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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">O compromisso visceral pelo l&#250;pus eritematoso sist&#233;mico &#40;LES&#41; estende-se para al&#233;m do rim e da pele&#46; Les&#245;es pleuropulmonares s&#227;o reconhecidas e as formas de destrui&#231;&#227;o alveolar difusa e hemorragia alveolar s&#227;o as mais dif&#237;ceis de controlar&#46; O compromisso pulmonar na evolu&#231;&#227;o cl&#237;nica do LES difere nas crian&#231;as e nos adultos&#44; tanto nos padr&#245;es morfol&#243;gicos como nas apresenta&#231;&#245;es cl&#237;nicas&#44; dependendo da imunoincompet&#234;ncia do doente e do tratamento institu&#237;do&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Um rapaz de 16 anos apresentou um quadro cl&#237;nico de astenia&#44; cansa&#231;o e pequenos g&#226;nglios linf&#225;ticos cervicais bilaterais e n&#227;o dolorosos&#44; entendido como infec&#231;&#227;o pelo EBV&#44; com serologia concordante &#40;IgG e IgM de EBV e EBNA positivos&#41;&#46; Os sintomas persistiram durante oito meses e progressivamente instalou-se eritema nasal e malar&#44; discreto e descamativo e tamb&#233;m febre persistente&#44; dispneia e estertores basais &#224; ausculta&#231;&#227;o&#46; Foram efectuadas bi&#243;psia de um g&#226;nglio linf&#225;tico cervical e bi&#243;psia cir&#250;rgica pulmonar&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Observou-se hiperplasia folicular no g&#226;nglio linf&#225;tico e aus&#234;ncia de c&#233;lulas LMP1 &#40;EBV&#41; positivas&#46; Na bi&#243;psia pulmonar eram evidentes fen&#243;menos de bronquiolite e vasculite &#224; custa de c&#233;lulas macrof&#225;gicas identificadas pelo marcador CD68&#46; Os macr&#243;fagos dissociavam as paredes vasculares e bronquiolares e tamb&#233;m estavam presentes nos septos interalveolares peribroncovasculares e nos espa&#231;os alveolares&#44; observando-se assim um padr&#227;o de panbronquiolite difusa e vasculite&#46; N&#227;o se identificaram c&#233;lulas LMP1 &#40;EBV&#41; positivas&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">O padr&#227;o pulmonar micronodular bilateral observado na TAC resolveu com corticoterapia&#46; O diagn&#243;stico de LES foi confirmado pela positividade dos anticorpos ANA&#44; anti-dsDNA&#44; anti-nDNA e anti-histonas&#46;</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Este &#233; o primeiro caso divulgado na literatura m&#233;dica de compromisso pulmonar sob a forma de vasculite e pad&#227;o de panbronquiolite difusa como primeira manifesta&#231;&#227;o cl&#237;nica do l&#250;pus eritematosos sist&#233;mico&#46;</p>"
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        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Visceral involvement in systemic lupus erythematosus &#40;SLE&#41; extends beyond renal and cutaneous management&#46; Pleuro-pulmonary lesions have been recognised and diffuse alveolar damage and hemorrhage are the most difficult patterns to control&#46; Pulmonary compromise in clinical evolution of SLE differs from children to adults&#44; both in morphological patterns and in clinical presentation&#44; depending on immunocompetence and the treatment prescribed&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A 16-year-old boy presented asthenia&#44; malaise and bilateral cervical painless adenopathies understood as EBV infection as serological EBV IgG&#44; IgM and EBNA were positive&#46; The symptoms persisted for eight months when discrete erythematous and desquamative nasal and malar rash expressed together with persistent fever&#44; dispnoea and bibasilar crackles&#46; Lymph node and pulmonary biopsises were performed&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Lymph node presented follicular hyperplasia and LMP1 &#40;EBV&#41; immunostaining was negative&#46; In lung biopsy bronchovascular lesions were