Search

Resumen Introduccion En los ultimos anos se ha incrementado la incidencia de sifilis en Espana. En un porcentaje importante existe coinfeccion con el virus de la inmunodeficiencia humana (VIH). Dado que estos pacientes tienen mayor riesgo de complicaciones neurologicas y de fracaso del tratamiento, hay que seguirlos cuidadosamente por el riesgo de desarrollar neurosifilis. En los pacientes coinfectados por el VIH –si bien las guias coinciden en realizar puncion lumbar en aquellos con sifilis latente tardia o de duracion incierta– la indicacion en pacientes con sifilis precoz activa es controvertida. Recientemente se han realizado estudios para determinar parametros clinicos o analiticos que identifiquen a aquellos pacientes que se beneficiarian de la puncion lumbar. Exponemos las diversas opiniones y aportamos la experiencia en nuestro servicio. Material y metodo Hemos realizado puncion lumbar de forma sistematica a todos los pacientes con sifilis precoz activa coinfectados por el VIH en el periodo 2003-2006. Resultados En el 100 % no se objetivo neurosifilis en LCR, y los parametros entraban dentro de la normalidad o eran compatibles con la infeccion por el VIH. Un 38 % presento un recuento de linfocitos CD4 + ≤ 350 y un 87,5 % tenia una titulacion en suero RPR ≥ 1:32. Conclusion Es posible que en la practica clinica se abuse de la realizacion de PL en estos pacientes, debido a la ausencia de criterios bien definidos. Nuestros datos estan en correlacion con los criterios actuales que apoyan la idea de restringir la realizacion de PL a determinados grupos.

Introduction: In the last years, the incidence of syphilis has incremented in Spain and coinfection with HIV occurs in a high percentage. In HIV-infected patients with syphilis, neurological complications, treatment failure and relapse appear to be slightly raised. Therefore, careful follow-up must be carried out because of the risk of developing neurosyphilis. According to the guidelines, lumbar puncture (LP) is indicated in HIV-infected patients with late latent syphilis or syphilis of unknown duration, but it is discussed in HIV-infected patients with early active syphilis. Recent research has been developed in order to determine clinical and analytical findings for identification of patients with high neurosyphilis risk. We review different opinions about this topic and report our experience. Methods. We have performed LP in all HIV-infected patients with early active syphilis during 2003-2006. Results. Of the eight studied patients, none met criteria for neurosyphilis. Three of eight (38 %) had a peripheral blood CD4 cell count CD4 + 350 cells/L. Seven of eight (87'5 %) had RPR 1:32. Conclusion. In these patients, performance of LP could be over indicated because of lack of well-established criterion. Our results are in agreement over to recent studies which restrict indication of LP to specific groups.

Lichenoid drug eruptions can mimic idiopathic lichen planus and other dermatoses. The list of drugs that can cause them is long and growing steadily. Although cutaneous side effects of antipsychotics are rare, various cutaneous manifestations have been reported in association with olanzapine. We present the case of a patient who developed an atypical lichenoid eruption due to olanzapine. A review of the literature in Medline from 1951 to 2007 and in the Indice Medico Espanol (Spanish Medical Index) revealed no previous cases of lichenoid eruptions associated with the use of this drug.