Marta Miranda A

Forma atípica de enfermedad por arañazo de gato: Compromiso óseo en dos pacientes pediátricos detectado mediante cintigrafía ósea. Revisión de la literatura

Resumen La enfermedad por aranazo de gato (EAG) esuna patologia benigna y autolimitada transmitidapor el rasguno o mordedura de un gato portadorde Bartonella henselae , que se manifiesta comolinfoadenopatia cercana al sitio de inoculacion yque afecta, en 80% de los casos, a sujetos bajo21 anos de edad. Menos de 25% de los pacientesdesarrollara la forma atipica de la enfermedad,con compromiso de organos como higado, bazo,sistema nervioso central y retina. La osteomielitisha sido descrita en series antiguas como de esca-sa ocurrencia, aunque publicaciones recientessugieren una incidencia mayor. El esqueleto axiales el mas frecuentemente comprometido, princi-palmente pelvis y columna dorsolumbar, pudien-do ser las lesiones esqueleticas unicas o multi-ples; estas no siempre son dolorosas y puedenaparecer hasta semanas o meses despues delinicio de los sintomas. Se presenta los casosclinicos de dos ninas con compromiso esqueleti-co, serologia positiva para B. henselae y recupe-racion completa posterior. Una de ellas (edad 12anos) presento fiebre y dolor abdominal severo,demostrandose lesion hipodensa hepatica yosteomielitis multifocal en la columna y pelvis.La otra (edad 10 anos) solo curso con adenopatiasubmandibular, sin fiebre ni compromiso gene-ral, y una lesion indolora en la cresta iliaca,visible al cintigrama oseo (CO). Un CO conlesiones axiales uni o multifocales en un pacientefebril sin etiologia clara, debe hacer sospecharEAG atipica entre las posibles causas. El CO esindispensable si se quiere descartar un compro-miso oseo asociada a EAG, especialmente enpacientes sintomaticos con radiografias norma-les e incluso, aquellos sin dolor oseo.

Dermatomiositis juvenil: manifestaciones clínicas y de laboratorio

more additional skin signs. Ninety percent of patients had risen se^um activity of muscle associateden^imes, lactic dehydrogenase (LDH) being the most constantly elevated: 7/7 studied cases. All patients showedabnormal electromyographic and hystologic findings in muscle biopsy. Treatment was based upon rehabilitation,prednisone (average daily dose: 1.5mg • kg of body weight) associated o

Artritis reumatoidea juvenil y espondiloartropatias: estudio comparative

To identify early differential diagnostic criteriae berween both disease enlities, 75 patients under 16 years of agewith juvenile rheumatoid arthritis (JRA, n:40| or ankylosing spondylitis [JAS, n:35) were retrospectively studied andcompared by sex., age, nutritional state, joint localization, blood cell counts, erithrocyte sedimentation rate, serumrheumatoid factor, antinuclear antibodies and HLA B27 at clinical onset. Significant differences [p of JRA cases. This clinical andepidemiological differences coJd help, at the onset of clinical manifestations, to make more accurate differentialdiagnosis between JRA and JAS patients.|Key words; arthritis, rheumatoid, spondylitis, ankylosing, juvenile.)

Espondilodiscitis y artritis de tobillo por Candida albicans en escolar

A thirteen year old boy with known rnucocutaneous candidiasis since age six month, had evidence of arthritis at his right ankle together with lower thoraxic painful xyphosis. At X ray examination right ankles articular space was disminished and an initially eroded upper surface of the astragallus was seen, together with evidence of impacted T1G-T11 vertebral bodies and spondilodyscitis at T10-11 and T4-5. Triphasic oseous scintigraphy showed increased counts in the afected ankle and in T11 vertebral body. Candida athicans was isolated frorr articular bioosy but no microorganism was identified from T11 samples. During the search,of an immunologic system abnormality, malignant tumors and HIV were discarded, but selective deficiency of celular immunity for Candida albicans was demonstrated. He was treated with anphotericin B and 5-fluocytocin for along two months approximately, physiotherapy and oral ketoconazole for an additional six months, without complications. He is now asymptomatic, without evidence of osteoarticula r infection. There it is only slight equinus deformity at his right foot and minimal non painful dorsal xyphosis. (Key words: candidiasis, mucocutaneous, osteoarticular, spondilodyscitis.)