Personal Pathological History Research Articles

Polymorphisms of PDCD1 and COL9A1 Genes in Plaque, Palmoplantar and Arthropathic Psoriasis in Romanian Patients

In recent years, genetic studies have brought new insights into psoriasis, a chronic inflammatory disease with multiple determining and favoring factors. Recent advances in the technology of genetic analysis have enabled the discovery of many loci with causal or susceptibility roles and the finding of correlations related to different types of treatment responses. In this study, genomic deoxyribonucleic acid (DNA) was extracted from 2 mL peripheral blood for the evaluation of rs10204525 for Programmed Cell Death 1 (PDCD1) gene and rs550675 for Collagen Type IX Alpha 1 Chain (COL9A1) gene in 45 psoriasis patients and 43 healthy subjects without a personal pathological history of dermatological diseases. All patients were diagnosed by clinical and histopathological examination, and the severity of disease and its impact on quality of life were evaluated by Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) scores. Comparisons were made between controls and patients, but also between different clinical types of psoriasis according to disease severity. The rank of C/T alleles for rs550675 (COL9A1 gene) was higher in the patients versus the control group (p = 0.026), while the G/A alleles for rs10204525 (PDCD1 gene) had no differences between the two groups (p = 0.450). Case and control comparisons also showed statistical significance between homozygous CC/TT genotypes (p = 0.039). After subdividing the three types of psoriasis (plaque psoriasis, arthropathic psoriasis and palmoplantar psoriasis) according to disease severity, there were differences between CC/CT genotype (p = 0.0246) and CC/TT (p = 0.007) genotype in patients with plaque psoriasis in favor of severe disease. At the same time, the GA/GG versus AA pattern was significantly higher in patients with plaque psoriasis.

Influenza A in children complicated by encephalitis - case study

Influenza is a seasonal disease that can cause annual outbreaks, especially during the cold periods of the year, in temperate areas. Symptomatology mainly involves the upper and lower respiratory tract, but varies greatly depending on the age and medical history of each person. In this paper we present a clinical case of influenza type A complicated with encephalitis in a female child aged 5 years and 6 months with a personal pathological history of neurological damage (Guillain-Barre syndrome). The diagnosis of influenza was established on the basis of symptoms (productive cough, rhinorrhea, marked physical asthenia, high fever) and confirmed by laboratory tests (rapid influenza antigen test and influenza RT PCR from nasopharyngeal secretions - positive). Neurological involvement was clinically supported by the occurrence of bradykinesia, bradypsy, broad-based gait, confirmed by neurological examination. The diagnosis of encephalitis was completed by analysis of cerebrospinal fluid (CSF) obtained by lumbar puncture in which influenza virus type A was identified and by electroencephalogram (EEG) showing altered tracing. Under antiviral (Oseltamivir), pathogenic (corticosteroid therapy), brain depleting (mannitol solution), non-specific human and symptomatic immunoglobulins treatments, the evolution was slowly favorable with remission of symptoms. The case presented argues that although influenza in immunocompetent children is generally a self-limiting and uncomplicated condition, it can evolve severely with the development of complications and after-effects and sometimes increased mortality especially in immunocompromised hosts.

Cutaneous larva migrans

A 13-year-old female presented to our clinic with a pruritic, progressive, 5 centimeters long cutaneous linear erythema on the left foot. The patient informed us that the lesion appeared progressively 2 weeks before. She spent hours in contact with seawater and sand without protection due to beach holidays. At first, the patient detected irritated redness on the dorsum of her left foot. She noticed that the lesion progressed forming a tortuous red cutaneous line. No personal pathological history was reported. Physical examination revealed an erythematous linear serpiginous skin lesion on the dorsum of the left foot (Figure 1). The clinical diagnosis was cutaneous larva migrans caused by Ancylostoma braziliense. The patient was treated with cycles of 30 second with liquid nitrogen applied directly on the lesion, remitting completely.

