Magnesium – association with inflammation and renal disease in systemic lupus erythematosus

Introduction: Recent studies suggest that magnesium deficiency may play a role in inflammation. In diabetes and cardio-vascular diseases, conditions with a component of chronic inflammation, C–reactive protein levels are higher and associated with low serum magnesium. The objective of this study is to evaluate serum magnesium levels in patients with systemic lupus erythematosus and its potential association with inflammation and renal manifestations. Methods: All patients with systemic lupus erythematosus followed in a Systemic Immune Diseases Unit, from January 2012 until January 2014, were included in this cross sectional analysis. Patients with infection, neoplasia, liver failure and chronic kidney disease (stage > 3) were excluded. Clinical information and laboratory results (serum magnesium, C-reactive protein, erythrocyte sedimentation rate, serum creatinine and spot urine test) were collected. A multivariate analysis was performed to explore possible predictive factors for hypomagnesaemia. Results: One hundred and two patients were included (94.1% female, 21-86 years). 33.4% had hypertension, 8.8% had diabetes and 20.6% had hypomagnesaemia (< 1.8mg/dL). There were no significant differences between the inflammatory parameters of patients with hypomagnesaemia or normomagnesaemia. Serum magnesium was significantly lower with increasing comorbidities (p = 0.01). Leukocyturia was significantly higher in the hypomagnesaemia group (p = 0.03) and haematuria had a negative correlation with serum magnesium (-0.23, p < 0.05). Multivariate analysis showed that patients with hypertension and diabetes had higher risk of hypomagnesaemia: OR 42.29 (95% CI, 1.43-1249.31). Leukocyturia was also individually and independently associated with hypomagnesaemia: OR 8.37 (95% CI, 1.40-49.97). Conclusion: The presence of hypomagnesaemia in our patients with systemic lupus erythematosus was high. There was no association between the levels of serum magnesium and the inflammatory parameters. Increasing comorbidities and leukocyturia were independent predictors of lower serum magnesium. Finally, the association of leukocyturia and haematuria with lower serum magnesium may suggest a relationship with a higher disease activity.

Mucopiocelo fronto-etmoidal, a propósito de um caso clínico

O mucocelo é uma lesão quística, benigna, expansiva dos seios perinasais. A sobreinfecção deste, designada de mucopiocelo, pode levar a um período de crescimento rápido, com maior risco de complicações. Relata-se o caso clínico de uma doente do sexo feminino, 59 anos, que recorreu ao Serviço de Urgência após crise inaugural de convulsão tónico-clónica generalizada, com queixas de aumento de volume periorbitário direito e febre desde há 1 semana. Apresentava à direita celulite orbitária e proptose ínfero-externa, com área de flutuação na parte medial da pálpebra superior, oftalmoplegia e quemose do olho direito acompanhada de rinorreia mucopurulenta. Realizou TC que demonstrou volumoso abcesso subperiosteal direito, ao nível da parede medial da órbita, tendo como ponto de partida aparente as células etmoidais anteriores homolaterais e seio frontal direito. Colocou-se a hipótese de mucopiocelo fronto-etmoidal. Foi submetida a drenagem de urgência do abcesso e a cirurgia endoscópica nasal com marsupialização da lesão fronto-etmoidal. Verificou-se resolução completa do quadro clínico. Apesar de consideradas lesões benignas, os mucocelos, apresentam potencial destrutivo, principalmente se infectados, necessitando, por vezes, de intervenção cirúrgica de urgência. A abordagem endoscópica destas lesões reafirma-se como tratamento de eleição.