O101 Takayasu's arteritis — case report

Abstracts

I European

Journal

of Internal

Medicine

14 (2003)

S29

Sl-S159

high-risk group. Only 2 and 5 patients were readmitted with re-bleeding in the intermediate and high-risk groups respectively and none in the low risk group (p 0.008). Median hospital stay was 3, 5 and 6 days for low, intermediate and high risk groups respectively with a statistically significant difference between high vs. intermediate and low risk patients (P
weight loss, signs of systemic venous congestion, paradoxical pulse, Kussmaul sign, distant heart sounds and pericardial knock. The electrocardiogram displays low voltage of QRS complex and diffuse repolarization abnormalities. Echocardiographic examination show pericardial thickening confirmed by magnetic resonance imaging, suggesting constrictive pericarditis. The patient underwent a pericardiectomy which temporalily alleviate symptoms of heart failure. The removed pericardium stained positive for acid-fast bacilli. Poor outcome was associated with New York Heart Association functional class before surgery, impairement of hepatic function and incomplete pericardium removal. This case illustrates the importance of early pericardiectomy before end-stage pericardial fibrosis.

099 Role of brain natriuretic peptide in identifying the origin of pulmonary edema in critical patients J. Pimenta, E. Monteiro, C. Sousa-Dias, J.A. Paiva, P. Bettencourt (Porro, P)

0101 Takayasu’s E. Pereira, (Porto, P)

Introduction: It is often difficult to establish the etiology of severe respiratory insufficiency associated to pulmonary edema. Hemodynamic profile obtained by pulmonary catheterization has been considered the ‘gold standard’ in distinguishing pulmonary edema of cardiac origin (with increased left ventricle filling pressures-LVFP) from that resulting of intrinsic pulmonary damage (acute respiratory distress syndrome), with normal LVFP. The role of brain nahiuretic peptide (BNP) as a marker of increased LVFP in chronic conditions is well documented, but its potential value in critical patients with acute respiratory insuficiency and pulmonary edema is still unexplored. Goals: To evaluate the role of BNP in identifying the mechanism of pulmonary edema. Population and methods: We studied 20 patients with respiratory insufficiency and pulmonary edema admitted to an intensive care unit. All were submitted to an evaluation of pulmonary capillary wedge pressure and, in the 3 subsequent hours, a peripheral blood sample was collected for BNP quantification using a rapid point-of-care immunofluorescence assay. Results: The population was 60.62 14.9 years old and 11 patients were females. Ten patients had PCWP>= 18 mm Hg. Mean BNP values were .556-C451 pg/ml (743 in patients with PCWP>=18 mm Hg and 370 in those with PCWP<18 mmHg, p=O.O3). We found a positive correlation between BNP values and PCWP (r=0.56, p=O.Ol). The performance of BNP in identifying patients with PCWP
Case presentations 0100 Constrictive M.J. Marta,

tuberculous A. Oliveira,

pericarditis: case report M. Gato Varela, J.A. Saavedra

(Lisboa,

P)

Constrictive pericarditis is a rare disease characterized by the encasement of the heart by a rigid, noncompliable pericardium, with impaired diastolic filling of the ventricules. Its etiology is often unclear (420/c), probably associated with viral infection and tuberculosis, especially in developing countries. The authors present a case report of a 28.year-old black woman, born and resident in Angola, with history of tuberculosis. Admitted to our hospital for global heart failure, the patient presents with

arteritis P. Dias,

- case report C. Marujo, S. Ferreira,

M. Pizarro,

M.E.

Macedo

Takayasu’s arteritis, is a large vessel vasculitis, predominantly in the aorta and its branches, that affects mainly young women. The clinical course is variable and the diagnosis is usually made by angiography. A 41-year-old woman was admitted after an ischemic stroke, presenting left sided hemiparesis. She suffered, for several years, of visual disturbances, headache, night sweats, myalgias, arthralgias, and Raynaud’s phenomenon. The computed tomography scan and magnetic resonance imaging identified multiple small areas of ischemia, on right frontal, parietal and occipital lobes. The patient had hypertension measured on the left arm and pulselessness of right radial, brachial, carotid and temporal arteries. Laboratory results showed an elevated erythrocyte sedimentation rate and thrombocytosis. Renal function was normal. Auto-immunity tests were negative. The angiography showed oclusion of the proximal segment of the brachiocephalic artery. Right carotid and subclavian arteries were supplied by the circle of Willis. Takayasu’s arteritis was diagnosed. An aorto-subclavian bypass was performed. Corticosteroids and cyclophosphamide were initiated. After one month, she improved of the systemic complaints. Two years after surgery, with corticosteroid therapy, the patient was admitted to the hospital with an acute myocardial infarction with three vessel disease. Two years later, the patient suffered another ischemic stoke. The erythrocyte sedimentation rate maintains elevated. At this time an angiography was repeated showing occlusion of the bypass, the right external carotid, of the right superficial femoral artery and a stenosis at the level of aorto-iliac bifurcation. We report a case of rapidly progressive Takayasu’s Arteritis with an expected bad prognosis.

0102 Pain and erythema in the lower limbs - a clinical G. Rocha. A. Martins, G. Gama, S. Pires, F. Brandao, Lisboa, P)

case J. Atouguia

(Porfo,

The authors describe the clinical case of a 30-year-old Caucasian female, born in Portugal and living in the USA (state of New York) who developed increasing asthenia and pain on the lower limbs, resulting in her admission at an American Hospital, in April 2000. Clinical improvement was obtained under symptomatic treatment, including blood transfusion, and was discharged with a probable diagnosis of mononucleosic syndrome. She arrived in Portugal in July 2000, and because she repeatedly presented the same symptoms, she was admitted in our Hospital. On admission she presented skin lesions in both thighs, which were diagnosed as ‘erythema migrans’. An electromyographic study of the lower limbs showed a severe axonal polineuropathy. Serological tests for B. burgdoferi were positive in 3 laboratories, and were confirmed by Western Blot. A skin biopsy was performed which showed a positive PCR for Borrelia DNA. A diagnosis of Lyme disease was established and