Widespread Bilateral Pulmonary Embolism: A Case Report

We present a 45-year-old man with a personal pathological history of deep vein thrombosis of the lower limbs without current medical management. It begins suddenly with respiratory difficulty, decreased oxygen saturation, and dyspnea. Upon arrival at the emergency department, chest angio tomography was performed, highlighting bilateral filling defects, from main branches to segmental branches, so admission to the hemodynamics room for right heart catheterization was decided. Thrombectomy, bilateral ultrasound rheolysis and targeted fibrinolysis were performed, with improvement in mean pulmonary artery pressure (mPAP) to 19 mmHg compared to the previous one.

Occipital Cavernous Malformation. Case Report and Literature Review

We present a 47-year-old female patient with a personal pathological history of squamous cell carcinoma of the cervix treated with multimodal therapy. She is rushed to our hospital because of a generalized tonic-clonic seizure. After performing computed axial tomography and magnetic resonance imaging studies of the skull, an occipital lesion was evident that was located above the tentorium cerebellum in relation to her right transverse sinus. An occipital approach is performed where said lesion is completely

The Role of Ketone Bodies in Treatment Individualization of Glioblastoma Patients.

Glioblastoma is the most common and aggressive primary brain tumor in adults. According to the 2021 WHO CNS, glioblastoma is assigned to the IDH wild-type classification, fulfilling the specific characteristic histopathology. We have conducted a prospective observational study to identify the glucose levels, ketone bodies, and the glucose-ketone index in three groups of subjects: two tumoral groups of patients with histopathological confirmation of glioblastoma (9 male patients, 7 female patients, mean age 55.6 years old) or grade 4 astrocytoma (4 male patients, 2 female patients, mean age 48.1 years old) and a control group (13 male patients, 9 female patients, mean age 53.9 years old) consisting of subjects with no personal pathological history. There were statistically significant differences between the mean values of glycemia (p value = 0.0003), ketones (p value = 0.0061), and glucose-ketone index (p value = 0.008) between the groups of patients. Mortality at 3 months in glioblastoma patients was 0% if the ketone levels were below 0.2 mM and 100% if ketones were over 0.5 mM. Patients with grade 4 astrocytoma and the control subjects all presented with ketone values of less than 0.2 mM and 0.0% mortality. In conclusion, highlighting new biomarkers which are more feasible to determine such as ketones or glucose-ketone index represents an essential step toward personalized medicine and survival prolongation in patients suffering from glioblastoma and grade 4 astrocytoma.

Clinical and Pharmacotherapeutic Profile of Patients with Type 2 Diabetes Mellitus Admitted to a Hospital Emergency Department

