Mauricio Restrepo

Espondiloartritis en el Hospital Pablo Tobón Uribe. Descripción de una cohorte

Resumen Las espondiloartritis comparten un contexto ambiental, genetico y clinico. Objetivo Conocer y describir el comportamiento demografico, clinico y radiologico de pacientes con espondiloartritis en el Hospital Pablo Tobon desde el 1 de enero de 2005 hasta el 31 de diciembre de 2008. Materiales y metodos Este es un estudio descriptivo, observacional, de corte transversal. Se empleo estadistica descriptiva para las variables demograficas, clinicas, radiologicas y los diversos tipos de tratamiento. Resultados 71 pacientes fueron identificados. Las caracteristicas clinicas mas importantes fueron: dolor lumbar inflamatorio en el 84% de los pacientes, entesopatia, 67%; artritis periferica, 64% y dolor gluteo alternante, 57%. Las articulaciones comprometidas con mayor frecuencia fueron: sacroiliacas, 62%; tobillos, 32%; rodillas, 30%; tarso, 14%. El 64% presento sacroilitis radiologica. Las manifestaciones extraarticulares mas frecuentes fueron: dactilitis, 22%; uveitis, 19%; compromiso renal, 5% y fibrosis pulmonar, 1%. Los indices de actividad (BASDAI) fueron de 4.82 y la funcion (BASFI) de 4. 54% y 34% de los pacientes tenian eritrosedimentacion y PCR elevada, respectivamente. El HLA B27 + en el 52%. Los DMARDs (sulfasalazina y metotrexate) fueron los medicamentos mas usados en el 68% de los casos. Le siguieron los AINES en el 52% y los medicamentos anti-TNF en el 42% de los pacientes (Infliximab 20%, adalimumab 16% y etanercept 6%). Conclusion Nuestros pacientes tenian una enfermedad activa y con limitacion funcional. Se encontro un alto porcentaje de pacientes con espondiloartritis indiferenciada. La dactilitis fue la manifestacion extraarticular mas frecuente y el compromiso radiologico fue similar al descrito en la literatura.

Lupus Eritematoso Sistémico Ampolloso: dramática respuesta a la terapia con dapsona

Resumen El lupus ampolloso es una manifestacion poco frecuente del lupus eritematoso sistemico (LES). Otras enfermedades ampollosas tales como el penfigoide ampolloso, epidermolisis ampollosa adquirida, dermatosis ampollosa Ig A lineal y dermatitis herpetiforme tambien han sido informadas en LES. Describimos un paciente que desarrollo lesiones ampollosas 14 dias luego de iniciar terapia con altas dosis de glucocorticoides y ciclofosfamida para manifestaciones severas del LES (nefritis y hemorragia alveolar). Se confirmo el diagnostico de lupus ampolloso. La respuesta al tratamiento con dapsona fue notable a las 48 horas. En este articulo revisamos la epidemiologia, hallazgos clinicos, histopatologicos e inmunopatologicos; el diagnostico diferencial y el tratamiento del LES ampolloso.

Cocaine-Levamisole-Induced Vasculitis/Vasculopathy Syndrome

Purpose of reviewTo understand the clinical spectrum of cocaine-levamisole-induced vasculitis. Worldwide recreational drug consumption is high among the adult population from various social strata. The use of cocaine with levamisole, a frequently added antiparasitic diluent, favors the manifestations of vasculitic lesions, especially in the skin.Recent findingsNew insights into immunological mechanisms involved in the pathogenesis of the disease. There are still many unknown aspects in the pathogenesis of this disease, such as the immune system interaction with p-ANCAs and the release of inflammatory NETs (neutrophil extracellular traps), which are the origin of auto-antigens and tissue damage, manifesting as vasculitic purpura on the skin. The clinical presentation constitutes a challenge for the clinician to be able to distinguish it from small-vessel vasculitides.SummaryThis paper intends to improve the understanding of this condition, exhibiting the broad clinical spectrum of local and systemic manifestations of cocaine-levamisole-induced vasculitis, to facilitate a timely diagnosis, in order to take corrective measures and avoid sequelae, along with tissue damage and the consequent deformities and permanent scars.

Infiltrating CD16+ Are Associated with a Reduction in Peripheral CD14+CD16++ Monocytes and Severe Forms of Lupus Nephritis

Our aim was to characterize glomerular monocytes (Mo) infiltration and to correlate them with peripheral circulating Mo subsets and severity of lupus nephritis (LN). Methods. We evaluated 48 LN biopsy samples from a referral hospital. Recognition of Mo cells was done using microscopic view and immunohistochemistry stain with CD14 and CD16. Based on the number of cells, we classified LN samples as low degree of diffuse infiltration (<5 cells) and high degree of diffuse infiltration (≥5 cells). Immunophenotyping of peripheral Mo subsets was done using flow cytometry. Results. Mean age was 34.0 ± 11.7 years and the mean SLEDAI was 17.5 ± 6.9. The most common SLE manifestations were proteinuria (91%) and hypocomplementemia (75%). Severe LN was found in 70% of patients (Class III, 27%; Class IV, 43%). Severe LN patients and patients with higher grade of CD16+ infiltration had lower levels of nonclassical (CD14+CD16++) Mo in peripheral blood. Conclusions. Our results might suggest that those patients with more severe forms of LN had a higher grade of CD14+CD16+ infiltration and lower peripheral levels of nonclassical (CD14+CD16++) Mo and might reflect a recruitment process in renal tissues. However, given the small sample, our results must be interpreted carefully.

