Browsing by Author "Pinheiro, S"
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- Catatonia in Anti-N-Methyl-D-Aspartate (NMDA) Receptor Encephalitis Misdiagnosed as SchizophreniaPublication . Ponte, A; Brito, A; Nóbrega, C; Pinheiro, S; Gama Marques, JAnti-N-Mmethyl-D-aspartate receptor encephalitis is an autoimmune disease of the central nervous system with prominent neurologic and psychiatric features. Symptoms appear progressively and sometimes with an exclusively psychiatric initial presentation. The patient's evaluation should be meticulous, and we should use all the diagnostic tests required for the exclusion of entities that can mimic this disease. We report the diagnostic investigation of a case of anti-N-methyl-D-aspartate receptor encephalitis in a patient with a previous diagnosis of schizophrenia with poor response to antipsychotics. The aim of this case report is to highlight the importance of close surveillance for neuropsychiatric symptoms, especially catatonia, and to recognize autoimmune encephalitis in the differential diagnosis of psychotic disorders with neurological symptoms and resistance or intolerance to antipsychotics. A prompt diagnosis will contribute to a faster onset of therapy and an overall improvement in prognosis.
- Doença de Horton. A Propósito de 40 CasosPublication . Pinheiro, S; Horta, A; Gomes, P; Febra, C; Ricardo, A; Oliveira, S; Goes, MJ; Rolo, J; Serra, MJ; Castro, ASApresentamos uma casuística de 40 casos de Doença de Horton observados no Serviço de Medicina 2 e na Consulta de Doenças Autoimunes do Hospital de Santo António dos Capuchos, entre 1984 e 2002. Pretendemos comentar e destacar os aspectos práticos, clínicos, de diagnóstico e de terapêutica, relacionados com o adequado controle da doença, através da análise comparativa da literatura com os nossos dados.
- Erasmus Syndrome: an Underrecognized EntityPublication . Magalhães, A; Moreira, I; Pinheiro, S; Borba, AWe present a case of a 33-year-old male who worked as a plumber and a locksmith. The patient presented with diffuse myalgia and asthenia, skin sclerosis and puffy fingers, Raynaud's phenomenon, exertional dyspnea and erectile dysfunction. The presence of specific autoantibodies enabled the diagnosis of systemic sclerosis. Chest-computed tomography revealed upper lobe consolidation. After extensive evaluation, the multidisciplinary interstitial lung disease team concluded that the patient also had advanced silicosis. After a year, there was significant clinical, radiologic, and functional deterioration of the lung disease. The patient was referred for lung transplant. Silica inhalation is the cause of silicosis but is also implicated in the development of systemic sclerosis (Erasmus syndrome). Although they share a common risk factor, it is rare to find both diseases co-existing. We present this case of a young patient where both diseases presented aggressively in order to raise awareness to this association.
- FavismoPublication . Oliveira, S; Pinheiro, S; Gomes, P; Bayão Horta, A; Santos Castro, AO favismo é um síndrome hemolítico agudo que ocorre em indivíduos com deficiência de glucose-6-fosfato desidrogenase (G6PD), após o consumo de favas. Os autores apresentam o caso clínico de um doente do sexo masculino, de 16 anos de idade, internado no Serviço 2 de Medicina do Hospital dos Capuchos por um quadro de hemólise aguda, vindo-se a constatar uma diminuição marcada de G6PD, e tendo sido a ingesta de favas o factor desencadeante. A propósito do caso clínico, é feito um estudo da família e uma breve revisão teórica acerca do favismo.
- Fenómeno da Migração nas Doenças InfeciosasPublication . Amaral, M; Ferrão, J; Piteira, MT; Pinheiro, S
- Limbic Encephalitis When the Immune Response Is the Hidden ProblemPublication . Amaral, M; Ferrão, J; Duarte, B; Pinheiro, SLimbic Encephalitis (LE) defined as a rare and frequently underrecognized immunomediated syndrome, presents with a constellation of unspecific behavioral and neuropsychiatric symptoms, developing over weeks to months. Personality disturbance, complex partial mesotemporal seizures and a subacute severe impairment of short-term memory are the cardinal symptoms, reflecting the involvement of the grand lobe limbique. The etiology is still poorly understood. Until recently, paraneoplastic etiology was thought to be the most common cause of LE, often preceding the malignancy identification (60%–75%). In the last decade other associations have been considered, namely infectious or autoimmune diseases. It appears that non-paraneoplastic LE (unassociated with onconeural antibodies) is at least 5 times more frequent than the one where paraneoplastic antibodies are detected, even excluding the cases of paraneoplastic LE that are antibody-negative (40%). To date, co-occurrence of two possible etiologies of this rare syndrome, in the same patient, has never been reported.
