Quetiapine is an atypical antipsychotic, derived from dibenzothiazepine, widely used for its improved safety profile, particularly in patients with Parkinson's disease. Despite its favorable profile, there have been isolated reports of myoclonus induced by this drug, even at low doses. We present the case of a 71-year-old patient with Parkinson's disease who developed myoclonus after administration of quetiapine at subtherapeutic levels (12.5 mg). The myoclonus completely resolved after discontinuation of the drug and the introduction of clonazepam, highlighting the importance of recognizing this rare adverse effect.
{"title":"Reporte de caso: mioclonias inducidas por quetiapina","authors":"Marcos Franchello MD , Ximena Sagues MD , Jerónimo Cossio MD , Griselda Alvarado MD","doi":"10.1016/j.rmclc.2025.03.005","DOIUrl":"10.1016/j.rmclc.2025.03.005","url":null,"abstract":"<div><div>Quetiapine is an atypical antipsychotic, derived from dibenzothiazepine, widely used for its improved safety profile, particularly in patients with Parkinson's disease. Despite its favorable profile, there have been isolated reports of myoclonus induced by this drug, even at low doses. We present the case of a 71-year-old patient with Parkinson's disease who developed myoclonus after administration of quetiapine at subtherapeutic levels (12.5<!--> <!-->mg). The myoclonus completely resolved after discontinuation of the drug and the introduction of clonazepam, highlighting the importance of recognizing this rare adverse effect.</div><div>.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 2","pages":"Pages 84-87"},"PeriodicalIF":0.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143878521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adverse drug reactions (ADR) are unexpected, unpleasant, and comprise a diagnostic challenge for any physician. Some ADRs occur instantly after being exposed to a certain medication, but others, as described in this case, can present weeks after treatment is started. We present a case of severe drug-induced hypersensitivity syndrome after exposure to minocycline prescribed for acne treatment.
{"title":"Drug-induced hypersensitivity syndrome associated with minocycline prescribed for acne treatment. Case report","authors":"Rodolfo Valenzuela MD , Paola Aravena MD , Katerine Garcia MD , Eduardo Cerda MD , Andrés Ferre MD, MSc","doi":"10.1016/j.rmclc.2025.03.003","DOIUrl":"10.1016/j.rmclc.2025.03.003","url":null,"abstract":"<div><div>Adverse drug reactions (ADR) are unexpected, unpleasant, and comprise a diagnostic challenge for any physician. Some ADRs occur instantly after being exposed to a certain medication, but others, as described in this case, can present weeks after treatment is started. We present a case of severe drug-induced hypersensitivity syndrome after exposure to minocycline prescribed for acne treatment.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 2","pages":"Pages 93-97"},"PeriodicalIF":0.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143878523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.rmclc.2025.03.002
Karen Vergara MD
Raynaud's phenomenon (RP) is a vasospastic disorder, often triggered by cold or stress, that causes changes in the color of the fingers due to excessive vasoconstriction. A prevalence ranging from 5% to 14.5% has been described. Between 5% and 10% of patients with RP develop autoimmune diseases, such as systemic sclerosis, systemic lupus erythematosus, or rheumatoid arthritis. Of relevance, approximately 50% of patients with systemic sclerosis and RP experience digital ulcers, which can cause considerable pain and functional impairment.
The clinical cases described in this article correspond to a 33-year-old woman and an 18-year-old man with RP and digital ulcers. The woman showed no improvement despite medical treatment, while the man experienced healing of his lesions.
The pathophysiology of RF involves genetic and environmental factors, and the management of digital ulcers requires a multidisciplinary approach, combining medical care with wound care and the use of vasodilators. Although rare, digital ulcers represent a significant challenge that needs further research and better treatment options.
The aim of this paper is to describe the clinical features, laboratory, complementary studies, treatment and evolution of two patients with digital ulcers.