Artritis reactiva asociada con bacteriemia por Brevundimonas diminuta

Resumen Dentro del grupo de las espondiloartritis, la artritis reactiva se define como una inflamacion articular desencadenada por una infeccion bacteriana extra-articular. Existen pocos reportes de artritis reactiva asociada con bacteriemia simultanea causada por patogenos diversos. Brevundimonas diminuta es un bacilo Gram negativo aislado ocasionalmente de especimenes clinicos. Reportamos el caso de una paciente, sin inmunodeficiencia conocida, con artritis reactiva y bacteriemia simultanea por B. diminuta .

Síndrome de seudotumor cerebral en una mujer embarazada y con lupus eritematoso sistémico

Systemic lupus erythematous is a chronic multi-systemic autoimmune disease that affects multiple organ systems, including the central nervous system. Pseudotumor cerebri is a disorder associated with increased intracranial pressure in the absence of a space-occupying lesion or other identifiable cause that affects young and obese women.We present the case of a pregnant woman with both pseudotumor cerebri and a new diagnosis of active systemic lupus erythematous.

CE-06 Urinary neutrophil gelatinase – associated lipocalin and monocyte chemoattractant protein-1 as biomarkers for lupus nephritis in colombian SLE patients

Background Some previous studies in Caucasian, Asian, and African-American patients have shown that urine levels of Neutrophil Gelatinase–Associated Lipocalin (uNGAL) and Monocyte Chemoattractant Protein-1 (uMCP-1) were significantly greater in patients with LN. However, information in Mestizo and Afro-Latin American patients is very limited. Our aim was to evaluate diagnostic value of uNGAL and uMCP-1 as potential markers for the diagnosis of LN in Colombian SLE patients Materials and methods We examined urinary levels of NGAL and MCP-1 in 93 consecutive SLE patients (ACR criteria 1982) from Hospital San Vicente Fundación, at Medellín, Colombia. uNGAL and uMCP-1 were measured by ELISA techniques (R&D system, Minneapolis, USA). In addition, serum Anti-C1q antibodies were measured (Inova, San Diego, USA). Several clinical and serological features were analysed as well as disease activity (SLEDAI). Mann-Whitney tests were used to compare data and Spearman’s rho for correlations. Additionally, ROC curves relating the specificity and sensitivity profiles of the 2 biomarkers were done. Results Ninety-three SLE patients were recruited (88% female) with median age of 33.6 ± 12.4 years and median disease duration of 11.5 ± 14.8 years. Mestizo (75%) and Afro-Latin American (22%) were majority. One quarter of patients had an early SLE (< 2 years of duration) and 64 were admitted at the time of urine collection. Hematologic disease (89%), arthritis (83%), cutaneous involvement (82%), and renal disease (66%) were among most common manifestations. 63% of patients were positive for anti-C1q. We found significant positive correlation between uNGAL levels and SLEDAI (r = 0.331, p = 0.02) and between uMCP1 with SLEDAI (r = 0.428, p < 0.02) and with uNGAL (r = 0.467, p < 0.0001). uNGAL and uMCP-1 were significantly higher in patients with LN than in patients without LN (53.0 ± 56.3 vs 16.0 ± 16.6 pg/ml, p = 0.001 and 2340.4 ± 4521.4 vs 472.4 ± 596.5, p = 0.015, respectively). uNGAL levels were also significantly higher in patients with active LN (>500 mg proteinuria/24 hrs) than in inactive LN (66.1 ± 61.9 vs 9.0 ± 8.6, p < 0.001). A ROC curve constructed for uNGAL, uMCP-1, and anti-C1q for LN in all SLE patients showed a good level of sensitivity and specificity (Figure 1). Conclusions Colombian LN patients had 4 times and 5 times higher levels of uNGAL and uMPC-1, respectively than patients without LN. Additionally, uNGAL was significantly higher in patients with active LN. Both markers were correlated with disease activity. A multinational prospective study is ongoing under GLADEL cohort, in order to evaluate those biomarkers in 14 Latin American countries. Abstract CE-06 Figure 1 Receiver operating characteristic (ROC) curve of urinary NGAL, MCP-1 and anti C1q for the identification of LN (dotted line for uNGAL, solid green line for uMCP-1 and solid red line for anti C1q) Acknowledgements JA Gómez-Puerta was supported by Colciencias (conv. 656 de 2014). Anti-C1q antibodies were provided by Inova, Werfen, Colombia

Hemorragia alveolar difusa y nefropatía en dos pacientes con síndrome antifosfolipídico primario

Resumen Informamos dos pacientes clasificadas como sindrome antifosfolipidico primario que presentaron hemorragia alveolar y nefropatia durante su evolucion. La primera paciente presento una glomerulonefritis membranoproliferativa con patron “full house” en la inmunofluorescencia; los autoanticuerpos especificos de LES fueron persistentemente negativos y los niveles de complemento serico permanecieron normales; la segunda paciente presento una proteinuria en rango no nefrotico y sindrome HELLP y, posteriormente, una hemorragia pulmonar. Ninguna de las pacientes ha desarrollado un cuadro definitivo de LES luego de varios anos de seguimiento.

Síndrome de Churg-Strauss: a propósito de un caso con manifestaciones poco usuales

Summary Churg-Strauss syndrome, a necrotizing systemic vasculitis which involves the small and (more rarely) the medium-sized vessels, is a primary vasculitis strongly associated with antineutrophil cytoplasm antibodies (ANCA). It is characterized by the presence of asthma, eosinophilia and extravascular eosinophilic granulomas. Herein, we report a 36-year-old woman with a history of late onset asthma and allergic rhinitis who developed central nervous system involvement, peripheral neuropathy, leukocytoclastic vasculitis and eosinophilia. Interestingly, unusual clinical manifestations of Churg-Strauss syndrome such as mesenteric microaneurysms and jaw claudication were present in this particular patient. A brief review of the literature of Churg-Strauss syndrome is presented.