Percorrer por autor "Cruz, D"
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- Limited Antineutrophil Cytoplasmic Antibodies (ANCA)-Negative Granulomatosis With Polyangiitis: Successful Response to RituximabPublication . Andrade, MM; Fernandes, M; Freire, S; Cruz, DGranulomatosis with polyangiitis (GPA), a systemic vasculitis, is commonly characterized by the presence of antineutrophil cytoplasmic antibodies (ANCA). However, a subset of patients with limited disease may exhibit ANCA negativity. In this article, we report the case of a 40-year-old female diagnosed with GPA with intolerance to methotrexate titration and glucocorticoid therapy, leading to the initiation of rituximab treatment. Subsequently, the patient exhibited sustained clinical, laboratory, and radiological improvement. The identification of limited GPA has important therapeutic implications as the effectiveness of the medical treatment in ANCA-negative GPA may differ. Rituximab has emerged as an optimal treatment, irrespective of ANCA status, offering prolonged responses and a favorable tolerance profile in these patients.
- Pregnancy in Patients With McArdle's DiseasePublication . Rodrigues Dos Santos, J; Távora, C; Nogueira da Fonseca, I; Cruz, DThe influence of hereditary disorders of metabolism in pregnancy can be unclear, probably due to their rarity. McArdle's disease does not have an impact on fertility; therefore, some cases of pregnancy have been reported in patients with McArdle's disease. This article reviews published cases of pregnant women with McArdle's disease, focusing on the period of pregnancy, delivery, and postpartum. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), the authors conducted a literature search of PubMed, Web of Science, and Dialnet, as well as the journal Ata Portuguesa de Ginecologia e Obstetrícia (Journal of the Portuguese Societies of Gynecology and Obstetrics). The authors searched for articles in Portuguese, English, French, and Spanish using the combination of keywords "pregnancy" and any of the following: "McArdle's Disease", "Type V Glycogenosis", or "Myophosphorylase", available as of February 18, 2023. Thirteen articles corresponded to the search criteria, describing a total of 26 patients with McArdle's disease and 37 pregnancies (one of them a twin pregnancy). No case reports or case series were excluded. The objective was to evaluate obstetric index, comorbidities, gestational age, description of pregnancy evolution, mode of delivery, intrapartum pharmacological measures, and clinical evolution in the postpartum period. Of the 16 cases in which age of the patient was mentioned, the mean age was 27.75 years. Of the 18 cases in which the obstetric index was mentioned, 13 (72.2%) pregnancies were first pregnancies and 5 (27.8%) were second pregnancies. In addition to McArdle's disease, some patients had other comorbidities: one had Crohn's disease; one had dilated cardiomyopathy; one had grade II obesity; one had arterial hypertension, dyslipidemia, gastroesophageal reflux disease, and grade III obesity; and one had recurrent tonsillitis and allergic rhinitis. The mean age of pregnant women was 27.75 years. In most cases (75.7%), there was no mention of complications during pregnancy. There were four (10.8%) cases of rhabdomyolysis (two triggered by infectious diseases, one by exercise, and one with no evident trigger). Two women developed gestational diabetes, one had pre-eclampsia, one patient with dilated cardiomyopathy had worsening complaints of heart failure, and one patient developed idiopathic thrombocytopenia, which resolved after delivery. Of the 18 patients questioned about tolerance to exercise, two (11.1%) reported worsening of myalgia during pregnancy, while the rest reported symptomatic improvement. In 16 cases, it was necessary to perform a cesarean section. The remaining 22 deliveries were vaginal. Of the 14 cases in which anesthesia was specified, 12 (85.7%) patients were given epidural and 2 patients were given general anesthesia. There were three reported cases of rhabdomyolysis after childbirth. Pregnancy in patients with McArdle's disease does not seem to be associated with more complications than pregnancy in women without the disease, and there may even be an improvement of the symptoms during pregnancy. This review will help physicians provide such patients with better counseling and take measures to prevent complications. Implementing protocols designed specifically for pregnancy, delivery, and postpartum in patients with McArdle's disease could be beneficial, reducing the episodes of rhabdomyolysis.
