Introducción: los anti-TNF-α se asocian con mayor riesgo de desarrollar tuberculosis (TB). La prueba del derivado proteico purificado (purified protein derivative, PPD) se emplea para diagnosticar infección de tuberculosis latente (ITL). Se recomienda el cribado para TB previo al inicio de terapia anti-TNF-α y el seguimiento para evaluar la posible conversión de la PPD durante el tratamiento. El tratamiento de la ITL puede reducir el riesgo de desarrollar enfermedad activa en un 90%. Objetivos: actualmente los resultados de conversión de la PPD y su interpretación durante el tratamiento anti-TNF-α son variables, por tal motivo nos propusimos conocer la frecuencia de conversión de la PPD en este grupo de pacientes de nuestro medio.

El síndrome de Hughes Stovin es una vasculitis de pequeños y grandes vasos, más frecuente en hombres jóvenes. Se manifiesta con trombosis y aneurismas. Inicia con tromboflebitis que evoluciona a aneurismas con eventual desenlace fatal por ruptura de los mismos. Algunos autores consideran el síndrome de Hughes Stovin como una variante de la enfermedad de Behçet. El diagnóstico es clínico y el tratamiento de primera línea son los corticoides y la ciclofosfamida. Frente a un caso de trombosis, la anticoagulación es controversial por el riesgo de sangrado. Presentamos el caso de un varón joven con cuadro clínico compatible en el cual se descartaron otras patologías con requerimiento de tratamiento quirúrgico por mala evolución clínica.

A 25-year-old woman with a recent diagnosis of systemic lupus erythematosus and grade II lupus nephritis presented with a 14day evolution condition characterized by severe, colicky type, abdominal pain with a predominance on upper hemiabdomen, without irradiation, with partial response to non-steroid anti-inflammatory drugs, associated with nausea and two episodes of self-limiting diarrhea (hypocholia). She also referred polyarthralgia predominantly in the hands, wrists, shoulders, and knees, disabling for daily activities, associated with weight loss of 10 kilos, photosensitivity and alopecia. Physical examination revealed normotension, heart rate 90 bpm, afebrile, no lymph nodes, alopecia, malar rash, no presence of mucosal ulcers or synovitis; generalized mucosal cutaneous jaundice. The abdomen was soft, depressible and painless, with positive airfluid sounds without visceromegaly.

BackgroundSystemic lupus erythematosus (SLE) is a chronic and complex inflammatory disease which predominantly affects young females during reproductive ages. Its prognosis is worse in males, young people, Afro-American and Latin patients. Clinical and immunological features had been described around the world but few reports had been done in Argentinian patients.ObjectivesThe purpose of this study was to describe the clinical and immunological pattern in SLE patients, characteristics of lupus nephritis (LN), disease male’s course of SLE, treatments and causes of hospitalization.MethodsRetrospective study including patients (>18 years) followed in Rheumatology Department, which had unless two visits in the last year before data collection, its clinical reports were complete, and fulfilled SLICC or EULAR/ACR SLE criteria. We recorded data from the medical reports.ResultsOf the 70 patients, 63 were female (90%). The mean age at diagnosis was 27,86 ± 9,4 years. The most frequent manifestations were arthritis (75,7%), malar rash (65,7%), photosensitivity (31,4%), leukopenia (31,4%), alopecia (31,4%), Raynaud’s phenomenon (24,3%) and nasal and oral ulcerations (21,4%).94,3% of patients were positive for antinuclear antibodies, 45,7% had anti-Ro/SSa, 28,6% anti-RNP and 21% anti-Smith. 75% had low complement and 45,7% anti-DNA antibodies.LN occurred in the 50% of patients, and class IV was the most prevalent in this group. 66% of patients developed LN in the first year of SLE diagnosis. Autoantibodies in this manifestation were: anti-DNA 60%, anti-Ro/SSa 37%, 31% anti-RNP and 26% anti-Smith.The most common comorbidity was high blood pressure followed by hypothyroidism (34,3% and 25,7% respectively). All patients received hydroxychloroquine and 62,9% prednisone; half of the patients who were into prednisone treatment received 5mg or less. Other treatments were cyclophosphamide (42,9%), mycophenolate (28,6%) and methotrexate (15,7%). 60% of patients had been hospitalized because of SLE flares and 15,7% due to infections. 75% of flares were due to LN and 8% because of serositis.Is known that SLE in male patients is more aggressive and with poor prognosis. Although this study had only 7 men, 86% had LN, 29% had pericardial and pleural effusion and 29% thrombocytopenia, were we found several differences in female’s SLE presentation.ConclusionThis study shown similar results reported in other populations. We found that 50% of SLE patients developed LN, which is the most important cause of hospitalization. Although cutaneous and musculoskeletal manifestations were the most frequent, it’s important to take into account the clinical and prognostic differences between male and female.References[1]Pons Estel B et al. The GLADEL, multinational Latin American prospective inception cohort of 1214 patients with systemic lupus erythematosus: ethnic and disease heterogeneity among Hispanics. Medicine 2004;83;1-17[2]Alarcón GS, Friedman AW, Straaton KV, et al. Systemic lupus erythematosus in three ethnic groups: III. A comparison of characteristics early in the natural history of the LUMINA cohort. LUpus in MInority populations: NAture vs. Nurture. Lupus 1999;8:197–209[3]Aringer M et al. 2019 European League Against Rheumatism/American College of Rheumatology Classification Criteria for Systemic Lupus Erythematosus. Arthritis & Rheumatology. 2019;71;1400-1412[4]Cervera R et al. Morbidity and mortality in systemic lupus erythematosus during a 10-year period. Medicine 2003; 82: 299-308Disclosure of InterestsNone declared