Auto-induced eosinophilic panniculitis: a diagnostic dilemma

Eosinophilic panniculitis is characterized by a prominent infiltration of subcutaneous fat with eosinophils. The clinical spectrum of lesions that display pathologic changes of eosinophilic panniculitis is diverse, but nodular lesions are the most common. The factitial eosinophilic panniculitis are exceptional, show a pleomorphic pattern of findings and are associated with personality disorders. Its main challenge is to establish the correct diagnostic. We report an unusual case of factitial nodular febrile panniculitis of the left forearm and proximal arm in an 16 year-old girl. She admitted that the lesions were self-inflicted by autoinjection of several farming products as attempted suicide. We describe the clinical, radiological and histopathological features as well as the differential diagnosis of this type of panniculitis.     

Plasma fibronectin concentrations in patients with HIV infection and visceral leishmaniasis

Summary Concentrations of circulating fibronectin were studied in plasma of 22 patients with acquired immunodeficiency syndrome and 24 healthy blood donors. There were significant differences between the plasma fibronectin values of the patient population with AIDS (mean 2 SD=206±86 mg/l) and of the control group (mean±2 SD=297±92 mg/l). AIDS patients with visceral leishmaniasis showed a significant diminution of plasma fibronectin concentration (mean±2 SD=132±31 mg/l). A significant increase in plasma fibronectin concentrations was noted after 14 days of treatment with antimony (mean 2 SD=239±67 mg/l). These results suggest that the measurement of fibronectin concentrations in patients with AIDS especially with concurrent infection, contributes to diagnosis. A significant decrease in plasma fibronectin concentrations was observed in patients with AIDS and visceral leishmaniasis.

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Plasma-Fibronectin-Konzentrationen bei Patienten mit HIV-Infektion und viszeraler Leishmaniasis

Zusammenfassung Die Konzentrationen von zirkulierendem Fibronectin wurden im Plasma von 22 Patienten mit dem erworbenen Immunschwächesyndrom (AIDS) und bei 24 gesunden Blutspendern bestimmt. Zwischen Patienten mit AIDS und der Kontrollgruppe bestanden in den Plasma-Fibronectin-Konzentrationen keine signifikanten Unterschiede (Mittelwert ± 2 SD=206 ± 86 mg/l im Vergleich zu den Kontrollen mit 297 ± 92 mg/l). Bei Patienten mit viszeraler Leishmaniasis waren die Plasma-Fibronectin-Spiegel signifikant vermindert (Mittelwert ± 2 SD 132 ± 31 mg/l). Nach 14tägiger Therapie mit einem Antimonpräparat war ein signifikanter Anstieg der Werte auf im Mittel 239 ± 67 mg/l festzustellen. Daraus läßt sich ableiten, daß die Bestimmung der Fibronectin-Konzentrationen bei Patienten mit AIDS vor allem bei Begleitinfektionen diagnostische Bedeutung hat. Ein signifikanter Abfall der Plasma-Fibronectin-Spiegel läßt sich bei AIDS Patienten mit viszeraler Leishmaniasis beobachten.

     

Endophthalmitis and multiple brain abscess in a patient with endocarditis due to Streptococcus agalactiae

Endogenous endophthalmitis is a rare disease caused by hematogenic germ spread from an internal focus. Infections due to Streptococcus agalactiae are infrequent in adults although new cases had been described recently associated to inmunodepression. We present a patient with endocarditis due to Streptococcus agalactiae, endophthalmitis and multiple brain abscess. We also review the literature.     

Evaluation of the response to pharmacological stress in chronic aortic regurgitation

We evaluated the hemodynamic response of patients with chronic aortic regurgitation and decreased ejection fraction (EF), mean value +/- SD (37 +/- 9), to dobutamine stress echocardiography (DSE). Eleven patients were studied with DSE. Nine patients were in New York Heart Association (NYHA) Class II and two in NYHA Class III. Ten patients received medical treatment in the only other periodic evaluation. With DSE in nine patients, a significant decrease in left ventricular end-diastolic and end-systolic diameters (LVEDD and LVESD) as well as LV end-diastolic and end-systolic volumes (LVEDV and LVESV) was documented in comparison to resting values. EF and fractional shortening (FS) improved significantly with DSE. Systolic wall stress (SWS) and pulmonary arterial systolic pressure (PASP) did not change. Average follow-up was 6.7 months. Three patients underwent valve replacement with mechanical prostheses. Two of them are in NYHA Class I and the other died of LV failure 3 days after surgery. One patient deteriorated beyond surgical treatment and was in NYHA Class II. The other seven patients remain in NYHA Class II and await valve replacement. In patients with chronic aortic regurgitation and depressed EF, the variables relevant to myocardial reserve appear to be EF, FS, LVEDD, LVESD, LVEDV, and LVESV.     

Cushing's syndrome secondary to bronchial carcinoid tumor: contribution of gammagraphy with 111In-DTPA octreotide in the localization diagnosis

Bronchial carcinoid (BC) is a rare etiology of Cushing syndrome, and difficulties in differential diagnosis with Cushing's disease are often present. We report two cases in which octreotide scintigraphy was an important diagnostic tool. The first patient showed a 1 cm non-specific pulmonary nodule on CT scan that was positive on scintigraphy, being confirmed by surgery. The second case was a man that had been operated but not cured of an ACTH secreting BC that continued with high ACTH levels and negative localization imaging studies. A subsequent scintigraphy showed a positive image suggestive of recurrence. Octreotide scintigraphy may be considered in patients with suspicion of ectopic ACTH syndrome although a positive image in CT scan be present.