Percorrer por autor "Costa, MG"
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- Giant Cell Arteritis With Central Nervous System Vasculitis Presenting As Binocular Diplopia and Ptosis due to Third Cranial Nerve PalsyPublication . Casanova Pinto, J; Costa, MG; Fernandes, B; Ramalheira, CWe report the case of a woman in her 60s with no notable comorbidities presented with a four-week history of bilateral temporal headache, scalp tenderness, jaw claudication, and sporadic fever. She also reported binocular diplopia for the previous 24 hours. Examination revealed tender superficial temporal arteries (TA) and right-sided third cranial nerve palsy with ptosis. Laboratory tests showed elevated inflammation markers. Cranial and cervical computed tomography (CT) and CT angiography (CTA) were unremarkable. She was treated with a single dose of intravenous methylprednisolone, followed by oral prednisolone. Subsequent TA duplex ultrasound demonstrated artery wall thickness, and TA biopsy confirmed chronic inflammation with disruption of the internal elastic lamina, both consistent with giant cell arteritis. Cranial magnetic resonance imaging (MRI) revealed scattered punctate areas on T2-weighted fluid-attenuated inversion recovery (FLAIR) sequences, consistent with small-vessel vasculitis. Under corticosteroid treatment, the patient achieved full clinical remission at the four-month follow-up. This case illustrates an uncommon neurological presentation of giant cell arteritis with oculomotor nerve involvement, associated with findings suggestive of central nervous system vasculitis, and highlights the importance of early recognition and prompt corticosteroid treatment to prevent irreversible complications.
- Lupus Enteritis: An Unusual Flare of Systemic Lupus ErythematosusPublication . Casanova Pinto, J; Costa, MG; Fernandes, B; Ramalheira, CA woman in her 20s with previously diagnosed systemic lupus erythematosus (SLE) presented with a year-long history of chronic watery diarrhea, significant weight loss, and additive symmetrical inflammatory polyarthritis. She had been receiving hydroxychloroquine, azathioprine, and low-dose prednisolone but had discontinued treatment shortly before admission due to persistent vomiting. Laboratory evaluation showed new-onset proteinuria, hypokalemia, hypomagnesemia, microcytic anemia, lymphopenia, low complement levels, and markedly elevated antinuclear and anti-double-stranded deoxyribonucleic acid (anti-dsDNA) antibodies. Imaging demonstrated diffuse mural thickening and submucosal edema of the small bowel, a large left pleural effusion, and peritoneal fluid. The patient was treated with intravenous methylprednisolone pulses, followed by high-dose oral prednisolone and hydroxychloroquine. Renal biopsy revealed class III lupus nephritis, leading to the initiation of mycophenolate mofetil (MMF). Under this immunosuppressive regimen, gastrointestinal symptoms resolved, pleural effusion regressed, and renal parameters progressively improved. This case illustrates lupus enteritis as a rare but clinically significant manifestation of SLE, presenting with chronic diarrhea in association with other systemic features, including inflammatory polyarthritis, hematological involvement, and lupus nephritis. This report emphasizes the importance of considering lupus enteritis in patients with SLE who present with persistent gastrointestinal symptoms and of early recognition and prompt initiation of appropriate immunosuppressive therapy to prevent severe complications such as ischemia and perforation.
- Primary Antiphospholipid Syndrome Presenting With Life-Threatening Diffuse Alveolar HemorrhagePublication . Casanova Pinto, J; Costa, MG; Fernandes, B; Ramalheira, CAntiphospholipid syndrome (APS)-associated diffuse alveolar hemorrhage (DAH) results from antiphospholipid-induced endothelial dysfunction, microvascular thrombosis, and complement activation. Management requires balancing thrombosis prevention and hemorrhage control. High-dose corticosteroids are the first-line therapy. We report a case of a 33-year-old male presenting with progressive dyspnea, hemoptysis, and hypoxemia. Initial evaluation revealed thrombocytopenia, anemia, elevated inflammatory markers, and diffuse bilateral ground-glass opacities on a thoracic computed tomography, consistent with DAH. Autoimmune serology confirmed persistent positivity for lupus anticoagulant, anti-cardiolipin IgM, and anti-β2-glycoprotein-I IgM, fulfilling APS classification criteria. The patient developed respiratory failure, requiring mechanical ventilation and venovenous extracorporeal membrane oxygenation (VV-ECMO). High-dose corticosteroids were initiated, leading to gradual improvement. He was successfully extubated and discharged on long-term anticoagulation with warfarin. At four years of follow-up, he remains free of APS-related complications. This case highlights the importance of recognizing APS as a cause of DAH, particularly in patients with unexplained pulmonary hemorrhage. Early diagnosis and aggressive therapy can improve outcomes.