Ana Valea, Dan Nicolae Paduraru, Adriana Elena Nica, Maria Iuliana Oprisor, Adina Ghemigian and Mara Carsote

REZUMAT

Introduction. Scleroderma induces heterogeneous skin changes due to collagen anomalies, including facial. The recommended therapy is, among others, topic cortisol derived products, so an issue of diagnosis differential regarding the etiological type of Cushing’s syndrome (CS) is raised if a patient develops a suggestive phenotype.
Case presentation. This is a 64-year female presenting (since the last few months) red face, high blood pressure, central obesity. She has a 6-year history of scleroderma, intermittently treated with local corticotherapy. On admission, she associated metabolic disturbances as lipid profile anomalies, high uric acid, insulin resistance and increased number of white blood cells (which were not connected with a relapse of scleroderma, neither to an inflammatory syndrome). Low baseline plasma ACTH and morning serum cortisol level (not high, yet detectable) with abnormal diurnal rhythm suggested an adrenal source of CS. A 3 cm right adrenal tumor was found on computer tomography and later removed through a classical intervention. Two weeks after, the patient voluntarily reduced her prednisone dose causing an adrenal crisis which required re-admission as an emergency. After discharge, daily oral adrenal replacement therapy is needed for the moment.
Conclusions. Scleroderma, especially with skin involvement, and some of associated therapies may mask an endogenous CS as adrenal tumor derivate, thus delaying the adequate diagnosis and therapy. Patient’s
education regarding a potential life threatening condition as chronic adrenal insufficiency is necessary since post-operatory recovery of adrenal function is expected within 6 to 24 months.

Cuvinte cheie: Cushing’s syndrome, adrenal tumor, scleroderma

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Adriana Elena Nica, D.N. Paduraru, D. Ion, Alexandra Bolocan, Alexandra Moise and O. Andronic

ABSTRACT

Malignant fibrous histiocytoma is also known as malignant fibrous xanthoma and is a form of neoplasm with uncertain histological origin. This tumour is rich in histiocytes and fibroblasts. MFH represent one on the most common type of soft tissue sarcoma but it has a low incidence in general population. We report the case of a 60 years old male patient, presented at the University Emergency Hospital Bucharest for a tumoral mass on the left hemithorax, in evolution for about 1 year, with an accelerated grow in the last 6 months. This case is typically because the patient is a male and he is 60 years old ( range 50-70 years ). In the same time, there are some particularites that make the case special and determin us to draw some conclusions about the management of this pathology. Histiocytoma represent a rare tumoral pathology and it is difficult to do a differential diagnostic preoperatively. Surgery is the cornerstone of treatment for all soft tissues. The goal of surgery is to eradicate disease in the affected area. All excisions of tumoral mass must be with resection margins for oncological security to avoid the possible complications.

Keywords: histiocytoma fibrous malignant, xanthoma, thorax

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Adriana Elena Nica, Angelica Bratu, Dan Păduraru, Christina Chatzifilippidou and Sorin Mircea Oprescu

REZUMAT 

Endocardita acută de valvă aortică reprezintă o patologie gravă cu rezonanţă clinică care poate varia de la un tablou inaparent cu simptomatologie frustă până la embolii septice multiple şi şoc septic.

Cuvinte cheie: endocardită, proteză totală de şold, stafilococ auriu meticilino-rezistent, valvă aortică, sepsis

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