Type 2 diabetes mellitus (T2DM) is closely associated with other pathologies, which may require complex therapeutic approaches. We aim to characterize the clinical and pharmacological profile of T2DM patients admitted to an emergency department. Patients aged ≥65 years and who were already using at least one antidiabetic drug were included in this analysis. Blood glycemia, creatinine, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and hemoglobin were analyzed for each patient, as well as personal pathological history, diagnosis(s) at admission, and antidiabetic drugs used before. Outcome variables were analyzed using Pearson's Chi-Square, Fisher's exact test, and linear regression test. In total, 420 patients were randomly selected (48.6% male and 51.4% female). Patients with family support showed a lower incidence of high glycemia at admission (p = 0.016). Higher blood creatinine levels were associated with higher blood glycemia (p = 0.005), and hyperuricemia (HU) (p = 0.001), as well as HU, was associated with a higher incidence of acute cardiovascular diseases (ACD) (p = 0.007). Hemoglobin levels are lower with age (p = 0.0001), creatinine (p = 0.009), and female gender (p = 0.03). The lower the AST/ALT ratio, the higher the glycemia at admission (p < 0.0001). Obese patients with (p = 0.021) or without (p = 0.027) concomitant dyslipidemia had a higher incidence of ACD. Insulin (p = 0.003) and glucagon-like peptide-1 agonists (GLP1 RA) (p = 0.023) were associated with a higher incidence of decompensated heart failure, while sulfonylureas (p = 0.009), metformin-associated with dipeptidyl peptidase-4 inhibitors (DPP4i) (p = 0.029) or to a sulfonylurea (p = 0.003) with a lower incidence. Metformin, in monotherapy or associated with DPP4i, was associated with a lower incidence of acute kidney injury (p = 0.017) or acute chronic kidney injury (p = 0.014). SGLT2i monotherapy (p = 0.0003), associated with metformin (p = 0.026) or with DPP4i (p = 0.007), as well as insulin and sulfonylurea association (p = 0.026), were associated with hydroelectrolytic disorders, unlike GLP1 RA (p = 0.017), DPP4i associated with insulin (p = 0.034) or with a GLP1 RA (p = 0.003). Insulin was mainly used by autonomous and institutionalized patients (p = 0.0008), while metformin (p = 0.003) and GLP1 RA (p < 0.0001) were used by autonomous patients. Sulfonylureas were mostly used by male patients (p = 0.027), while SGLT2 (p = 0.0004) and GLP1 RA (p < 0.0001) were mostly used by patients within the age group 65-85 years. Sulfonylureas (p = 0.008), insulin associated with metformin (p = 0.040) or with a sulfonylurea (p = 0.048), as well as DPP4i and sulfonylurea association (p = 0.031), were associated with higher blood glycemia. T2DM patients are characterized by great heterogeneity from a clinical point of view presenting with several associated comorbidities, so the pharmacotherapeutic approach must consider all aspects that may affect disease progression.

Imaging and histological approach to the diagnosis of pulmonary lesions by COVID-19: case report

A 52-year-old white female patient, a teacher by profession, with no personal pathological history of interest, was admitted to the intensive care unit of the "Lucía Íñiguez Landín" Clinical Surgical Hospital with pneumonia due to COVID-19, for which received several treatments persisting after 20 days of the same a marked severe restrictive ventilatory pattern without achieving improvement and died. Digital radiography images and chest computed tomography images were obtained, and a pulmonary histological study was also performed. The novelty of the case is given by the current relevance of the use of imaging and histological studies of this pandemic entity that has spread rapidly throughout the world whose histopathological changes are not fully understood, which undermines clinical identification adequate treatment of patients and the implementation of effective therapeutic strategies, which is why this article was prepared with the aim of showing the findings in the diagnostic imaging corroborated with histology.

505 Unusual presentation of classic Kaposi’s sarcoma

Kaposi’s sarcoma is vascular neoplasia, with purplish, infiltrative lesions and the possibility of affecting the viscera or lymph nodes, that can be classified into 4 categories: epidemic (related to HIV infection), classical (elderly men in the Mediterranean basin), endemic (Africa) and iatrogenic (immunosuppressive therapy). Case presentation Will illustrate the case of a 69-year-old man, without personal pathological history, who came to the consultation for an erythematous–slightly purplish plaque, glossy, supple, mobile, well defined, irregular in shape, with a diameter of 5 cm located at the level of the foreskin, with a 2-month onset, asymptomatic.

Características clínico-demográficas de pacientes recuperados de COVID-19 en una unidad de rehabilitación de tercer nivel

To determine the clinical-demographic characteristics of patients recovered from COVID-19 in a third level rehabilitation service. A cross-sectional and descriptive study of recovered COVID-19 patients in a rehabilitation service was carried out. Demographic, personal pathological history, his work activity and COVID-19 were taken, as well as alterations after the disease. Descriptive statistics were performed. 186 files were collected. The mean age was 48.04 ± 11.32 years. Male predominance was found (65.6%). 50% of the patients were health workers. The most common previous pathological conditions were sedentary lifestyle (73.7%) and diabetes mellitus (29%). 43.5% presented grade 3 dyspnea according to the modified Medical Research Council scale. There was a high prevalence of neuromuscular involvement, predominantly peripheral neuropathy (48.4%) and dysautonomia (46.2%). It was possible to determine the clinical-demographic characteristics of patients recovered from COVID-19 in a third-level rehabilitation service, such as age, sex, type of work, previous pathological conditions (diabetes mellitus and arterial hypertension), body mass index, dyspnea, hospitalization, and post-illness disorders. Further investigation of COVID-19 is needed in the development of conditions to different systems.

