Case Description A 72-year-old woman with primary Sjögren Syndrome (SS) was diagnosed during an inpatient hospital stay with dry symptoms. The patient had respiratory and constitutional symptoms, requiring a pulmonary imaging evaluation by high-resolution computed tomography (HRCT) of the thorax. Clinical Findings Multiple cavitary pulmonary nodules, halo sign, and focal areas of ground-glass opacity with predominance in both bases were found in the images. Complementary studies were done where a neoplastic focus was ruled out. The diagnosis of nodular pulmonary amyloidosis was confirmed with a pulmonary biopsy performed by videothoracoscopy for histopathological study, which reported the formation of nodules in the parenchyma with amyloid deposits and positive immunohistochemical markers for CD3, CD20, and CD38 lymphocytic infiltration. Treatment and Outcome Initial inpatient management with intravenous cyclophosphamide and methylprednisolone was given. Subsequent outpatient management was given with high dose glucocorticoids. Clinical Relevance We presented a case of nodular pulmonary amyloidosis in a female patient with primary SS, which is a rare pulmonary manifestation of this syndrome.

AbstractHigh blood pressure in patients with diabetes mellitus results in a significant increase in the risk of cardiovascular events and mortality. The current evidence regarding the impact of intervention on blood pressure levels (in accordance with a specific threshold) is not particularly robust. Blood pressure control is more difficult to achieve in patients with diabetes than in non-diabetic patients, and requires using combination therapy in most patients. Different management guidelines recommend initiating pharmacological therapy with values >140/90 mm/Hg; however, an optimal cut point for this population has not been established. Based on the available evidence, it appears that blood pressure targets will probably have to be lower than <140/90mmHg, and that values approaching 130/80mmHg should be recommended. Initial treatment of hypertension in diabetes should include drug classes demonstrated to reduce cardiovascular events; i.e., angiotensin converting-enzyme inhibitors, angiotensin receptor blockers, diuretics, or dihydropyridine calcium channel blockers. The start of therapy must be individualized in accordance with the patient's baseline characteristics, and factors such as associated comorbidities, race, and age, inter alia.

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Mujer de 45 años de edad con antecedente de extabaquismo pesado, cursó con cuadro crónico de cefalea en región occipital irradiado a región temporal asociado a disminución de la agudeza visual de ojo izquierdo. El cuadro empeoró en los últimos seis meses y se asoció a polidipsia y poliuria. Presentó cuadro sincopal con amnesia retrógrada, para lo cual se realizó una tomografía axial computarizada (TAC) contrastada de cráneo que mostró múltiples lesiones parenquimatosas cerebrales y del cerebelo compatibles con metástasis. Se hizo estudio hormonal para evaluar la función hipofisiaria evidenciando un panhipopituitarismo secundario. Se detectó foco primario neoplásico mediante TAC contrastada de tórax, evidenciando una lesión espiculada en el lóbulo superior derecho sugestiva de carcinoma broncogénico, posteriormente se tomó biopsia por fibrobroncoscopia el cual confirmó por histopatología e inmunohistoquímica el diagnóstico de un adenocarcinoma broncogénico