IntroductionHashimoto's encephalopathy is a neurological disorder of unknown cause associated with thyroid autoimmunity. The disease occurs primarily in the fifth decade of life and may present in two types - a sudden vasculitic type or a progressive subacute type associated to cognitive dysfunction, confusion and memory loss.Case presentationWe report the case of a 62-year-old Hispanic woman, previously healthy, who developed a subacute onset of declining upper brain function. Serologic studies demonstrated high levels of antithyroid antibodies. Electroencephalographic and magnetic resonance image findings were consistent with Hashimoto's encephalopathy.ConclusionHashimoto's encephalopathy is a diagnosis of exclusion. This unusual disorder is often under-recognized because of the multiple and protracted neurocognitive manifestations; therefore, it is important to be aware of the clinical manifestations to make a correct diagnosis.

Introduction: Situs inversus totalis is an uncommon anomaly which exist a complete transposition of organs and it’s occasionally associated with congenital heart diseases, such as tetralogy of fallot. Pheochromocytoma is a rare neuroendocrine tumor with an annual incidence of 2-8 cases per million people and for years has been studied its relationship with the hypoxic pathway. Case Report: A 29 year old male with a history of tetralogy of fallot corrected at 10 years and situs inversus totalis. He was admitted to hospital with a progressive story of four months of constipation, palpitations, headache, dyspnea and sweating. Physical examination revealed a thinned man with peripheral cyanosis, clubbing and signs of decompensated congestive heart failure as hepatomegaly, legs edema, multifocal systodiastolic murmurs, abdominal distension and jugular venous distention. The echocardiogram shows severe right ventricular dysfunction and severe pulmonary hypertension. Furthermore, abdominal computed tomography shows right adrenal mass. Elevated metanephrines and catecholamines confirmed the diagnosis of pheochromocytoma. Surgical removal is decided and preoperative management begins with alpha-adrenergic blockade, however the patient had a hemodynamic decompensation with an unfavorable evolution. Discussion: In conclusion, there are few reports of cyanotic congenital heart disease with pheochromocytoma. Several studies show a significant association between both of them due to chronic hypoxia leads sustained hyperresponsiveness in adrenal medulla and it would cause the tumor. Special preoperative management of pheochromocytoma is recommended when there underlying heart disease and congestive heart failure. We present the first international report of tetralogy of fallot and pheochromocytoma in a patient with situs inversus totalis.

Varón de 73 años, diabético. Acudió con historia de siete días con fiebre, tos, y cansancio al caminar. En el primer día la prueba rápida fue no reactiva. Al cuarto día presentó polipnea y saturación de O 2 en 85%. La Tomografía de tórax mostró: Opacidades en vidrio deslustrado multilobar a predominio periférico en ambos pulmones. No había broncograma aéreo; se concluyó que las lesiones extensas en ambos pulmones eran sugerentes de COVID 19. CO-RADS 5. Recibió ceftriaxona, enoxaparina, dexametasona y oxígeno por máscara de reservorio. Estuvo hospitalizado tres semanas, la evolución fue favorable saliendo de alta. La tomografía está indicada en pacientes con COVID-19 y deterioro clínico y en un medio de recursos limitados, para estratificar pacientes con sospecha de COVID-19 que presenten clínica moderada-severa y alta probabilidad pre-test de tener la enfermedad. No está indicada en pacientes con sospecha de COVID-19 y clínica leve. La TEM de tórax permite distinguir la COVID 19 de la neumonía viral con una precisión de moderada a alta; Sensibilidad 97% y Especificidad 25%; VPP 92% y VPN de 42%.A 73-year-old male diabetic patient was admitted with a seven-day history of fevers, cough and dyspnea on exertion. A rapid test was negative on the first day of admission. On the fourth admission day the patient presented polypnea and oxygen saturation of 85%. The chest CT-scan showed multilobe peripheral ground glass opacities,

Paciente mujer de 55 años de edad, natural de Ayacucho, con antecedente de dermatomiositis desde hace 3 años, recibió tratamiento irregular con prednisona. Dos meses antes del ingreso presenta anemia hemolítica autoinmune y púrpura trombocitopénica idiopática, recibió pulsos de metilprednisolona y transfusión de paquetes globulares. Al ingreso, soporosa, mal estado general, marcada pérdida ponderal, deshidratada, livedo reticularis en miembros inferiores, onicodistrofia y onicolisis múltiple en los dedos de ambos pies. Western Blot positivo para HTLV-1. Evoluciona con hipoglicemia recurrente. Reportamos un caso de dermatomiositis y síndrome de Evans presentados en el contexto de una infección por virus linfotrópico humano tipo 1. Palabras clave: Anemia hemolítica autoinmune; Dermatomiositis; Virus 1 linfotropico T humano (fuente: DeCS-BIREME). DERMATOMIOSITIS AND EVANS SYNDROME ASSOCIATED WITH HTLV-1 INFECTIONA 55-year-old female patient, born in Ayacucho, with a history of dermatomyositis for 3 years, who received irregular treatment with prednisone. Two months prior to admission, she presented with autoinmune hemolytic anemia and idiopathic thrombocytopenic purpura. The patient received methylprednisolone pulse therapy and packed red blood cells transfusions. Upon admission, she was drowsy, with a poor overall status, marked weight loss, dehydration, with presence of livedo reticularis in her lower extremities, and onychodystrophy and onycholysis on the toes of both feet. Western blot test was positive for human T-lymphotropic virus type 1 (HTLV-1). The patient evolved with recurrent hypoglycemia. Therefore, we report a case of dermatomyositis and Evans syndrome in the context of an HTLV-1 infection. Key words: Anemia, hemolytic, autoimmune; Dermatomyositis; Human T-lymphotropic virus 1 (source: MeSH NLM). INTRODUCCIÓNLa infección por el virus linfotrópico humano (HTLV-1) es una enfermedad emergente en Latinoamérica. Es endémica en países como Brasil, Colombia, Perú y afecta principalmente a poblaciones quechuas, afroamericanos y descendientes de japoneses, alcanzando una prevalencia global de 0,5-5%. En el Perú, la prevalencia varía entre 1,3 a 3,8%, considerándose una infección endémica. La transmisión de HTLV-1 ocurre a través de tres vías: sexual, de madre a niño (sobre todo a través de lactancia materna) y por transfusión de sangre (1,2) .Entre las formas clínicas relacionadas a la infección por HTLV-1 existen tres grupos más o menos bien definidos que incluyen en el primer grupo a enfermedades con manifestaciones inflamatorias como el síndrome de Sjögren, tiroiditis, alveolitis, nefritis intersticial, uveítis, polimiositis-dermatomiositis (PM-DM) y la paraparesia espástica tropical. Un segundo grupo contempla neoplasias como la leucemia de células T del adulto y el linfoma cutáneo. En el tercer grupo se consideran a las infecciones como la sarna noruega, la dermatitis infectiva, la onicomicosis múltiple, la tuberculosis, la hiperinfestación por Strongyloides stercolaris, la lepra y la paracoccidiodomicos...