Osteoarticular tuberculosis in an HIV-positive patient: a case report

The authors report a case of a 38-year-old HIV-positive woman, with subcutaneous nodules on the thoracic region with 3 months of evolution. Clinical, laboratory, and epidemiological features were evaluated and associated with apparent damage to the T11-T12 vertebrae, identification by imaging tests, positivity in a polymerase chain reaction-based test, and reactivity to the Mantoux tuberculin skin test (PPD-RT 23). The patient was diagnosed with osteoarticular tuberculosis and received treatment for a year, and clinical cure was achieved.

Multiple Embolism in a Female Patient with Infective Endocarditis: Low Back Pain and Hematuria as the Initial Clinical Manifestations

A 59-year-old female patient with mitral valve prolapse and a previous history of lumbosacral spondyloarthrosis and lumbar disk hernia had an episode of infective endocarditis due to Streptococcus viridans, which evolved with peripheral embolism to the left kidney, spleen, and left iliac artery, and intraventricular cerebral hemorrhage. Her clinical manifestations were low back pain and hematuria, which were initially attributed to an osteoarticular condition. Infective endocarditis is a severe polymorphic disease with multiple clinical manifestations and it should always be included in the differential diagnosis by clinicians.

Efeito da dieta e do ciclismo indoor sobre a composição corporal e nível sérico lipídico

FUNDAMENTO: O ciclismo indoor é um exercício aeróbico no qual se utiliza grandes grupamentos musculares dos membros inferiores, carente de impacto osteoarticular e de elevado gasto calórico, o que o torna interessante para se gerar uma estratégia não farmacológica. OBJETIVO: Analisar a composição corporal e o perfil lipídico sérico de mulheres com sobrepeso após doze semanas de dieta hipocalórica e treinamento de ciclismo indoor. MÉTODOS: Foram randomizadas 40 mulheres (23,90 ± 3,10 anos), subdivididas em quatro grupos: controle (C), ciclismo indoor (CI), ciclismo indoor associado a dieta hipocalórica (CD) e dieta hipocalórica (D). As variáveis analisadas foram: estatura e massa corporal, IMC, percentual de gordura, massa magra, triglicerídeos, colesterol e lipoproteinas (HDL,LDL,VLDL). O treinamento de ciclismo indoor consistiu em três sessões semanais de 45 minutos cada e a uma restrição energética de aproximadamente 1.200 kcal. O estudo teve duração de 12 semanas. Utilizou-se a estatística descritiva (média e desvio padrão) e inferencial (test t de Student). O nível de significância adotado foi de p < 0,05. RESULTADOS: Os grupos CI, CD e D reduziram significativamente as médias das variáveis antropométricas após as 12 semanas de intervenção (massa corporal, percentual de gordura e índice de massa corporal), além dos níveis séricos de colesterol total e triglicerídios. Em relação ao HDL colesterol, houve aumento significativo para os grupos CI e CD. CONCLUSÃO: De acordo com os resultados, o ciclismo indoor e a dieta hipocalórica contribuíram no combate ao sobrepeso bem como no controle do nível sérico dos lipídeos.

Coxiella burnetii, the agent of Q fever in Brazil: its hidden role in seronegative arthritis and the importance of molecular diagnosis based on the repetitive element IS1111 associated with the transposase gene

Coxiella burnetii is the agent of Q fever , an emergent worldwide zoonosis of wide clinical spectrum. Although C. burnetii infection is typically associated with acute infection, atypical pneumonia and flu-like symptoms, endocarditis, osteoarticular manifestations and severe disease are possible, especially when the patient has a suppressed immune system; however, these severe complications are typically neglected. This study reports the sequencing of the repetitive element IS1111 of the transposase gene of C. burnetii from blood and bronchoalveolar lavage (BAL) samples from a patient with severe pneumonia following methotrexate therapy, resulting in the molecular diagnosis of Q fever in a patient who had been diagnosed with active seronegative polyarthritis two years earlier. To the best of our knowledge, this represents the first documented case of the isolation of C. burnetii DNA from a BAL sample.

