Background Hemophagocytic Lymphohistiocytosis (HLH) is a severe and acute inflammatory syndrome, underdiagnosed, difficult to treat and can occur at any stage of life. The macrophage activation syndrome is a variant of secondary HLH occurs in autoimmune diseases.1 Objectives Describe the clinical, laboratory, treatment and outcome of patients diagnosed with secondary HLH, identifying probable etiological and triggers causes. Methods A retrospective study was performed between 2008 and 2012 at the Donostia University Hospital, Spain. Inclusion criteria were to met diagnostic criteria for HLH and had a bone marrow biopsy with hemophagocytics cells. Mains endpoints were: demographics, diagnostic criteria, probable etiology, triggers causes and treatments. Secondary endpoints were: time delay in diagnosis, days of hospitalization, need for admission to the Intensive Care Unit (I.C.U.) and the cause, and overall mortality. Results We recruited 11 patients (7 men and 4 women) with a mean age of 48.9 years (16 - 78 years). The below table describes the probable etiologies and triggers of secondary HLH. As no data in the literature described, we found as etiologies and triggers causes of secondary HLH: Campylobacter jejuni in a previously healthy patient without comorbidities; Pneumocystis jirovecii in a patient with Human immunodeficiency virus (H.I.V.); and patient with grade IV glioblastoma multiforme after starting chemotherapy with temozolomide. Hemophagocytics cells were found in ascitic fluid in one patient with Adult Still´s Disease. The mean delay in diagnosis was 14.5 days (3 – 31 days) and average time of hospitalization was 46.7 days (10 – 130 days). The 45% of patient required admission in I.C.U, the leading cause was the multiple organ failure (MOF). The overall mortality rate was 36.4% (4 MOF and 1 massive hemoptysis). Treatment given was steroids, synthetic immunosuppressants and biological drugs. Conclusions The secondary HLH should be suspected in any patient with prolonged fever unresponsive to broad-spectrum antibiotics, hepatosplenomegaly, cytopenias, coagulation and liver disorders. Hemophagocytics cells might be found in pathological body fluids before a bone marrow biopsy had been done or when there are doubts in the result of it. Meet all the diagnostic criteria is not necessary to start treatment when you have a high clinical suspicion and a bone marrow biopsy with hemophagocytics cells. Mortality can be influenced by etiology, trigger cause, and diagnosis and treatment delay. References Henter JI, et al. HLH-2004: Diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis. Pediatr Blood Cancer 2007; 48:124. Disclosure of Interest None Declared

BackgroundOverall, bacteria are the most common cause of infectious arthritis. Its incidence appears to be increasing in developed countries with an annual incidence of 2-6 cases/100,000 inhabitants. It is more prevalent in extreme ages, and in patients with comorbidities. The 40% of patients with septic arthritis have a prior arthropathy. The most common causative microorganism is Staphylococcus aureus, followed by Streptococcus group, of which the Streptococcus pyogenes is the most involved. In 75% of cases the infection is acquired through the blood and in 80% of cases affects a single joint. The knee is the most affected joint. The diagnosis is confirmed by isolating the organism in synovial fluid and due to its high morbidity and mortality treatment with intravenous antibiotics should be started promptly.ObjectivesTo describe the demographic, clinical and laboratory features of patients with septic arthritis, with microorganism identified in synovial fluid and/or blood cultures between January 1985 and December 2014 at the University Hospital of Donostia (Guipuzcoa, Spain).MethodsRetrospective research of clinical data of patients diagnosed with septic arthritis between January 1985 and December 2014. Patients without microorganism identified in synovial fluid and/or blood cultures were excluded. Variables included were: age, sex, potential risk factors for infection, previous joint aspiration, history of arthropathy, clinical features, identified microorganism, affected joint, laboratory and imaging tests and the presence of osteomyelitis.ResultsA total of 259 patients were enrolled with a diagnosis of septic arthritis and microorganism identified well in synovial fluid and/or blood. The 67.20% of the patients were male and the median age was 61 (IQR=31). Risk factors were identified in 72.7% of patients. The 39.92% of patients had previous arthropathy and 12.86% had history of previous arthrocentesis.The most common causative agent was Staphylococcus Aureus in 62.89% of cases, followed in frequency by Streptococcus group (21.88%) and Escherichia coli (5.47%). In 76.11% of cases the diagnosis was made by isolation of germ in synovial fluid and in 19.03% of cases with isolation in synovial fluid and blood cultures. The knee joint was affected in 51.02% of cases.Pain and swelling were present in most patients, 98.78% and 91.46% respectively. The 64.61% had fever. Osteomyelitis was present in 9.96% of patients. Conservative treatment was the most used (76.86%) and 23.14% required surgery at some point.ConclusionsThe most common causative agent was S. aureus.Almost half of the patients had previous arthropathyA small percentage of patients had osteomyelitis.Disclosure of InterestNone declared

