Search

Pericarditis is usually a complication of viral or bacterial infection. In addition, it can be associated to systemic diseases such as autoimmune disorders, rheumatic fever, cancer, tuberculosis and AIDS. It can also be related to familial Mediterranean fever, an autosomic recessive inflammatory disease, characterized by fever, abdominal pain, and pleuritis mainly seen in persons from the Mediterranean area. In this study, we described the evolution and treatment response to colchicine in three patients with pericarditis associated to familial Mediterranean fever. Two of the patients had a pericardiectomy showing in their biopsy nonspecified inflammatory changes. Later their diagnosis were confirmed by genetic markers, echocardiogram and EKG. They were treated with antiviral and antibiotics without any improvement; subsequently they had good results with colchicine.

Hepatic dysfunction caused by malignancy is uncommon and can be the result of primary hepatocellular carcinoma, liver metastasis, secondary malignancies, or a complication of chemotherapeutic agents. Hematological malignancies, as leukemia, non-Hodgkin lymphoma, and Hodgkin lymphoma, typically do not result in hepatic dysfunction and rarely manifest as fulminant liver failure.A 43 year-old male was referred with 2-week diarrhea, nausea and vague abdominal discomfort. He was treated with oral antibiotics. However, symptoms progressed and he was admitted with advanced liver failure. On admission the patient was jaundiced, agitated, with tachycardia and hypotension. There were echymosis around the eyes and chest, active bleeding at sites of vein punctures and macroscopic hematuria. The abdomen was tender with an enlarged liver. Admission laboratory findings were consistent with acute hepato-renal failure. Viral hepatitis serology was negative, antinuclear antibody screen was negative, and iron panel was normal. Abdominal ultrasound showed liver and spleen enlargement. He developed refrac- tory hypoglycemia, further increase in serum lactate and died 5 days after admission.Acute liver failure is uncommon as the presenting feature of lymphoma. This fact may delay diagnosis, contributing to the reported poor prognosis. Establishing a diagnosis of malignancy as the cause of acute liver failure is difficult and requires a high index of suspicion. Given the poor prognosis associated with late or missed diagnosis and the potential benefits of early chemotherapy, lymphoma should be considered in any patient presenting with acute liver failure without an obvious etiology and associated with lactic acidosis and hepatomegaly.

Familial Mediterranean fever (MFF) is an autosomic recessive, inherited inflammatory disease principally seen in persons from the Mediterranean area. Clinical findings include fever, abdominal pain, and pleuritis. The most severe complication of MFF is renal amyloidosis, manifested as nephrotic syndrome, which evolves into chronic renal failure. In this study, we described clinical findings, evolution, and response to treatment in 52 patients diagnosed with MFF living in Mexico City in whom the most important clinical features were fever and abdominal pain. Differing from previous reported series of patients from the Mediterranean area, patient developed renal amyloidosis during the 20-year follow-up, which suggests that an environmental factor might have a significant influence in development of renal amyloidosis.

Background The use of protease inhibitors has revolutionized the treatment of HIV infection. These agents are well tolerated, although the Federal Drug Administration (FDA) has warned U.S. doctors that protease inhibitors may precipitate hyperglycemia and diabetes (DM), based on isolated reports from physicians. Methods Sixty-one patients with HIV infection with criterion of non-DM from the onset of the protease inhibitor therapy participated in the study. Plasma glucose levels were obtained every month during a 6-month period, with a basal determination prior to protease inhibitor therapy. Results All Mexican patients enrolled in this study had the same Hispanic-American ethnic origin. Four patients (6.55%) developed hyperglycemia related with saquinavir. One had family history of DM type II. These patients were controlled with diet. Conclusions Based on present data, we believe the benefits of these drugs to patients suffering from HIV infection outweigh the various risks of taking protease inhibitors. However, physicians who use these drugs have to be on the alert for hyperglycemia in the Mexican population, while patients should know the warning symptoms of hyperglycemia and diabetes.

Pyoderma gangrenosum is a rare cutaneous disorder frequently associated with systemic diseases. The authors report the case of a 28-year-old man with pyoderma gangrenosum and inferior cava vein syndrome due to thrombosis. The search for pyoderma gangrenosum-associated conditions (gastrointestinal, rheumatic, neoplasic, and infec tious diseases) was negative. A prolonged partial thromboplastin time and a positive test for circulating anticardiolipin antibodies strongly suggested the diagnosis of the antiphos pholipid syndrome. There are reports of at least three other cases of pyoderma gangrenosum associated with the antiphospholipid syndrome. This clinical case adds further evidence to the possible link between these disorders and warrants a search for anticardiolipin antibodies in patients with pyoderma gangrenosum.

Multiple and varied mechanisms have been proposed to underlie the difference in occurrence of amyloid nephropathy in patients with familial mediterranean fever (FMF). However, the precise mechanism(s) has, thus far, remained enigmatic.1 We have recently reviewed the 10-year follow-up of a group of 51 patients with FMF living in Mexico City. Thirty-five patients were male and 16 were female; thirty-eight patients had been born in Mexico City and the rest in Syria; the median age of the group was 39 years (range, 4 to 77 years); the median age at onset of symptoms was 17.54±12.54 years. The most frequent complaint was abdominal involvement (n=51), followed by fever (n=50), pleuritis (n=11), and arthritis (n=9). Abdominal involvement had been so severe that it led to surgical intervention in 46 of our patients. Urinalysis, done every 3 months in all but three patients, did not reveal protein urinary excretion during the 10-year