- Multimodality Imaging in Connective Tissue Disease-Related Interstitial Lung DiseasePublication . Ruano, C; Grafino, M; Borba, A; Pinheiro, S; Fernandes, O; Silva, S; Bilhim, T; Moraes-Fontes, MF; Irion, KInterstitial lung disease is a well-recognised manifestation and a major cause of morbidity and mortality in patients with connective tissue diseases. Interstitial lung disease may arise in the context of an established connective tissue disease or be the initial manifestation of an otherwise occult autoimmune disorder. Early detection and characterisation are paramount for adequate patient management and require a multidisciplinary approach, in which imaging plays a vital role. Computed tomography is currently the imaging method of choice; however, other imaging techniques have recently been investigated, namely ultrasound, magnetic resonance imaging, and positron-emission tomography, with promising results. The aim of this review is to describe the imaging findings of connective tissue disease-related interstitial lung disease and explain the role of each imaging technique in diagnosis and disease characterisation.
- Ocular Involvement in Systemic Lupus Erythematosus Patients: a Paradigm Shift Based on the Experience of a Tertiary Referral CenterPublication . Dias-Santos, A; Ferreira, J; Pinheiro, S; Cunha, JP; Alves, M; Papoila, AL; Moraes-Fontes, MF; Proença, RObjective: To evaluate ocular involvement in a cohort of systemic lupus erythematosus (SLE) patients of a tertiary referral center and to compare the results with the existing literature. Methods: Patients underwent a complete ophthalmological evaluation, including visual acuity, slit-lamp examination, fluorescein staining, Schirmer-I test, Goldmann applanation tonometry, fundoscopy, 10-2 automated threshold visual fields, fundus autofluorescence and spectral-domain optical coherence tomography to screen for hydroxychloroquine (HCQ) macular toxicity. Results: A total of 161 patients (16 men and 145 women) were enrolled in this study. The mean age was 47.6 years and the mean disease duration was 11.5 years. Fifty patients (31.1%) had at least one ocular manifestation of SLE. The most frequent manifestation was dry eye syndrome (12.4%), immediately followed by cataracts (11.2%) and HCQ macular toxicity (11.2%). Among patients with HCQ maculopathy, two presented with an atypical spectral-domain optical coherence tomography pattern. Five patients (3.1%) presented with glaucoma, two patients (1.2%) presented with SLE retinopathy while only one presented with lupus choroidopathy (0.6%). Conclusions: Compared with previous studies, we conclude there has been a significant reduction in disease-related ocular complications, particularly those associated with poor systemic disease control. On the other hand, drug and age-related complications are assuming a prominent role in the ophthalmic care of these patients.
- Osteomielite Vertebral Tuberculosa. Revisão e Apresentação de um Caso Clínico InvulgarPublication . Pinheiro, S; Oliveira, S; Horta, A; Castro, AA partir de uma invulgar apresentação clínica e radiológica de um caso de tuberculose (TB) vertebral, fazemos uma revisão da literatura sobre infecção tuberculosa da coluna. Destacam-se alguns aspectos epidemiológicos relativamente à infecção por Mycobacterium Tuberculosis em geral e à sua localização vertebral em particular, incluindo-se os dados disponíveis respeitantes ao nosso país. São ainda focados os mecanismos patogénicos da infecção óssea, considerando-se 3 padrões de lesão vertebral cada um com diferentes aspectos radiológicos e diferentes consequências clínicas.
- Recalcitrant Leg Ulcers as the Only Manifestation of Essential Type 2 CryoglobulinemiaPublication . Brasileiro, A; Barreto, P; Salvado, V; Diamantino, F; Pinheiro, SChronic leg ulcers are persistent conditions that might be a diagnostic and therapeutic challenge, with great impact in health care costs and patients’ quality of life. We report a case of a 60-year-old woman, with long-lasting recalcitrant leg ulcers, which led to left leg amputation 10 years ago. Several attempts to heal the right leg were made, including skin grafting in three different occasions and several surgical debridements, all with unsatisfactory outcome. Some months before the ulcers began, the patient had been diagnosed with undifferentiated connective tissue disease because of arthralgia and positive antinuclear antibodies, therefore low dose systemic corticosteroids and azathioprine were prescribed. For the last 4 years she has been followed in our department and since then no evidence of clinical or laboratorial criteria for autoimmune diseases was found, thus the immunosuppressive therapy was stopped. She maintained ever since a high rheumatoid factor but without other evidence of autoimmune disease. Medical history was otherwise irrelevant. Several cutaneous biopsies were performed, with no evidence of malignancy or vasculitis. Recently, cryoglobulins became positive, with type 2b cryoglobulin identification on immunofluorescence. Serology for Hepatitis C virus was consistently negative, hence an Essential type 2 Cryoglobulinemia diagnosis was established. No renal impairment, vascular purpura, arthralgia or arthritis was found. The authors emphasize the importance of considering less common etiologies for chronic leg wounds, even in the absence of other suggestive symptomatology, as well as the pertinence of reconsidering diagnosis in highly suspect cases.