BackgroundAccording to prospectus, cautious evaluation concerning potential risk of developing demyelinating diseases in patients treated with anti-TNF drugs should be considered before initiating therapy. There are several case reports of neurological complications in patients treated with anti-TNF drugs. The annual rate of this complications according with the Spanish Registry BIOBADASER in 2011, was 0.65/1000 patient-years (IC95 0.36-1.1) [1]. Until now, there is no cause-effect relationship known.ObjectivesTo describe the demographic characteristics, underlying disease and anti-TNF drug used in patients who developed neurological complications in the period 2000 – 2014 in the Rheumatology Department of the Donostia University Hospital, Spain.MethodsWe retrospectively identified patients who were administered anti-TNF drugs and subsequently developed neurological deficits. The analyzed variables were sex, age, underlying disease, anti-TNF drug, cumulative dose, complications, treatment and clinical outcome. The prevalence of these complications was measured.ResultsWe registered 388 patients treated with Infliximab (IFX), 39 with Adalimumab (ADA), 351 with Golimumab (GLM), 33 with Certolizumab (CZP) and 375 with Etanercept (ETN). A total of 7 cases (5 women and 2 men) were found with a median age of 48 years old, of whom 4 were diagnosed of rheumatoid arthritis (RA), 3 of spondyloarthritis (SA) and 1 of uveitis of unknown etiology. The anti-TNF drug found to be more associated with neurological complications was Infliximab (5 cases). The neurological complications included: posterior demyelinating optic neuritis (PDON), demyelinating motor polyneuropathy (DMPN) and “Stiff-man Syndrome” (SMS) with positive anti-glutamic acid decarboxylase (GAD) antibodies. The analized variables are shown in the table. The registered prevalence in our study was 0.6%.Table 1Case 1Case 2Case 3Case 4Case 5Case 6Case 7SexFFFMMFFAge (years)42783458483057Underlying diseaseRARARASASAUveitisRAAnti-TNF drugIFXIFXIFXIFXGLMADAIFXCumulative dose (mg)42003360630842050604017810Neurological complicationDMPNUnilateral PDONDMPN anti-GADSMS anti-GADBilateral PDONBilateral PDONUnilateral PDONDiscontinue anti-TNFYesYesYesYesYesYesYesAdditional treatmentIVIGGCIVIG + GCBotulinum toxinNoneNoneNoneOutcomeRecoveredRecoveredRecoveredPartially recoveredFollow upRecoveredRecoveredF: female; M: male; IVIg: intravenous immunoglobulin; GC: glucocorticoids.ConclusionsAll neurological complications developed after the use of monoclonal antibodies, being IFX responsible for 71% of cases. The cumulative drug dosage with IFX was very variable amongst patients, therefore complications do not seem to be directly related to the dose.ReferencesC. Rodríguez Lozano. Seguridad de las terapias biolόgicas: nuevos datos de BIOBADASER. Reumatol Clin. 2011;6(S3):S1–S6.Disclosure of InterestNone declared

Body contouring surgery is worldwide accepted as one of the most successful esthetic surgeries. Lipectomy, liposuction, and buttock fat infiltration are among the most frequent procedures realized, but also, they are not free of complications as any other surgery. A strategy to overcome these complications is to provide the patient with a good perioperative care, to improve every aspect of recovery. The areas to be improved are nutrition, immunology, pain and inflammation, hemodynamics, early mobilization, patient education and communication, and leadership to evaluate if it is correctly been done. The implementation of these fast recovery strategies is the best approach for our patients, with cost-efficiency optimization, a better experience, and a high overall satisfaction during the whole process. It constitutes a paradigm shift from the traditional steps around the well-being of the patient. If all the areas are covered and improved, the patient should have a fast recovery and a good experience of the surgery.