- Thinking Outside the Box: A Case of Persistent Symptomatic HypomagnesemiaPublication . Relvas, R; Ferreira Monteiro, N; Vale Rodrigues, R; Cruz, DAlthough present in a significant number of people, hypomagnesemia is still an undervalued diagnosis. Therefore, its awareness and comprehensive etiological investigation become imperative. Among its multiple possible causes, drug iatrogenesis plays an important and often overlooked role. Here, we present a case of a 78-year-old female with recurrent bouts of severe hypomagnesemia of unknown origin, which, after an extensive study, was determined to be induced by proton pump inhibitors (PPIs). As such, our goal is to raise awareness of the potential risk of this side effect even in monotherapy, as well as to elucidate its underlying mechanisms, which are still not fully understood. Furthermore, it is intended to foster a systematic therapeutic review in these patients and raise discussion about the potential benefits of systematic magnesium monitoring in patients on long-term PPIs.
- Thrombocytopenia induced by clopidogrel: a rare adverse effectPublication . Cruz, D; Rodrigues dos Santos, J; Távora, CIntroduction: Immune thrombocytopenic purpura (ITP) can be induced by several drugs but there are few case reports of ITP induced by clopidogrel. Second-line treatment with thrombopoietin receptor agonists (TPO-RA) presents solid evidence and should be considered in patients in need of elective surgery who are poor responders to steroids. Case description: We report the case of a 79-year-old male who developed severe immune thrombocytopenic purpura after initiating treatment with clopidogrel. Because he needed elective orthopaedic surgery and he did not respond to corticotherapy and immunoglobulin, second-line treatment with romiplostim was initiated with a significant increase in platelet count. Discussion and conclusion: Clopidogrel can induce ITP and this diagnosis should be considered in patients who present with isolated thrombocytopenia. First-line therapy of ITP is not always successful; second-line treatment with TPO-RA has a high response rate and should be considered in patients in need of elective surgery who have failed to respond to first-line therapy. Learning points: Clopidogrel can cause immune thrombocytopenic purpura (ITP); although there are some published cases in literature, it is a rare adverse effect.ITP induced by clopidogrel should be considered in the differential diagnosis of patients experiencing isolated thrombocytopenia.Second-line treatment of ITP with thrombopoietin receptor agonists (TPO-RA) presents solid evidence and should be considered in patients in need of elective surgery who are poor responders to steroids.
- Thrombocytopenia induced by clopidogrel: a rare adverse effectPublication . Cruz, D; Rodrigues dos Santos, J; Távora, CIntroduction: Immune thrombocytopenic purpura (ITP) can be induced by several drugs but there are few case reports of ITP induced by clopidogrel. Second-line treatment with thrombopoietin receptor agonists (TPO-RA) presents solid evidence and should be considered in patients in need of elective surgery who are poor responders to steroids. Case description: We report the case of a 79-year-old male who developed severe immune thrombocytopenic purpura after initiating treatment with clopidogrel. Because he needed elective orthopaedic surgery and he did not respond to corticotherapy and immunoglobulin, second-line treatment with romiplostim was initiated with a significant increase in platelet count. Discussion and conclusion: Clopidogrel can induce ITP and this diagnosis should be considered in patients who present with isolated thrombocytopenia. First-line therapy of ITP is not always successful; second-line treatment with TPO-RA has a high response rate and should be considered in patients in need of elective surgery who have failed to respond to first-line therapy. Learning points: Clopidogrel can cause immune thrombocytopenic purpura (ITP); although there are some published cases in literature, it is a rare adverse effect.ITP induced by clopidogrel should be considered in the differential diagnosis of patients experiencing isolated thrombocytopenia.Second-line treatment of ITP with thrombopoietin receptor agonists (TPO-RA) presents solid evidence and should be considered in patients in need of elective surgery who are poor responders to steroids.