sclerodermie anemie epilepsie
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7/18/2019 Sclerodermie Anemie Epilepsie
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Anemiemegaloblastică la o
pacientă cusclerodermie și
epilepsie
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I.Motivele internării
♀, 33 ani, reevaluare C-B +* Tumefacție mâini D>S
* Mialgii centuri
Artralgii inam –umeri
Artralgiimec -
genunchi↓G
3
kg/ 2
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II. A
!.• Scleroză sistemică - forma
cutanată difuză". • Alveolită #$ro%antă &n ca'rul SS
( • )+,
. • ,ile/ie gran' mal 0'e la !1 ani23
4. • utura 'e man/on rotator 'ret
1. • Anemie macrocitară &n tratament
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III. I/toricul $olii
!"
#$B%&Sdr' (a)naud * frig
luni&eg' edema.iate *m/ini, antebra.e
#urere in0am' * (CC,coate, S-1
Ac AntiScl56
> "66 7I
#2 SS45(6AC%&A7
A&8#94%:8
;
9loprost - <perfuzii
+Ciclofosfamidă
=!! mg
+ A97S + >#?
7% A%(6A&&(A&' @7A6B%A&5(
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(eevaluare → ?rogresia bolii
Clinic astenie, ponderală, indurare șiinDltrare tegumentară la nivelul m/inilor,antebra.elor, bra.elor, torace, fa.ă și mb'inferior, ulcera.ii digitaleE ușoară disfagie
solide, pirozis, abdomen ușor dureros lapalpare, Fn epigastru și fosa iliacă stg
Sdr' 9n0amator - 8 9 !":! m';< - =S (1
mm;h
$G2 T0-3 in =!: =": =(: aH la I!J
&ranzit baritat +,: /tomac hioton: hio?inetic
Dec "6!( – Sitalul Sf. Maria
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96A29S&9C
(O ?%657A(8 – fără le%iuni evolutiveulmonare
C& &5(AC$ - n. Inter/tițială – @+eammat@ – @onecoom$@
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CA?9A(5SC5?9$• capilare
dilatate
• Pemoragii
• rare zone
avasculare
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D,8 "6!( – BC= "6!
" C%($ #$
C9C545S4A69#89 TC<,ABE )7BE 9
,= - 8iclofo/fami'ă f FMe/na " f
" %ile ; lună: intra/italice/c
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$valuare pneumologică• 6A9 !"N
• 9A7 !"<
• Di/funcție re/.re/trictivă uGoară
• 8= H 5! 'in valre%i/ă
• D<8C 9 :!4 'in valre%i/a 'e J:5• 8T K
•
Di/funcție re/.re/trictivă uGoară• 8= H 5! re%i/ă• D<8C KKK• 8T BCMA<E2
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Tratament 'e fon'• 49B(5:8 ?%6 C57S59#A($ –ALATICIBE 46 M+: ( 8;LI
• >AS5#9A&A&5( – BI,DIIB, ,TAD !8 N
(;LI F ,BTCNII<IB, ! 8 N ";LI F 7B+7,BTB+
• #92$S&9> – DCM,IDCB, ! 8 N (;LI FCM,ALC< ! 8 N ";LI
• $?9$?S9$ – <,=,TIA8,TAM F 8A)AMAL,IBE08CBCM IBDI8AII<C M,DI87<7I B,7C<C+3
•
A(&(A299 –DI8<C,BA8 ICNI8AM M,<CNI8AM MAN !6
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!"<
Aci' olic 4mg;!c;" %ile
=it. )!" !666 mcg; !#;lună i.m.
A7$69$6$2A5B(AS&9C8
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S%?(AS59C9&A($
>$7&(9C%A(8#($A?&8;
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NO A<=,C<ITE I)CLABTE FS8<,C,MIL,M MCD,AT DI7L
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I=. ,Pamen clinic
• Micro/tomie
• liuri ra'iare
eriorale
• Ba/ /u$țiat
• Qtergerea liurilor'e ePre/ie
• Telangiecta%ii față:
torace anterior
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,NAM,B C)I,8TI=•
Dureri la nivelul centurilor /caulară Gi elvină:caracter miPt
• Tegumente in'urate 'ifu%
0m$ /u: m$ inf: față: a$'omen: torace3
• ierigmentare 'ifu%ă
•
io/u'orație
• Torace hier/onor 'ifu%
• e'ucerea ilo%ității
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* Tumefacțiamâinilor
0'r>/tg3* Scurtareafalangelor
'i/tale* Mo$ilitateartic re'u/ă
*** Acro/teoli%ă
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8icatrici /telate 'egetele II: III
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+onalgii $ilateral 0'r>/tg3 cu caractermecanic
8racmente $ilaterali'rartro%a genunchi 'ret
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>' ?A(AC979C
$9!6:R g;'l =,M9!!R:1;
=S9(! mm;h891:!5
Ac AntiScl 56 "66 7I
Anemiemegaloblastic
a
S'rinamator
Mar?erimunologic
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8reatinină /erică 9 6:6 mg;'l7ree /erică 9 !J:" mg;'l
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" 6 +
m
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#iagnostic ?5:9&9>Q
&5&A * httO;;.rheumtutor.com;"6!(-acreular-cla//i#cation-criteria-for-/clero'erma;
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Scor (odnan- !5 regiuni -
3
"
!
3
""
!
"
"
"
!
6 9 fărămo'i#cări
! 9 &ngroGareuGoară" 9 &ngroGareme'ie( 9 &ngroGaremaPimă
Scor acientăO
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>99' #iagnostic #94$($7R9AQ
Diffuse Limited - CREST
Skin involvement Distal and proximal
extremities, face, trunk
Distal to elbows, face
Raynaud’s
phenomenon
Onset within 1 year or at time of
skin changes
May precede skin disease by
years
Organ involvement Pulmonary (interstitial fibrosis);
renal (renovascular hypertensive
crisis); gastrointestinal; cardiac
Gastrointestinal; pulmonary
arterial hypertension after 10-15
years of disease in <10% of
patients; biliary cirrhosis
Nail fold capillaries Dilatation and dropout Dilatation without significantdropout
Antinuclear antibodiesAnti-topoisomerase 1 Anticentromere
* httO;;.me'icalcriteria.com;/ite;en;criteria;5R-rheumatolog;"6"-reu//.html
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=III. ,8CMABDEI I+I,BC-DI,T,TI8,
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N. A8TCI ,DI8TI)I<I TT 0/ecun'ară23*
* ,/ențialul &n eumatologie: rof. Dr. uPan'ra Ione/cu: ,'.Me'icală Amaltea
Scăderea#C5 *
predictor bun
al progresieispre 1&? Fnstadii
precoce
(Steen V. Arthritis Rheum
2005,52, 3698-
3700)
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IS8 ,D7S D,A,8TA, ,BA<E2
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NI. ATI87<AITEI<, 8AL7<7I
httO;;.nc$i.nlm.nih.gov;u$me';1RJR"(
E
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ATI87<AITEI<,8AL7<7I
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