival after KT in patients with SLE or other causes of ESRD. METHODS All SLE patients who had undergone KT in a retrospective cohort were included. Renal graft survival was compared with that of 50 controls, matched for age, sex, and year of transplantation. Survival was evaluated by the Kaplan-Meier test and the Cox proportional hazards model. RESULTS Twenty-five subjects with SLE were included. The estimated 1-year, 2- and 5-year survival rates for patients with SLE were 92%, 66% and 66%. Renal graft survival did not differ between patients with SLE and other causes of ESRD (P=.39). The multivariate analysis showed no significant difference in graft survival between the two groups (hazard ratio, HR=1.95, 95% confidence interval [CI] 0.57-6.61, P=.28). The recurrence rate of LN was 8% and was not associated with graft loss. Acute rejection was the only variable associated with graft loss in patients with SLE (HR=16.5, 95% CI 1.94-140.1, P=.01). CONCLUSIONS Renal graft survival in SLE patients did not differ from that reported for other causes of ESRD.

Expectations of Treatment of Hepatitis C in Children

Background: HCV infection in children differs from infection in adult through transmission paths, spontaneous viral clearance rate, and fibrosis progression duration of chronic infection. It is estimated that the rate of children with chronic hepatitis C will develop cirrhosis is less than 2%, however there are reports of children requiring liver transplantation. Objective: Was to present a general overview of the current treatments for HCV infection in children. Material and method: Databases such as PubMed, MEDLINE and Scopus were used as information sources to identify and analyzed the current information about the treatment for HCV infection in children. Results: In children the most commonly used drugs are pegylated alpha interferon in combination with ribavirin, both drugs are given in combination therapy in children over 3 years of age with detectable HCV RNA levels. The side effects reported are similar like to adults, including leukopenia, anemia, weight loss (determined by anorexia, nausea, and abdominal pain), changes in behavior, depression, suicidal ideation, thyroid disorders, and transient slowing of the growth rate. Recently, it has been approved that the other drugs with direct antiviral activity (DAAs), the protease inhibitors NS3/4, Boceprevir and Telaprevir were introduced into clinical practice in adults, only Boceprevir was tested and not approved for use in children, (Clinical Trials gob No P07614), adverse effects were reported in 37.5% of participants and included nausea, fatigue, malaise, increased systolic pressure, increased liver enzymes.

Hallazgos radiográficos de la afectación del hombro en espondilitis anquilosante

La espondilitis anquilosante (EA) es una enfermedad inflamatoia crónica, que afecta principalmente al esqueleto axial, y en menor edida al esqueleto apendicular. El hombro es la segunda articulaión extra-axial más frecuentemente afectada en la EA1. De todas as artropatías inflamatorias es la menos erosiva y las más osifiante, su característica predominante es la anquilosis articular2. Se resenta el caso de un paciente que presentó cambios destructivos no destructivos en la articulación del hombro. Varón de 36 años, con inicio de dolor lumbar inflamatorio a los 16 años, limitación de la movilidad lumbar y cervical, artritis de caderas, tobillos y hombros, y HLA-B27 positivo. A los 23 años requirió prótesis bilateral de cadera. Consultó por discapacidad de los movimientos de los hombros, de predominio derecho de un año de evolución. Al examen físico se demostró limitación de los arcos de movilidad para la flexión, extensión y abducción. Sus radiografías mostraron en la pelvis: sacroileítis grado II bilateral;

Artropatía destructiva de grandes articulaciones y calcinosis tumoral asociada a oxalosis primaria: reporte de un caso y revisión de la literatura

A case of destructive arthropathy of hips and shoulders with tumoral calcinosis associated with calcium oxalate deposits in a patient with primary oxalosis and end stage renal disease on hemodialysis.