Audiological profile and handicap levels in people with vestibular disorders at Centro Equilibra, Vértigo and Equilibrio, San José, Costa Rica

Background and objectiveVestibular disorders are linked to a group of pathologies that can affect the vestibular part, the auditory part, or both parts of the inner ear. The problem in this study is the little information that exists about the audiological profile of people suffering from vestibular disorders in Costa Rica. There are international research studies on this topic, but there are no records of studies conducted in the Costa Rican population. This is why there is interest in developing this research which aims to characterize the audiological profile and the levels of handicap in people with vestibular disorders under Centro Equilibra, Vertigo and Equilibrio consultation during the months of September to November 2019. Patients and methodsA descriptive, cross-sectional, quantitative, and observational analytical study with patients over 18 years old who attended Centro Equilibra. The main variables analysed were sex, age, personal pathological history, medical diagnosis, main vestibular symptoms, auditory manifestations, and levels of handicap. ResultsThe data was obtained from 177 people; vestibular disorders occurred more in the female sex (ratio 2.6:1). The mean age was 56 years. Fifty-three point seven percent presented slight sensorineural hearing loss, gradually decreasing. Of the population, 33.9% presented tinnitus, mostly at high frequencies. In the adult population, 52% presented some level of hearing handicap, unlike older adults, where the majority (77%) did not present any level of handicap. People with vestibular disorders perceive greater physical handicap (83%). ConclusionsHearing loss was the most common hearing manifestation and although statistical analysis shows that it is not directly related to vestibular disorders, it is related to concomitant metabolic diseases. For this reason, it is necessary to promote the prevention of metabolic diseases as one of the measures to improve hearing health, even from an early age.

Prevalence of gingivitis and risk factors among pregnant women from Acapulco, Guerrero: a cross-sectional study.

Gingivitis is a condition that has been associated with an exaggerated inflammatory response of the gums to oral biofilm, attributed to the secretion of hormones during pregnancy. To estimate the prevalence of gingivitis and identify associated risk factors among pregnant women in a private medical clinic from Acapulco, Guerrero. Cross-sectional study in a convenience sample of 92 pregnant women, during the period from January to March 2020. A self-administered questionnaire collected sociodemographic data, economic income, oral hygiene habits and personal pathological history. The periodontium was evaluated based on the new classification of gingival health and gingivitis induced by oral biofilm on six representative teeth. Multivariate analysis identified factors associated with gingivitis using the odds ratio and its 95% confidence interval as an estimate of the strength of association with CIETmap statistical software. The prevalence of gingivitis was 60% (55/92). Two factors remained in the final model of the multivariate analysis. The main associated strength was found in the variable of not using oral hygiene aids (ORa= 6.76; CI 95%= 2.01-22.78). The other variable was not attending dental visits (ORa= 3.74; CI 95%= 1.44-9.73). Gingivitis affected about six out of ten pregnant women. Knowing the risk factors, it will be important to reinforce health education strategies and the importance of clinical monitoring during pregnancy.

317 When Diagnosis Becomes a Challenge

Erythema dyschromicum perstans (EDP) or ashy dermatosis is a form of an acquired dermal macular hyperpigmentation. The etiology of this disease is still unknown. Often encountered in young adults, this type of dermatosis can sometimes occur in children. Women are affected more frequently than men. We report the case of a 35-year-old male patient with Fitzpatrick skin type III, non- smoker, with no occupational exposure to toxic substances. The patient has no significant family or personal pathological history and he denies drug use.