{"title":"Cuando el fenómeno de Raynaud se acompaña de las temidas úlceras digitales: reporte de dos casos","authors":"Karen Vergara MD","doi":"10.1016/j.rmclc.2025.03.002","DOIUrl":"10.1016/j.rmclc.2025.03.002","url":null,"abstract":"<div><div>Raynaud's phenomenon (RP) is a vasospastic disorder, often triggered by cold or stress, that causes changes in the color of the fingers due to excessive vasoconstriction. A prevalence ranging from 5% to 14.5% has been described. Between 5% and 10% of patients with RP develop autoimmune diseases, such as systemic sclerosis, systemic lupus erythematosus, or rheumatoid arthritis. Of relevance, approximately 50% of patients with systemic sclerosis and RP experience digital ulcers, which can cause considerable pain and functional impairment.</div><div>The clinical cases described in this article correspond to a 33-year-old woman and an 18-year-old man with RP and digital ulcers. The woman showed no improvement despite medical treatment, while the man experienced healing of his lesions.</div><div>The pathophysiology of RF involves genetic and environmental factors, and the management of digital ulcers requires a multidisciplinary approach, combining medical care with wound care and the use of vasodilators. Although rare, digital ulcers represent a significant challenge that needs further research and better treatment options.</div><div>The aim of this paper is to describe the clinical features, laboratory, complementary studies, treatment and evolution of two patients with digital ulcers.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 2","pages":"Pages 88-92"},"PeriodicalIF":0.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143878522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.rmclc.2025.04.001
Amauris Martínez Fernández MD , Stephany García Sánchez MD , Georgeana Chirino Rodríguez MD , Christian Mayorga Hernández MD
Objective
to present the use of tissue expansion technique to correct a scalp defect secondary to the resection of a giant warty congenital melanocytic nevus.
Clinical case
27 year old male patient who presents with a giant warty congenital melanocytic nevus, which occupies the right fronto-pareto-occipital region of the scalp and the upper pole of the ipsilateral auricle.
Discussion
the use of tissue expansion techniques is prioritized when the affected area is very extensive and the reconstructive result, using other surgical techniques, will not be satisfactory for the patient.
Conclusions
tissue expansion is an effective technique to reconstruct large defects of the scalp, preserving its characteristics, leaving scars that can be easily hidden.
{"title":"Técnica de expansión tisular para reconstrucción de cuero cabelludo en nevus melanocítico congénito gigante verrugoso. Reporte de caso","authors":"Amauris Martínez Fernández MD , Stephany García Sánchez MD , Georgeana Chirino Rodríguez MD , Christian Mayorga Hernández MD","doi":"10.1016/j.rmclc.2025.04.001","DOIUrl":"10.1016/j.rmclc.2025.04.001","url":null,"abstract":"<div><h3>Objective</h3><div>to present the use of tissue expansion technique to correct a scalp defect secondary to the resection of a giant warty congenital melanocytic nevus.</div></div><div><h3>Clinical case</h3><div>27 year old male patient who presents with a giant warty congenital melanocytic nevus, which occupies the right fronto-pareto-occipital region of the scalp and the upper pole of the ipsilateral auricle.</div></div><div><h3>Discussion</h3><div>the use of tissue expansion techniques is prioritized when the affected area is very extensive and the reconstructive result, using other surgical techniques, will not be satisfactory for the patient.</div></div><div><h3>Conclusions</h3><div>tissue expansion is an effective technique to reconstruct large defects of the scalp, preserving its characteristics, leaving scars that can be easily hidden.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 2","pages":"Pages 73-78"},"PeriodicalIF":0.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143878434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Immunotherapy with BCG for non-invasive or superficial bladder cancer is the standard adjuvant treatment following transurethral resection. Despite its effectiveness and safety, approximately 1 to 5% of patients experience local or disseminated (BCGitis) infectious adverse effects. We present the case of an 80-year-old male patient with a history of bladder cancer undergoing intravesical immunotherapy during the induction phase, hospitalized due to a month long history of generalized weakness, acute kidney injury, and a positive urine culture for Escherichia coli ESBL (+). Prior to a new dose of immunotherapy, treatment with imipenem was initiated. Abdomen and pelvic computed tomography (CT) scan revealed a left periprostatic inflammatory collection involving the ipsilateral ureter with proximal hydronephrosis, a finding justified by the patient's medical history. After completing treatment, he experienced a fever peak and an increase in inflammatory parameters. A new CT scan showed growth of the collection. Abscess puncture was performed with an extended study, obtaining positive acid-fast bacillus microscopy and amplification of specific nucleic acids, confirming the diagnosis of urogenital abscess caused by BCG. Therapy with rifampicin, isoniazid and ethambutol was initiated, achieving clinical improvement.
