An Med Interna

[Cytomegalovirus acalculous cholecystitis in an AIDS patient]

Year 1998
Salguero Camara ME. de Reyes Lartategui S. Daban Collado E. Ramos Ruiz JL. Elosegui Martinez F.
Servicio de Medicina Interna, Hospital Princesa de Espana, Jaen.
We report a case of acalculous cholecystitis in an AIDS patient, that appeared with insidious onset, abdominal right upper quadrant pain and fever. Cholecystectomy was performed and CMV inclusions were observed in tissue sections. CMV acalculous cholecystitis is an uncommon condition associated to the acquired immunodeficiency syndrome. It should be considered, especially when abdominal pain and fever are present in marked immunosuppressed AIDS patients. Unfortunately, a limited experience in treatment, either medical or surgical, was reported. In our case, the response to surgical procedure was successful, disappearing the abdominal pain and the fever. The patient refused both ganciclovir and foscarnet therapy.

[Serum levels of soluble interleukin-2 receptor in alcoholic patients]

Year 1998
Sopena B. Fernandez-Rodriguez CM. Martinez Vazquez C. Mendez MX. de la Fuente J. Freire M. Arnillas E. Outon A.
Servicio de Medicina Interna, Complejo Hospitalario Xeral-Cies, Vigo, Pontevedra.
OBJECTIVES: Contribution of cellular immunity to the onset and perpetuation of alcohol-induced liver damage remains controversial. The aim of this work was to know whether T-cells participate in the pathogenesis of alcoholic liver injury by measuring the serum levels of sIL-2R in alcoholic patients with different degree of hepatic damage. PATIENTS AND METHODS: Fifty two patients and eighteen healthy subjects (Control group) were included. All patients were active drinkers of at least 100 grams/day of ethanol over a ten-years period. Serum sIL-2R was determined by ELISA. Liver biopsy was performed in all patients and liver function tests, serum immunoglobulins and complement proteins C3 and C4 were measured in all participants. The relationship between the sIL-2R and the severity of liver disease was studied. RESULTS: Circulating sIL-2R was higher in the group of patients than in the control (2.388 +/- 275.7 U/ml vs. 795.7 +/- 48.7 IU/mL; p < 0.001). There were not increased circulating sIL2R in those patients with alcoholic hepatitis. However, patients with cirrhosis showed increased serum sIL-2R regardless of the presence of alcoholic hepatitis. Furthermore, serum levels of sIL-2R inversely correlated with hepatic function test (r = -0.69; p < 0.001 for serum albumin; and r = -0.73; p < 0.001 for the prothrombin time) and were highest in those patients of the Child-Turcotte's class C. CONCLUSIONS: Circulating sIL-2R increases in alcoholic cirrhosis. However, our data do not support a contributory role of the cellular immunity, as assessed by circulating sIL-2R levels to the alcoholic liver damage. The increased serum sIL-2R in cirrhosis may result from defective heptic clearance of this molecule.

[Cyclosporine in inflammatory bowel disease]

Year 1998
Colomina Aviles J. Pascual Perez R. Ortuno Cortes J. Garcia Garcia A. Del Pino Cuadrado J.
Servicio de Medicina Interna, Hospital General de Elda, Alicante.
Inflammatory Bowel Disease (IBD), as Ulcerative Colitis (UC) as well as Crohn's Disease (CD), can appear as severe outbreak resistant to steroid treatment. These cases require surgery or immunosupressive therapy (mercaptopurine or azathioprine). Cyclosporine A (CYA) is a selective, reversible immunosupressor of the T helper lymphocites, used in the treatment of organ transplants and in certain autoimmune diseases. CYA is not a first line therapy for IBD. In spite of the positive results obtained in some uncontrolled studies, only one randomized trial has shown the superiority of CYA over the placebo in the treatment of UC and avoided colectomy in one third of the patients with the severe form of this disease. It can also contribute to the healing of resistault CD fistulaes. The potential toxicity of CYA and the few controlled clinical trials limit its use. However CYA needs to define its role in the treatment of IBD through II more controlled trials.

[Whipples disease: early diagnosis through articular disease and hyperpigmentation]

Year 1998
Gomez de la Torre R. Claros Gonzalez IJ. Lopez Muniz C. Velasco Alvarez A.
Servicio de Medicina Interna, Hospital Narcea, Carmen, Asturias.
We present a new case of Whipple's disease. The patient have a clinical history of steatorrhea and diarrhea of various years of evolution with hyperpigmentation of skin and mucosae and migratory polyarthralgias with inflammatory sings. The biochemicals analysis for rheumatoid and endocrinological diseases were negatives. A endoscopically yeyunal biopsy was performed and the diagnosis of Whipple's disease was made. We comment this clinical presentation of Whipple's disease with a seronegative inflammatory rheumatological disease. The differential diagnosis with seronegative arthritis was emphasized.