296 The Reverse of Medal – Dermatological Complications After Renal Transplantation

Kidney transplant represent the last resort for the patients with end-stage renal disease, but this revolutionary method of treatment is accompanied by multiple complications, the dermatological being among the most common. Bassal cell carcinoma, squamous cell carcinoma, cutaneous lymphoma and Kaposi’s sarcoma are just few of the complications. We present the case of a 62 years old patient, which at the age of 54 he underwent a kidney transplant, without other personal pathological history. This patient presented to the clinic for multiple skin lesions: on the right earlobe and nasal wing, on the right arm and on the bilateral legs, with slow evolution of about two years, round-ovals, relatively well delimited, with dimensions between 0.4/0.3cm-2.5/2.4cm, red-brown, covered by bloody crusts (lesions located in the calves).

Perfil audiológico y grados de discapacidad en las personas con alteraciones vestibulares pertenecientes a la consulta del Centro Equilibra, Vértigo y Equilibrio, San José, Costa Rica

Background and objectiveVestibular disorders are linked to a group of pathologies that can affect the vestibular part, the auditory part, or both parts of the inner ear. The problem in this study is the little information that exists about the audiological profile of people suffering from vestibular disorders in Costa Rica. There are international research studies on this topic, but there are no records of studies conducted in the Costa Rican population. This is why there is interest in developing this research which aims to characterize the audiological profile and the levels of handicap in people with vestibular disorders under Centro Equilibra, Vertigo and Equilibrio consultation during the months of September to November 2019. Patients and methodsA descriptive, cross-sectional, quantitative, and observational analytical study with patients over 18years old who attended Centro Equilibra. The main variables analysed were sex, age, personal pathological history, medical diagnosis, main vestibular symptoms, auditory manifestations, and levels of handicap. ResultsThe data was obtained from 177 people; vestibular disorders occurred more in the female sex (ratio 2.6:1). The mean age was 56years. Fifty-three point seven percent presented slight sensorineural hearing loss, gradually decreasing. Of the population, 33.9% presented tinnitus, mostly at high frequencies. In the adult population, 52% presented some level of hearing handicap, unlike older adults, where the majority (77%) did not present any level of handicap. People with vestibular disorders perceive greater physical handicap (83%). ConclusionsHearing loss was the most common hearing manifestation and although statistical analysis shows that it is not directly related to vestibular disorders, it is related to concomitant metabolic diseases. For this reason, it is necessary to promote the prevention of metabolic diseases as one of the measures to improve hearing health, even from an early age.

Contribution of Optical Coherence Tomography in the Diagnosis of Idiopathic Polypoidal Choroidal Vasculopathy in a Young Adult at Iota-Teaching Hospital

Introduction: Idiopathic polypoidal choroidal vasculopathy (IPCV) is a common cause of hemorrhage of the retinal pigmentary epithelium and neurosensory retinal detachment of oxidative origin. Its diagnosis is more easily made by Optical Coherence Tomography and Fluorescence Angiography or ICG. The aim of our work is to highlight the accuracy of OCT and AGF in the diagnosis of IPCV. We report a clinical case received in February 2019 in the vitreoretinal surgery and functional exploration of the visual apparatus department of the IOTA-Teaching Hospital. Case Report: A young man with a personal pathological history of arterial hypertension was referred to the department for macular OCT for central serous chorioretinitis. OCT and intravenous fluorescein angiography showed features of idiopathic polypoidal choroidal vasculopathy. The patient received anti-VEGF injections followed by significant visual improvement. Discussion: The pathogenesis of IPCV is not clearly elaborated, but it appears to be primarily due to an abnormality of choroidal vasculature. Conclusion: IPCV can occur in young subjects and leads to severe impairment of visual function. These severe visual impairments are resolved by the correct use of anti VEGF associated or not with the Argon laser.