{"title":"BCGitis: Absceso pélvico por Mycobacterium bovis BCG posterior a inmunoterapia en cáncer de vejiga. Reporte de un caso","authors":"Eduardo Cerda MD , Katerine García de Urbina MD , Andrés Ferre MD, MSc , Jorge Dreyse MD , Andrés Giglio MD, MSc , Rodolfo Valenzuela MD","doi":"10.1016/j.rmclc.2025.03.004","DOIUrl":"10.1016/j.rmclc.2025.03.004","url":null,"abstract":"<div><div>Immunotherapy with BCG for non-invasive or superficial bladder cancer is the standard adjuvant treatment following transurethral resection. Despite its effectiveness and safety, approximately 1 to 5% of patients experience local or disseminated (BCGitis) infectious adverse effects. We present the case of an 80-year-old male patient with a history of bladder cancer undergoing intravesical immunotherapy during the induction phase, hospitalized due to a month long history of generalized weakness, acute kidney injury, and a positive urine culture for Escherichia coli ESBL (+). Prior to a new dose of immunotherapy, treatment with imipenem was initiated. Abdomen and pelvic computed tomography (CT) scan revealed a left periprostatic inflammatory collection involving the ipsilateral ureter with proximal hydronephrosis, a finding justified by the patient's medical history. After completing treatment, he experienced a fever peak and an increase in inflammatory parameters. A new CT scan showed growth of the collection. Abscess puncture was performed with an extended study, obtaining positive acid-fast bacillus microscopy and amplification of specific nucleic acids, confirming the diagnosis of urogenital abscess caused by BCG. Therapy with rifampicin, isoniazid and ethambutol was initiated, achieving clinical improvement.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 2","pages":"Pages 98-102"},"PeriodicalIF":0.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143878351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.rmclc.2025.04.003
Antonio Arroyo MD , Anibal Zamorano MD , Diego Silva MD , Tomás Gacitúa MD , Mario Portilla MD , Pablo Salazar MD , Javiera Zamorano
Objective
To describe a case of cardiac arrest (CA) associated with protamine induced vasoplegic syndrome (PIVS), managed with the Cardiac Advanced Life Support (CALS) protocol and extracorporeal life support (ECLS) using extracorporeal membrane oxygenation (ECMO).
Case report
A 51-year-old male patient with multiple valvular diseases underwent mitral valve replacement and tricuspid annuloplasty. In the immediate postoperative period, while still in the operating room, he developed severe protamine-induced hypotension, followed by asystolic CA. He was managed with direct cardiac massage, reconnection to extracorporeal circulation (ECC), and vasopressor infusion, achieving return of spontaneous circulation (ROSC) after 15 minutes. Following the patient's hemodynamic stabilization, sternotomy closure and ECC discontinuation were performed. In the Coronary Intensive Care Unit, he experienced another asystolic CA, unresponsive to advanced resuscitation maneuvers. A re-sternotomy and ECLS with femoral vein-arterial ECMO (FV-FA) were performed, achieving ROSC. During the intervention, a left ventricular wall rupture secondary to direct massage was identified and successfully repaired. The patient remained on ECMO for 12 days and evolved without neurological sequelae.
Discussion
PIVS was the triggering factor, worsened by multifactorial refractory shock. The implementation of ECLS with ECMO and a trained multidisciplinary team was crucial for the patient's survival.
Conclusions
ECLS with ECMO, used within 30 minutes, in conjunction with the CALS protocol, improves survival and prevents neurological sequelae in cases with protamine-induced vasoplegic syndrome.
