Massimo Delfino

Favorable Response to High-Dose Interferon-Alpha in Idiopathic Hypereosinophilic Syndrome with Restrictive Cardiomyopathy Case Report and Literature Review

The idiopathic hypereosinophilic syndrome is characterized by a prolonged overproduction of eosinophils of unknown cause in addition to specific organ damage due to eosinophil-derivated protein toxicity. Its prognosis is correlated with heart involvement that results in a restrictive cardiomyopathy. This is frequently biventricular. Isolated left ventricular infiltration has rarely been reported. The authors report a case of idiopathic hypereosinophilic syndrome with cardiac involvement obliterating the left ventricular cavity with a favorable clinical outcome following a combination therapy with interferon-alpha, hydroxyurea and prednisone. Data from other studies dealing with the treatment of idiopathic hypereosinophilic syndrome with interferon- alpha are reviewed and discussed.

Myocardial Infarction with Normal Coronary Arteries in a Patient with Primary Antiphospholipid Syndrome Case Report and Literature Review

Primary antiphospholipid syndrome is associated with an increased risk of vascular throm bosis. The authors describe a young patient without any risk factor for coronary artery disease who was admitted to the hospital because of a transient cerebral ischemic attack. Standard EKG showed signs of a previous silent inferior wall myocardial infarction, confirmed by echocar diography, technetium-99 scintigraphy, and left ventricular angiography. Coronary arteries appeared normal at angiography. Blood tests showed the presence of antiphospholipid anti bodies and lupus anticoagulant. Since there is evidence that these antibodies are associated with an increased risk of microvascular thrombosis, the authors conclude that this silent myocardial infarction could be caused by a cardiac microvascular disease accompanying the antiphospholipid syndrome.

CASE REPORT: Ursodeoxycholic Acid Treatment in Abdominal Sarcoidosis

Sarcoidosis is a multisystemic granulomatous disease of unknown origin with broad-spectrum clinical manifestations. Major complains at onset are usually related to the respiratory system, which is involved in 90% of cases (1). Extrathoracic sarcoidosis is usually found in the liver, skin, joints, and peripheral lymph nodes. Microscopically, liver involvement in systemic sarcoidosis usually ranges from 50 to 90% of the cases (2), but is often clinically silent.

A Case of Pneumocystis jirovecii Pneumonia in a Severely Malnourished, HIV-Negative Patient A Role for Malnutrition in Opportunistic Infections?

Malnutrition increases the risk of infections in patients receiving medical and surgical procedures, but it is not clear whether it may facilitate also the development of opportunistic infections in human immunodeficiency virus (HIV)-negative patients not receiving immunosuppressive therapies. Here we report the first case of a non-HIV, severely malnourished woman who developed Pneumocystis jirovecii pneumonia. This report highlights the clinical relevance of malnutrition as a determinant of immune suppression, which in turn may also favor opportunistic infections. Therefore, routine nutrition screening and assessment, as well as timely start of nutrition therapy, should be prioritized in daily clinical practice to reduce complications and improve outcome.