Donde caben tres, caben cuatro: abordaje diagnóstico-terapéutico de complicaciones agudas en el paciente pluripatológico complejo

We present a multi-pathological 81-year-old man diagnosed with chronic ischemic cardiomyopathy, chronic heart failure, atrial fibrillation, chronic obstructive pulmonary disease, chronic anemia, arterial hypertension and diabetes. He came with asthenia and increased breathlessness and we realize a new anemization. During his stay in hospital we get unexpected findings.Se presenta el caso de un hombre con pluripatología de 81 años, diagnosticado de cardiopatía isquémica crónica, insuficiencia cardíaca, fibrilación auricular, enfermedad pulmonar obstructiva crónica, anemia crónica, hipertensión arterial y diabetes, que acudió a la consulta por astenia y aumento de disnea, y en el que se descubrió una anemización aguda. Por este motivo, ingresó para estudio, con nuevos hallazgos inesperados

Debilidad muscular y polifarmacia

A case report of a pluripatological 71-years-old man is presented. The patient had muscle weakness and muscle enzymes elevation (liver cytolysis, aldolase, LDH and CK), that was compatible with a proximal myopathy of subacute onset. We carried out differential diagnosis based on clinical findings, laboratory tests, presence of autoantibodies, electromyography and imaging tests. He was diagnosed of statin-associated autoimmune myopathy.Se presenta el caso de un hombre de 71 años, pluripatológico complejo, que consultaba por debilidad proximal de cintura escapular y pelviana junto con elevación de enzimas musculares, siendo compatible con una miopatía proximal de inicio subagudo. Tras realizar un amplio diagnóstico diferencial, basado en hallazgos clínicos, pruebas de laboratorio, presencia de autoanticuerpos, electromiografía y pruebas de imagen, se diagnosticó de miopatía autoinmune asociada a estatinas.

Detrás de la astenia

A 67-year-old woman diagnosed with heart failure, atrial fibrillation and mitral prosthetic carrier who attends consultations by dyspnea, anemia and constitutional table that after clinical worsening requires admission Internal Medicine plant to complete study and treatment. A comprehensive study is carried out with differential diagnosis of the multiple causes of constitutional syndrome, without great results until the realization of the ETE where a specific finding is revealed that after the proper treatment the clinical picture was resolved as well as a clinical improvement in the patient.Mujer de 67 años pluripatológica, diagnosticada de insuficiencia cardíaca, fibrilación auricular y portadora de prótesis mitral que acudió a Consultas Externas por cuadro de disnea, anemia y síndrome constitucional que, tras empeoramiento clínico, requirió ingreso en planta de Medicina Interna para completar estudio y tratamiento. Se realizó un estudio amplio, con diagnóstico diferencial de las múltiples causas de síndrome constitucional, sin grandes resultados hasta la realización de la ecocardiografía transesofágica, en la que se evidenció un hallazgo específico que, tras el tratamiento adecuado, permitió la resolución del cuadro clínico así como una gran mejoría clínica en la paciente

Current clinical spectrum of common variable immunodeficiency in Spain: The multicentric nationwide GTEM-SEMI-CVID registry

Common variable immunodeficiency (CVID) constitutes a heterogenic group of primary immunodeficiency disorders with a wide-ranging clinical spectrum. CVID-associated non-infectious morbidity constitutes a major challenge requiring a full understanding of its pathophysiology and its clinical importance and global variability, especially considering the broad clinical, genetic, and regional heterogeneity of CVID disorders. This work aimed to develop a nationwide, multicenter, retrospective study over a 3-year period describing epidemiological, clinical, laboratory, therapeutic, and prognostic features of 250 CVID patients in Spain. The mean diagnostic delay was around 10 years and most patients initially presented with infectious complications followed by non-infectious immune disorders. However, infectious diseases were not the main cause of morbimortality. Non-infectious lung disease was extraordinarily frequent in our registry affecting approximately 60% of the patients. More than one-third of the patients in our cohort showed lymphadenopathies and splenomegaly in their follow-up, and more than 33% presented immune cytopenias, especially Evans' syndrome. Gastrointestinal disease was observed in more than 40% of the patients. Among biopsied organs in our cohort, benign lymphoproliferation was the principal histopathological alteration. Reaching 15.26%, the global prevalence of cancer in our registry was one of the highest reported to date, with non-Hodgkin B lymphoma being the most frequent. These data emphasize the importance of basic and translational research delving into the pathophysiological pathways involved in immune dysregulation and diffuse lymphocytic infiltration. This would reveal new tailored strategies to reduce immune complications, and the associated healthcare burden, and ensure a better quality of life for CVID patients

Paniculitis mesentérica asociada al uso de bifosfonatos: ¿son estos más proinflamatorios de lo que sabemos?

La paniculitis mesentérica se caracterizada por una inflamación crónica inespecífica del tejido adiposo del mesenterio intestinal, y su etiología es desconocida. Se ha relacionado con malignidad, vasculitis, enfermedades reumáticas y con determinados fármacos. Presentamos un caso de paniculitis mesentérica asociada a la toma de bifosfonatos, no descrita previamente en la literatura, apoyando así el concepto de sus potenciales efectos secundarios proinflamatorios.Mesenteric panniculitis is characterized by chronic inflammation of the adipose tissue of the intestinal mesentery, and its etiology is unknown. It has been associated with malignancy, vasculitis, rheumatic diseases and the use of certain drugs. We present a case of panniculitis associated with bisphosphonate use, not previously described in the literature, thus suggesting its potential secondary proinflammatory effect