consistent with vasculitis and bronchiolitis due to intense macrophage infiltration&#44; validated with CD68 antibody and intra- alveolar macrophages were also present with septal compromise&#59; LMP1 &#40;EBV&#41; positive cells were not visualized&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The lung pattern seen in CAT as diffuse micronodules all over the lung parenchyme resolved after corticosteroid therapy&#46; The diagnosis of SLE was confirmed by ANA&#44; anti-dsDNA&#44; anti-nDNA and anti-histones positivity&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">To the best of our knowledge this is the first reported case of pulmonary SLE involvement with vasculitis and diffuse panbronchiolitis &#8211; like pattern as the first clinical sign of the disease&#46;</p>"
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Vasculite e padrão de panbronquiolite difusa no lúpus eritematoso sistémico – Caso clínico
Vasculitis and diffuse panbronchiolitis-like in systemic lupus erythematosus – Case report
Lina Carvalho1, Sara Freitas2
1 Professora de Anatomia Patológica. Faculdade de Medicina da Universidade de Coimbra
2 Pneumologista Eventual. Hospitais da Universidade de Coimbra
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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">O compromisso visceral pelo l&#250;pus eritematoso sist&#233;mico &#40;LES&#41; estende-se para al&#233;m do rim e da pele&#46; Les&#245;es pleuropulmonares s&#227;o reconhecidas e as formas de destrui&#231;&#227;o alveolar difusa e hemorragia alveolar s&#227;o as mais dif&#237;ceis de controlar&#46; O compromisso pulmonar na evolu&#231;&#227;o cl&#237;nica do LES difere nas crian&#231;as e nos adultos&#44; tanto nos padr&#245;es morfol&#243;gicos como nas apresenta&#231;&#245;es cl&#237;nicas&#44; dependendo da imunoincompet&#234;ncia do doente e do tratamento institu&#237;do&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Um rapaz de 16 anos apresentou um quadro cl&#237;nico de astenia&#44; cansa&#231;o e pequenos g&#226;nglios linf&#225;ticos cervicais bilaterais e n&#227;o dolorosos&#44; entendido como infec&#231;&#227;o pelo EBV&#44; com serologia concordante &#40;IgG e IgM de EBV e EBNA positivos&#41;&#46; Os sintomas persistiram durante oito meses e progressivamente instalou-se eritema nasal e malar&#44; discreto e descamativo e tamb&#233;m febre persistente&#44; dispneia e estertores basais &#224; ausculta&#231;&#227;o&#46; Foram efectuadas bi&#243;psia de um g&#226;nglio linf&#225;tico cervical e bi&#243;psia cir&#250;rgica pulmonar&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Observou-se hiperplasia folicular no g&#226;nglio linf&#225;tico e aus&#234;ncia de c&#233;lulas LMP1 &#40;EBV&#41; positivas&#46; Na bi&#243;psia pulmonar eram evidentes fen&#243;menos de bronquiolite e vasculite &#224; custa de c&#233;lulas macrof&#225;gicas identificadas pelo marcador CD68&#46; Os macr&#243;fagos dissociavam as paredes vasculares e bronquiolares e tamb&#233;m estavam presentes nos septos interalveolares peribroncovasculares e nos espa&#231;os alveolares&#44; observando-se assim um padr&#227;o de panbronquiolite difusa e vasculite&#46; N&#227;o se identificaram c&#233;lulas LMP1 &#40;EBV&#41; positivas&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">O padr&#227;o pulmonar micronodular bilateral observado na TAC resolveu com corticoterapia&#46; O diagn&#243;stico de LES foi confirmado pela positividade dos anticorpos ANA&#44; anti-dsDNA&#44; anti-nDNA e anti-histonas&#46;</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Este &#233; o primeiro caso divulgado na literatura m&#233;dica de compromisso pulmonar sob a forma de vasculite e pad&#227;o de panbronquiolite difusa como primeira manifesta&#231;&#227;o cl&#237;nica do l&#250;pus eritematosos sist&#233;mico&#46;</p>"
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