Mononeuropatia múltipla periférica confluente associada a hepatite B aguda: relato de caso

A thirty three year-old, male patient was admitted at the Hospital of the São Paulo University School of Medicine, at the city of São Paulo, Brazil, with complaint of pains, tingling and decreased sensibility in the right hand for the last four months. This had progressed to the left hand, left foot and right foot, in addition to a difficulty of flexing and stretching in the left foot. Tests were positive for HBeAg, IgM anti-HBc and HBsAg, thus characterizing the condition of acute hepatitis B. The ALT serum level was 15 times above the upper normal limit. Blood glucose, cerebral spinal fluid, antinuclear antibodies (ANA) and anti-HIV and anti-HCV serum tests were either normal or negative. Electroneuromyography disclosed severe peripheral neuropathy with an axon prevalence and signs of denervation; nerve biopsy disclosed intense vasculitis. The diagnosis of multiple confluent mononeuropathy associated to acute hepatitis B was done. This association is not often reported in international literature and its probable cause is the direct action of the hepatitis B virus on the nerves or a vasculitis of the vasa nervorum brought about by deposits of immune complexes.Um paciente de 33 anos, do sexo masculino, foi internado no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil, queixando-se de dores, formigamento e diminuição da sensibilidade em mão direita há quatro meses, que progrediram para mão esquerda e ambos os pés, com surgimento de dificuldade de flexão e extensão do pé esquerdo. As pesquisas de anti-HBc IgM, HBeAg e HBsAg foram positivas, caracterizando quadro de hepatite B aguda, com ALT atingindo valores quinze vezes acima da normalidade. Os exames de glicemia, FAN, líquor, sorologias anti-HIV e anti-HCV foram normais ou negativos. A eletroneuromiografia mostrou intensa neuropatia periférica de predomínio axonal, com sinais de desnervação; a biópsia de nervo demonstrou intensa vasculite. Foi feito o diagnóstico de mononeuropatia múltipla confluente associada a hepatite B aguda. Esta associação é pouco referida na literatura internacional, e tem como causa provável uma ação direta do vírus da hepatite B sobre os nervos ou uma vasculite da vasa nervorum causada pela deposição de imunocomplexos

Genomic Sequence around Butterfly Wing Development Genes: Annotation and Comparative Analysis

, where a whole-genome BAC library allows targeted access to large genomic regions. genes. Comparative analysis with orthologous regions of the lepidopteran reference genome allowed assessment of conservation of fine-scale synteny (with detection of new inversions and translocations) and of DNA sequence (with detection of high levels of conservation of non-coding regions around some, but not all, developmental genes)., both involved in multiple developmental processes including wing pattern formation