{"title":"Síndrome vasopléjico inducido por protamina. La importancia del ECLS con ECMO y protocolo CALS en casos complejos","authors":"Antonio Arroyo MD , Anibal Zamorano MD , Diego Silva MD , Tomás Gacitúa MD , Mario Portilla MD , Pablo Salazar MD , Javiera Zamorano","doi":"10.1016/j.rmclc.2025.04.003","DOIUrl":"10.1016/j.rmclc.2025.04.003","url":null,"abstract":"<div><h3>Objective</h3><div>To describe a case of cardiac arrest (CA) associated with protamine induced vasoplegic syndrome (PIVS), managed with the Cardiac Advanced Life Support (CALS) protocol and extracorporeal life support (ECLS) using extracorporeal membrane oxygenation (ECMO).</div></div><div><h3>Case report</h3><div>A 51-year-old male patient with multiple valvular diseases underwent mitral valve replacement and tricuspid annuloplasty. In the immediate postoperative period, while still in the operating room, he developed severe protamine-induced hypotension, followed by asystolic CA. He was managed with direct cardiac massage, reconnection to extracorporeal circulation (ECC), and vasopressor infusion, achieving return of spontaneous circulation (ROSC) after 15<!--> <!-->minutes. Following the patient's hemodynamic stabilization, sternotomy closure and ECC discontinuation were performed. In the Coronary Intensive Care Unit, he experienced another asystolic CA, unresponsive to advanced resuscitation maneuvers. A re-sternotomy and ECLS with femoral vein-arterial ECMO (FV-FA) were performed, achieving ROSC. During the intervention, a left ventricular wall rupture secondary to direct massage was identified and successfully repaired. The patient remained on ECMO for 12 days and evolved without neurological sequelae.</div></div><div><h3>Discussion</h3><div>PIVS was the triggering factor, worsened by multifactorial refractory shock. The implementation of ECLS with ECMO and a trained multidisciplinary team was crucial for the patient's survival.</div></div><div><h3>Conclusions</h3><div>ECLS with ECMO, used within 30<!--> <!-->minutes, in conjunction with the CALS protocol, improves survival and prevents neurological sequelae in cases with protamine-induced vasoplegic syndrome.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 2","pages":"Pages 103-108"},"PeriodicalIF":0.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143878431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Jugando con la balanza: el desafío de las patologías con tratamientos opuestos","authors":"Karen Vergara MD , Andrés Giglio Jimenez MD, MSc, MHA, MPH","doi":"10.1016/j.rmclc.2025.03.001","DOIUrl":"10.1016/j.rmclc.2025.03.001","url":null,"abstract":"","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 2","pages":"Pages 126-127"},"PeriodicalIF":0.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143878436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.rmclc.2025.01.005
Josefa Alfonso MD , Francisco Medina MD , Salvador Madrid MD
Introduction
Light chain amyloidosis (AL) is a rare condition characterized by multisystem involvement. Due to the non-specific nature of its symptoms, there is often a significant delay between the onset of symptoms and a definitive diagnosis. Here, we present the case of a patient with predominant gastrointestinal and cardiac involvement.
Case report
A previously healthy 64-year-old female presented with a six-month history of asthenia, 15 kg weight loss with preserved appetite and chronic diarrhea. Upper endoscopy revealed erosive gastropathy and villous atrophy, later confirmed as systemic amyloidosis by duodenal biopsy with positive Congo Red staining. The patient developed pleuritic pain and pleural effusion, leading to a diagnosis of pneumonia. Cardiac studies revealed amyloid cardiomyopathy. Stage III amyloidosis AL with lambda light chains was diagnosed. During her hospitalization, the patient required a pacemaker due to cardiac rhythm disturbances and began chemotherapy with the CyBorD regimen, with good clinical response. She is currently receiving outpatient treatment, with good tolerance to the second cycle of chemotherapy.
Discussion
In our patient, the diagnosis of amyloidosis AL was primarily based on histological findings in the gastrointestinal tract. Of note was the rapid cardiac involvement, making it challenging to optimize pharmacological treatment. We highlight this case due to the rarity of the disease and the significant therapeutic challenges it presents.
{"title":"Amiloidosis de cadenas ligeras con afectación cardíaca y gastrointestinal en un paciente adulto mayor: reporte de un caso clínico","authors":"Josefa Alfonso MD , Francisco Medina MD , Salvador Madrid MD","doi":"10.1016/j.rmclc.2025.01.005","DOIUrl":"10.1016/j.rmclc.2025.01.005","url":null,"abstract":"<div><h3>Introduction</h3><div>Light chain amyloidosis (AL) is a rare condition characterized by multisystem involvement. Due to the non-specific nature of its symptoms, there is often a significant delay between the onset of symptoms and a definitive diagnosis. Here, we present the case of a patient with predominant gastrointestinal and cardiac involvement.</div></div><div><h3>Case report</h3><div>A previously healthy 64-year-old female presented with a six-month history of asthenia, 15<!--> <!-->kg weight loss with preserved appetite and chronic diarrhea. Upper endoscopy revealed erosive gastropathy and villous atrophy, later confirmed as systemic amyloidosis by duodenal biopsy with positive Congo Red staining. The patient developed pleuritic pain and pleural effusion, leading to a diagnosis of pneumonia. Cardiac studies revealed amyloid cardiomyopathy. Stage III amyloidosis AL with lambda light chains was diagnosed. During her hospitalization, the patient required a pacemaker due to cardiac rhythm disturbances and began chemotherapy with the CyBorD regimen, with good clinical response. She is currently receiving outpatient treatment, with good tolerance to the second cycle of chemotherapy.</div></div><div><h3>Discussion</h3><div>In our patient, the diagnosis of amyloidosis AL was primarily based on histological findings in the gastrointestinal tract. Of note was the rapid cardiac involvement, making it challenging to optimize pharmacological treatment. We highlight this case due to the rarity of the disease and the significant therapeutic challenges it presents.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 1","pages":"Pages 42-46"},"PeriodicalIF":0.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143452774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We present the case of a 76-year-old man, previously healthy, who developed a lymphoproliferative syndrome manifested by plasmacytosis. Due to his medical complications, the patient required respiratory and hemodynamic support. This case prompts us to reflect: what factors can guide the identification of causes of plasmacytosis other than multiple myeloma?