INFORME DE UN CASO: QUISTE PARASITARIO MESENTÉRICO SUMADO A INSUFICIENCIA RENAL CRÓNICA SECUNDARIO A LUPUS ERITEMATOSO SISTÉMICO EN ADOLESCENTE.

Introduction Mesenteric cysts are abdominal tumors with a low incidence, the clinical presentation depends on the location and size of the cyst, the recommended treatment is surgical resolution. In next pages. Case description We present the case of a 17-year-old female adolescent with no significant personal pathological history, who initially presented nausea and incoercible vomiting, accompanied by fever and abdominal pain of 5 days of evolution, which caused moderate dehydration and consequently acute kidney injury and later chronic kidney failure that is aggravated by systemic lupus erythematosus that the patient develops during the clinical course. Concomitantly, the patient presents significant abdominal distention, so it is performed a CT scan (Tomography), which reveals the presence of a mesenteric cyst that displaces intra-abdominal organs, so it is made a reference to general surgery. Patient remains awaiting renal biopsy to determine histopathological classification for underlying autoimmune disease. The patient remains awaiting surgical resolution. Conclusion Mesenteric cyst is a rare entity, surgery is the treatment of choice and the only definitive diagnostic method for mesenteric cysts, the patient remains awaiting surgical resolution.

Contrast-induced nephropathy associated factors in patients with significant coronary obstruction

Coronary intervention is associated with the appearance of contrast-induced nephropathy. The purpose of the study was to assess the risk of developing contrast-induced nephropathy in patients with significant coronary obstruction and its relationship with known risk factors for this nephropathy. A prospective cohort study was designed with 160 patients treated at the cardiocenter of the “Hermanos Ameijeiras” hospital, Cuba, who underwent invasive coronary angiography, between January 2016 and July 2017. The average age was 61.6 ± 9 ,2 years; 70.6% were men. The personal pathological history of ischemic heart disease (85.6%) and arterial hypertension (75.6%) predominated. 75% of the cases presented a significant coronary occlusion. The frequency of contrast nephropathy was 42.5%. The factors that had an important statistical relationship with the presence of significant arterial occlusion were known ischemic heart disease (p &lt;0.001), previous percutaneous coronary intervention (p = 0.007), creatinine after the procedure (p = 0.043) and CIN (p = 0.016) as well as the volume of contrast administered (p = 0.006). In the subgroup of patients with significant occlusion, low hematocrit (p = 0.025) and emergency percutaneous coronary intervention (p = 0.007) were the most influential factors. It is concluded that patients with significant coronary occlusion have an increased risk for the development of contrast nephropathy. The correction of those risk factors that are modifiable (such as low hematocrit) and the correct application of the hydration protocol are essential to prevent this complication.

MO061IS THE PM290I MUTATION RELATED TO ORGAN INVOLVEMENT OF FABRY DISEASE?

