We report the case of a teenager with chronic lymphocytic meningitis for whom Tropheryma whipplei 16S rRNA PCR results were positive in two cerebrospinal fluid samples and one duodenal biopsy specimen. PCR targeting another specific sequence of Tropheryma whipplei and sequencing of the initially amplified 16S rRNA fragment did not confirm the results. CASE REPORTA 13-year-old boy went to the emergency room with a persistent headache which lasted for 2 weeks and nausea, vomiting, and dizziness. His past medical history included Helicobacter pylori infection (which was treated successfully) and unspecific abdominal upper pain lasting for 2 years. Upon examination, the patient was afebrile, and the neurological exam disclosed only bilateral papilledema and meningeal syndrome. Routine laboratory analysis and a computed tomography scan of the brain were normal, so a lumbar puncture was performed. The opening pressure was 390 mm H 2 O with a white blood cell count of 195 cells/ml (98% mononuclear cells), protein level of 93 mg/dl, and glucose level of 55 mg/dl. Samples were sent for Gram and Ziehl-Neelsen staining; viral, bacterial, mycobacterial, and fungal cultures; and PCR testing for herpes simplex virus and enterovirus. All results, as well as those of serologies, were negative for human immunodeficiency virus, cytomegalovirus, Epstein-Barr virus, cysticercosis, toxoplasmosis, Borrelia burgdorferi, Brucella abortus, and Mycoplasma pneumoniae. After 24 hours, the patient remained asymptomatic without specific treatment (just analgesics and antiemetics). Cranial MRI was normal, and rheumatologic testing showed no abnormalities. He was diagnosed with subacute lymphocytic meningitis of unknown origin. Two weeks after being discharged, the headaches and vomiting recurred, so another lumbar puncture was performed, revealing 125 white blood cells/ml (98% mononuclear cells), protein level of 62 mg/dl, and glucose level of 59 mg/dl. The new assessment of cerebrospinal fluid (CSF) samples included cytology, adenosine deaminase activity, cryptococcus antigen, and VDRL and serology tests for human immunodeficiency virus, cytomegalovirus, Epstein-Barr virus, cysticercosis, and toxoplasmosis. These tests were negative once again.Even though the suspicion for Whipple's disease was very low, PCR for Tropheryma whipplei was performed with the two CSF samples. The amplification by PCR was performed in a LightCycler thermocycler (Roche), using the primers Whip1 (5Ј-AGAGATACGCCCCCCGCAA-3Ј) and Whip2 (5Ј-ATT CGCTCCACCTTGCGA-3Ј), which targeted a 266-bp sequence of the 16S rRNA gene (11). The PCR was performed using the following protocol: initial denaturation at 95°C for 10 min, followed by 40 cycles of denaturation at 95°C for 5 s, annealing at 62°C for 7 s, extension at 72°C for 10 s, and a melting curve. The PCR of the CSF samples yielded an apparently positive result, based on the amplification and melting curve and the agarose gel electrophoresis of the PCR product, in the two CSF samples. In order to confirm the Whipple's disea...

Intradural lipomas behave similarly to any other spinal cord tumor. They are very rare, accounting for less than 1% of all spinal cord tumors, and mainly affect pediatric and occasionally young adult patients. Back pain, weakness (paraparesis or quadriparesis), sensory alterations, and incontinence are the most common manifestations. We present the case of a 47-year-old patient who attended our department due to a 3-year history of nontraumatic limping secondary to a cervical intradural extramedullary lipoma. The lipoma was partially resected and symptoms progressed satisfactorily.

Avaliação dos fatores preditivos de invasão neoplásica do complexo areolomamilar em pacientes com câncer de mama Evaluation of the predictive factors involved in the neoplastic invasion of the nipple-areolar complex in patients with breast cancer