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Introducao: A febre reumatica (FR) e uma doenca inflamatoria de base imunologica, em geral, decorrente de faringoamigdalite. Objetivo: relatar um caso de FR em uma crianca com manifestacoes cardiacas. Caso: Crianca de 5 anos de idade, sexo feminino, foi admitida em hospital secundario com queixa de cansaco, dispneia ortostatica e aos pequenos esforcos, dor toracica e epigastrica, negando febre e antecedentes recentes de amigdalite. Paciente apresentou lesao cutânea na perna com inflamacao local e dificuldade de melhora. Ao exame fisico da admissao, paciente em regular estado geral, taquidispneica moderada, hipocorada, com edema palpebral, com presenca de ritmo de galope, sopro sistolico em focos aortico e pulmonar, sopro sistodiastolico em focos tricuspide e mitral. As hipoteses diagnosticas aventadas foram insuficiencia cardiaca e respiratoria, doenca reumatica, endocardite e cardiopatia pre-existente descompensada. Exames complementares informaram: ASLO: 298; PCR: 2,85; VHS: 90; radiografia de torax evidenciou cardiomegalia e sinais de congestao pulmonar; ecocardiograma revelou regurgitacao em valva tricuspide, espessamento de valva mitral e insuficiencia de grau acentuado; eletrocardiograma evidenciou intervalo PR de 160 ms (80-150 ms). Como conduta inicial a paciente foi admitida na UTI, com prescricao de dieta hipossodica, furosemida, penicilina benzatina. Posteriormente aos exames complementares, iniciou-se espironolactona, captopril e prednisona para cardite grave. Para o diagnostico do primeiro surto de FR utilizam-se os criterios de Jones. No presente caso observou-se cardite grave, elevacao do VHS, do PCR e prolongamento do intervalo PR. A partir disso, pode-se considerar a presenca de 1 criterio maior e 3 criterios menores, somados a elevacao do ASLO, corroborando a hipotese apresentada de FR. Consideracoes Finais: A suspeita diagnostica de FR e fundamental quando da apresentacao de cardite em crianca sem historia de doenca cardiaca, ainda que nao apresente relato recente de faringoamigdalite, a fim de diagnosticar de modo precoce e evitar lesao cardiaca cronica com sequelas permanentes.

Lipschütz ulcers (LU) are non-sexually related genital ulcers, rarely reported. We describe a healthy 11-year-old girl, who presented with fever and a painful vulvar ulcer associated with erythematous tonsillitis. Throat swab test for Group A Streptococcus (GAS) was positive. She was treated with amoxicillin. Further investigation was negative, including Herpes Simplex virus DNA from ulcer swab and serology for Epstein-Barr virus, cytomegalovirus and Mycoplasma pneumoniae Antistreptolysin O titre was high. The ulcer healed in 2 weeks, with no recurrence in a 1 year follow-up period. The association of LU with GAS tonsillitis is very rare. info:eu-repo/semantics/publishedVersion

Staphylococcus aureus is a Gram-positive bacteria described as an important causative agent of sepsis. The contact between host leukocytes and bacteria activates the innate immune response. Nitric oxide, tumor necrosis factor (TNF)-α and interleukin (IL)-1β play a key role in increasing microbicidal activity and controlling cell influx into infectious focus. Contrarily, IL-10 acts as an anti-inflammatory cytokine and bacterial killing suppressor. Immunoregulatory properties have also been attributed to hormones, including cholecystokinin (CCK). CCK protects cardiovascular function and inhibits the inflammatory response induced by lipopolysaccharide, product derived from Gram-negative bacteria. Nevertheless, the role of CCK during Gram-positive infection remains a literature gap. Our aims were to investigate whether CCK protects rats against bacterial dissemination during sepsis induced by S. aureus. We determined whether CCK modulates local and systemic inflammatory response, as well as the cell migration into the infectious focus and the bactericidal capacity of leukocytes. Our results revealed that proglumide (nonselective CCK receptor antagonist) pretreated rats showed higher bacterial counts in blood and peritoneal lavage fluid (PLF) and reduced TNF-α and IL-10 levels in PLF. Moreover, the dissemination of S. aureus may be related to the failure of neutrophil and macrophage migration into the peritoneal cavity. Also, CCK improved the phagocytic and bactericidal ability of these inflammatory cells. Noteworthy is that the adoptive transfer of CCK-treated neutrophils and macrophages in septic rats improved immune defense, reducing bacterial number in blood and PLF. All together, our study clearly demonstrates an important protective role of CCK against sepsis induced by S. aureus.

Group A beta-hemolytic streptococcus is the most common agent implicated in post-infectious acute glomerulonephritis. We report a case of acute poststreptococcal glomerulonephritis associated with sinus-related orbital abscess in an 11-year-old boy treated with surgical drainage and intravenous ceftriaxone and clindamycin. Twelve days after supportive measures, renal function was normalized. We also discuss this potentially severe nonsuppurative complication of orbital cellulitis caused by group A beta-hemolytic streptococcus. Os estreptococos beta-hemolíticos do grupo A são os agentes mais comumente envolvidos na glomerulonefrite aguda pós-infecciosa. Relatamos um caso de glomerulonefrite pós-estreptocócica aguda associada a um abscesso orbitário secundário à sinusite, em menino de 11 anos de idade, o qual foi tratado com ceftriaxona e clindamicina endovenosas e drenagem cirúrgica. Doze dias após tratamento de suporte, a função renal se normalizou. Também discutimos a importância desta grave e potencial complicação não supurativa das celulites orbitárias causadas pelos estreptococos beta-hemolíticos do grupo A.

CONTEXT: Erythema elevatum diutinum is a chronic and rare dermatosis that is considered to be a variant of leukocytoclastic vasculitis. It is probably mediated by immune complexes. It is generally associated with autoimmune, neoplastic and infectious processes. Recently, it has been added to the group of specific dermatoses that are associated with HIV. CASE REPORT: We report on the case of a patient who had erythema elevatum diutinum as the first clinical evidence for diagnosing HIV infection. Dapsone was used in the treatment of this patient, and partial regression of the lesions was achieved within 15 days, even before antiretroviral therapy was prescribed. CONCLUSION: When there is a diagnosis of erythema elevatum diutinum, HIV infection should be investigated, especially in atypical and exacerbated clinical manifestations. CONTEXTO: O eritema elevatum diutinum é uma dermatose crônica, rara, variante clínica da vasculite leucocitoclástica, provavelmente mediada por imunocomplexos. Está sendo incluído no grupo das dermatoses específicas associadas à infecção pelo HIV. Em geral, associa-se a outros processos infecciosos, auto-imunes e neoplásicos. RELATO DE CASO: Relatamos o caso de um paciente em que a manifestação cutânea de eritema elevatum diutinum foi a primeira evidência clínica para diagnóstico da infecção pelo HIV. O tratamento foi feito com dapsona e se obteve regressão parcial das lesões após 15 dias, mesmo antes de o esquema anti-retroviral ser prescrito. CONCLUSÃO: Frente ao diagnóstico de eritema elevatum diutinum, deve-se investigar a infecção pelo HIV, principalmente nas apresentações clínicas atípicas e exacerbadas.