Abstract Background and Aims Fabry disease (FD) is an X-linked hereditary disease. It results from mutations in the GLA gene, leading to deficient activity of the enzyme alpha-galactosidase A and progressive accumulation of undegraded glycosphingolipids in cell lysosomes. Enzyme replacement therapy improved the natural course of this disease, but an early diagnosis is crucial for a successful treatment. Method A screening study for GLA gene mutations was conducted for all patients under dialysis, from a single centre. All the probands with a detectable mutation were analysed individually. Data on the patient's family and personal pathological history were retrospectively collected, by consulting the clinical file. Results 35 years-old female diagnosed with chronic proteinuric kidney disease in the postpartum period. Despite optimal medical treatment the disease progressed, and she started renal replacement therapy with peritoneal dialysis. Five years later she was enrolled in a pilot screening study for FD and the heterozygous mutation c.870G&amp;gt;C (p.Met290Ile; M290I) in exon 6 of the GLA gene was found. The proband didn’t meet the criteria for a definitive FD diagnosis, but she remained under follow-up at our nephrology metabolic diseases consultation, as the mutation was described as pathogenic and associated with a classic FD phenotype. Later that same year, reassessment exams revealed a worsening left ventricle mass index, a new ischemic cerebral lesion and a substantial increase in serum globotriaosylsphingosine (LysoGb3) levels. These clinical changes led to the decision to initiate enzyme replacement therapy. Until now there are only a few descriptions of this genetic variant in the scientific literature. A Portuguese study analysed a total of 11 FD patients and described 2 patients with p.M290I mutation, without detectable Gb3 accumulation. Another study was designed to evaluate the genotype-phenotype relationship in 73 Chinese FD patients. Contrary to other reports, the p.M290I mutation was not associated to the classic FD phenotype. A Swiss investigation with a similar design analysed 69 FD patients during their routine annual examinations. M290I mutant enzyme was found in a 48-year-old heterozygous female with a classic FD phenotype but with a low serum LysoGb3. A Spanish newborn screening identified one male patient with FD and the p.M290I genetic variant but was unable to provide any information about the clinical expression of this mutation, since the diagnosis was made between the third and fifth days of life. The study describing the most patients carrying the M290I mutant enzyme is Brazilian and screened a total of 25,223 dialysis patients. Among 89 FD-positive patients, the p.M290I mutation was present in 22. However, the authors did not provide detailed information about the clinical manifestations or α-Gal A activity and LysoGb3 levels of these patients. Finally, a recent Portuguese screening of 150 hypertrophic cardiomyopathy patients found 25 patients with FD. Of these, one female carried the GLA gene variant p.M290I, with a non-detectable LysoGb3 plasma level. Conclusion We describe a case of FD due to a previously known but still poorly described GLA mutation, which offers strong evidence of its pathogenicity. To our knowledge, this is the first report of p.M290I mutation-associated disease activity evidenced by elevated levels of serum LysoGb3. Despite the absence of classic FD symptoms such as neuropathic pain, cornea verticillata and angiokeratoma, the presence of severe multiple organ evolvement, characterized by renal failure, cardiac disease and ischaemic stroke, strongly suggests a classic phenotype. Consequently, it is our opinion that the presence of a p.M290I GLA mutation should require a strict ongoing patient follow-up, as it may cause clinically significant disease.

P0717 / #1448: IMMUNOMEDIATED ENCEPHALITIS IN PEDIATRICS, CASE REPORT

Aims & Objectives: Immunomediated encephalitis, is a type of encephalitis given by antibodies against N-Methyl aspartate (NMDA). It occurs frequently in children under 18 years with predominance in females, and a good response to treatment. Methods: Male adolescent of 13 years of age referred to the psychiatric hospital for conduct disorder, aggressiveness and irritability, does not know his relatives, sensory disorder, alteration of the state of consciousness, disconnection with the environment, dyslalia, dysarthria, with personal pathological history of Sindrome from Steven Jhonson at 2 years old. Mother says that 3 days prior to admission presents abruptly behavioral disorders, does not obey orders, irritability, incongruity when speaking, clothes are placed upside down, also remains decayed, hyporexic, argues that adolescent is calling attention however the picture is exacerbated by what he decides to be valued by a doctor, denies trauma, refers to thermal quantification not quantified in the last 3 days. Results: The following results are reported in the tests performed on our patient: • Simple brain CT scan: normal • Simple and contrasted brain resonance imaging: normal • cerebral fluid: normal • • Negative drug panel • normal eye fundus • Anti NMDA in spinal fluid, serum and serum: positive Our patient later required tracheostomy and gastrostomy, as well as physical, language and occupational therapy. however, the connection with the medium was not recovered, nor the prostrationConclusions: Among the most frequent clinical characteristics, the presentation of fever with psychiatric abnormalities, abnormal movements and orofacial dyskinesias stands out; the latter occur more frequently in the pediatric patient