{"title":"¿Será esta plasmocitosis una neoplasia de células plasmáticas? La importancia en la distinciÓn entre una plasmocitosis reactiva y una clonal: reporte de un caso","authors":"Rodrigo Naser MD , Ignacio Domínguez MD , Alejandro Revello MD , Marcelo Abarca MD","doi":"10.1016/j.rmclc.2025.01.006","DOIUrl":"10.1016/j.rmclc.2025.01.006","url":null,"abstract":"<div><div>We present the case of a 76-year-old man, previously healthy, who developed a lymphoproliferative syndrome manifested by plasmacytosis. Due to his medical complications, the patient required respiratory and hemodynamic support. This case prompts us to reflect: what factors can guide the identification of causes of plasmacytosis other than multiple myeloma?</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 1","pages":"Pages 36-41"},"PeriodicalIF":0.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143453134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.rmclc.2025.01.003
Carolina Abreu MD, Marta Ferreira MD, Pedro Moules MD, Carla Noronha MD, Ana Isabel Reis MD
We report the case of a 43-year-old male smoker who presented to the emergency department with skin lesions resembling pyoderma on the lower extremities, punctate and necrotic digital ulcers, fever, malaise, polyarthralgia and elevated inflammatory markers. He later developed bilateral, asymptomatic cavitary pulmonary nodules, diffuse alveolar hemorrhage, pansinusitis, and positive PR3-ANCA, establishing the diagnosis of GPA. An excellent initial response was observed with pulse methylprednisolone, oral prednisolone, intravenous pulse cyclophosphamide, and hyperbaric oxygen therapy (HOT).
Three months later, however, he was diagnosed with a NET of the small intestine. It was polypoid and multifocal, with high catecholamine production but low Ki-67, leading to a reduction in immunosuppressive therapy. Two new flares occurred, with skin, renal, ocular, intestinal, and joint involvement, along with elevated c-ANCA levels, prompting a reinduction strategy with rituximab, plasmapheresis, corticosteroids, and HOT, resulting in significant improvement.
In addition to the complex and challenging clinical management of this case, this unique combination – GPA and NET – is highlighted.
{"title":"Granulomatosis with polyangiitis and neuroendocrine intestinal tumor: a unique and challenging combination in a case report","authors":"Carolina Abreu MD, Marta Ferreira MD, Pedro Moules MD, Carla Noronha MD, Ana Isabel Reis MD","doi":"10.1016/j.rmclc.2025.01.003","DOIUrl":"10.1016/j.rmclc.2025.01.003","url":null,"abstract":"<div><div>We report the case of a 43-year-old male smoker who presented to the emergency department with skin lesions resembling pyoderma on the lower extremities, punctate and necrotic digital ulcers, fever, malaise, polyarthralgia and elevated inflammatory markers. He later developed bilateral, asymptomatic cavitary pulmonary nodules, diffuse alveolar hemorrhage, pansinusitis, and positive PR3-ANCA, establishing the diagnosis of GPA. An excellent initial response was observed with pulse methylprednisolone, oral prednisolone, intravenous pulse cyclophosphamide, and hyperbaric oxygen therapy (HOT).</div><div>Three months later, however, he was diagnosed with a NET of the small intestine. It was polypoid and multifocal, with high catecholamine production but low Ki-67, leading to a reduction in immunosuppressive therapy. Two new flares occurred, with skin, renal, ocular, intestinal, and joint involvement, along with elevated c-ANCA levels, prompting a reinduction strategy with rituximab, plasmapheresis, corticosteroids, and HOT, resulting in significant improvement.</div><div>In addition to the complex and challenging clinical management of this case, this unique combination – GPA and NET – is highlighted.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 1","pages":"Pages 25-30"},"PeriodicalIF":0.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143452709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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