Diagnóstico sequencial de duas mal formações arteriovenosas cerebrais

Introdução: As malformações arteriovenosas cerebrais (MAV) são lesões vasculares do sistema vascular cerebral durante o período de embriogênese. Relato de Caso: Trata-se de um paciente do gênero masculino de 19 anos, diagnosticado e tratado da primeira MAV no esplênio do corpo caloso. Após 1 ano e meio, o mesmo paciente foi diagnosticado com uma segunda MAV no joelho do corpo caloso, recebendo o segundo tratamento adequado. Comentários: Embora a angiografia cerebral seja considerada padrão ouro para avaliar a angioarquitetura da MAV, torna-se indispensável o acompanhamento de sua evolução após o tratamento cirúrgico, radiocirúrgico ou por embolização, para um diagnóstico decisivo e expansivo, principalmente, em casos de micromalformações

The importance of histopathology in the diagnosis of isolated renal sarcoidosis: a case report

ABSTRACT Introduction: Sarcoidosis is a systemic inflammatory disease of unknown etiology, characterized by the presence of non-caseating granulomas in several organs; renal impairment alone is a rare condition. When it affects the kidneys, the most prevalent manifestations are hypercalcemia and hypercalciuria. This paper aims to address the topic of renal sarcoidosis, by means of a case report, and reinstate the importance of histopathology in its diagnosis. Methods: The data came from an observational clinical study with a qualitative approach, through an interview with the renal sarcoidosis patient and data from her medical records. Case report: Patient D.M.S., 50 years old, Caucasian, presented with reddish eyes and body pains lasting for fifteen days as first manifestations of the disease. Upon kidney ultrasound scan, we found renal parenchymal nephropathy. Serial renal function and metabolic tests reported anemia and progressive urea and creatinine changes, as well as hypercalcemia and hypercalciuria, confirming acute kidney failure (AKF). A histopathological examination suggested the diagnosis, which was confirmed by clinical, laboratory and histopathological data. There was therapeutic resolution after steroid therapy. Discussion: The symptomatology of sarcoidosis is diverse and often non-specific. Renal manifestation, which usually occurs after organ involvement, is present in less than 5% of patients, and about 1% to 2% of these patients may develop AKF. Conclusions: The use of histopathology together with clinical and laboratory data to diagnose isolated renal sarcoidosis, rule out other etiologies and introduce early treatment is of paramount importance