Erros comuns de interpretação de ressonância magnética de joelho: como reconhecê-los e evitá-los

A ressonância magnética tornou-se o método de imagem de escolha para o estudo das articulações, devido a sua grande diferenciação tecidual, resolução de estruturas, imagens em múltiplos planos e estudos dinâmicos (cinemáticos). Talvez a articulação do joelho seja o exame de ressonância magnética mais solicitado na área osteoarticular. O conhecimento detalhado da anatomia, fisiologia e aspecto de imagenologia da região permite uma interpretação adequada dos exames. No entanto, por vezes, estruturas anatômicas que só aparecem esporadicamente, variantes anatômicas e artefatos podem causar erros de interpretação desses exames. O presente artigo tem por finalidade discutir as causas mais freqüentes de erros de interpretação, suas causas e como evitá-los.

Manifestações extrapulmonares da paracoccidioidomicose

Neste trabalho os autores realizam um estudo revisional e iconográfico de pacientes portadores da paracoccidioidomicose disseminada, apresentando os principais achados radiográficos no sistema nervoso central, glândulas adrenais, sistema osteoarticular, ganglionar e trato digestivo destes pacientes. Os métodos de diagnóstico por imagem têm permitido uma abordagem mais precisa destes pacientes e se mostrado cada vez mais sensíveis na detecção de lesões, mesmo em pacientes assintomáticos. Na maioria dos casos essas alterações são inespecíficas, podendo simular tanto lesões neoplásicas como infecciosas crônicas, sendo muitas vezes indistinguíveis da tuberculose. Apesar destas alterações serem incaracterísticas e do diagnóstico de certeza da paracoccidioidomicose só ocorrer após a confirmação micológica ou histológica do fungo, é possivel sugerir um diagnóstico preciso quando os achados de imagem forem analisados em um contexto clínico e epidemiológico pertinente.

Computed tomography findings of paracoccidiodomycosis in musculoskeletal system

Objective: To evaluate musculoskeletal involvement in paracoccidioidomycosis at computed tomography. Materials and Methods: Development of a retrospective study based on a review of radiologic and pathologic reports in the institution database. Patients with histopathologically confirmed musculoskeletal paracoccidioidomycosis and submitted to computed tomography were included in the present study. The imaging findings were consensually described by two radiologists. In order to avoid bias in the analysis, one patient with uncountable bone lesions was excluded from the study. Results: A total of seven patients were included in the present study. A total of 18 bone lesions were counted. The study group consisted of 7 patients. A total number of 18 bone lesions were counted. Osteoarticular lesions were the first manifestation of the disease in four patients (57.14%). Bone lesions were multiple in 42.85% of patients. Appendicular and axial skeleton were affected in 85.71% and 42.85% of cases, respectively. Bone involvement was characterized by well-demarcated osteolytic lesions. Marginal osteosclerosis was identified in 72.22% of the lesions, while lamellar periosteal reaction and soft tissue component were present in 5.55% of them. One patient showed multiple small lesions with bone sequestra. Conclusion: Paracoccidioidomycosis can be included in the differential diagnosis of either single or multiple osteolytic lesions in young patients even in the absence of a previous diagnosis of pulmonary or visceral paracoccidioidomycosis

Description of Lyme disease-like syndrome in Brazil: is it a new tick borne disease or Lyme disease variation?

An emerging clinical entity that reproduces clinical manifestations similar to those observed in Lyme disease (LD) has been recently under discussion in Brazil. Due to etiological and laboratory particularities it is named LD-like syndrome or LD imitator syndrome. The condition is considered to be a zoonosis transmitted by ticks of the genus Amblyomma, possibly caused by interaction of multiple fastidious microorganisms originating a protean clinical picture, including neurological, osteoarticular and erythema migrans-like lesions. When peripheral blood of patients with LD-like syndrome is viewed under a dark-field microscope, mobile uncultivable spirochete-like bacteria are observed. PCR carried out with specific or conservative primers to recognize Borrelia burgdorferi sensu stricto or the genus Borrelia has been negative in ticks and in biological samples. Two different procedures, respectively involving hematoxylin and eosin staining of cerebrospinal fluid and electron microscopy analysis of blood, have revealed spirochetes not belonging to the genera Borrelia, Leptospira or Treponema. Surprisingly, co-infection with microorganisms resembling Mycoplasma and Chlamydia was observed on one occasion by electron microscopy analysis. We discuss here the possible existence of a new tick-borne disease in Brazil imitating LD, except for a higher frequency of recurrence episodes observed along prolonged clinical follow-up.