RESUMEN
Infectious complications are rarely observed in the course of sarcoidosis. Only small series or cases reports of infection are described in sarcoidosis. Corticosteroids-induced immune suppression, pulmonary fibrosis and T-CD4 lymphopenia, are often present. Pulmonary nocardiosis is an important cause of opportunistic infection in immunosuppressed patients, and the incidence of this infection is increasing. Pulmonary nocardiosis manifests as an acute, subacute or chronic infection with a marked tendency towards remissions and exacerbations. We report a case of pulmonary nocardiosis in a patient with sarcoidosis followed for pulmonary fibrosis receiving corticosteroids. During the investigation of pyrexia and dyspnea, evidence of Nocardia spp. infection was found in the bronchial secretions. Six months of trimethoprim/sulfamethoxazole therapy ensured further resolution of this pleuropulmonary infection. Pulmonary nocardiosis is exceptional in sarcoidosis and mainly occur, in patients receiving corticosteroids, and with CD4+ T-lymphocytopenia. Sarcoidosis by itself does not appear to be a risk factor of opportunistic infection.
Asunto(s)
Nocardiosis/complicaciones , Sarcoidosis Pulmonar/complicaciones , Adulto , Antiinfecciosos/uso terapéutico , Femenino , Humanos , Nocardiosis/diagnóstico por imagen , Nocardiosis/tratamiento farmacológico , Radiografía Torácica , Sarcoidosis Pulmonar/diagnóstico por imagen , Sarcoidosis Pulmonar/tratamiento farmacológico , Combinación Trimetoprim y Sulfametoxazol/uso terapéuticoRESUMEN
INTRODUCTION: Tocilizumab is a humanized monoclonal antibody directed against interleukin-6 receptor and is beginning to be reported as effective in some cases of Still's disease refractory in adults (ASD). ASD is rare, heterogeneous, with unpredictable evolution. The distal destructive arthritis represents a possible complication. PATIENT: We report an unusual case of adult-onset Still's disease with severe distal interphalangeal destructive arthritis with refractory early and prolonged remission after the first tocilizumab infusion. CONCLUSION: Tocilizumab can be used in patients with refractory ASD after failure or intolerance of conventional treatments.
Asunto(s)
Anticuerpos Monoclonales Humanizados/uso terapéutico , Cartílago Articular/patología , Interleucina-6/antagonistas & inhibidores , Enfermedad de Still del Adulto/tratamiento farmacológico , Enfermedad de Still del Adulto/patología , Antiinflamatorios/uso terapéutico , Cartílago Articular/diagnóstico por imagen , Resistencia a Medicamentos , Mano/diagnóstico por imagen , Mano/patología , Humanos , Masculino , Metilprednisolona/uso terapéutico , Radiografía , Enfermedad de Still del Adulto/diagnóstico por imagen , Adulto JovenRESUMEN
INTRODUCTION: Acquired ichthyosis is a rare condition that usually reveals malignant diseases. CASE REPORT: A 70-year-old man was admitted with weight loss, diffuse ichthyosis, lymphadenopathy of the inguinal lymph nodes and elevated inflammatory markers in peripheral blood. Histology of the lymph node revealed mixed-cellularity Hodgkin disease. The evolution was fatal in spite of the chemotherapy. DISCUSSION: Acquired ichthyosis is a cutaneous paraneoplastic syndrome, generally related to hematologic malignancies. A possible pathomecanism is the stimulation of epidermal growth secondary to the production of epidermal growth factor (EGF) by tumour cells. Acquired ichtyosis can rarely reveal systemic or infectious diseases. It can also be drug-induced or idiopathic.