Abílio Gonçalves’s research while affiliated with Hospital da Figueira da Foz and other places

Cystic cuboid adenomatous malformations (CCAM) are congenital pulmonary lesions, usually benign, that can progress into malignancy. Bronchopulmonary sequestration (BPS) is another type of malformation that consistsof an ectopic pulmonary tissue mass that doesn’t participate in blood-gas exchanges, with vascularization provided by anomalous branches of the thoracic aorta. Hybrid lesions are lesions that have histological features of CCAM but with systemic vascularization, a pathognomonic sign of BPS. These lesions are rare and difficult to diagnose. The diagnoses are mostly made in the pre-or neonatal phases of life. The diagnosis in adults is uncommon. The treatment is surgical resection of the lesion or wedge lobectomy. The case report describes a case of a hybrid lesion diagnosed in an asymptomatic adult, as well as a review of the adequate diagnostic workup for pulmonary lesions. In the literature, there are few cases of congenital lung lesions described in adults.

Introduction: Although scarce, regional telestroke networks have been developed worlwide in the last few decades. The COVID-19 pandemic put the healthcare system under exceptional pressure. We aimed to assess the impact of the first year of the COVID-19 pandemic on the telestroke network performance in the central region of mainland Portugal. Methods: Retrospective multicenter cohort study including the eight hospitals of the regional stroke network. The first year of the COVID-19 pandemic (19/03/2020 to 18/03/2021) was compared with the period that preceded it, between 01/01/2018 and 18/03/2020. We analysed the number of telestroke consultations, the number of patients transferred for endovascular treatment, time metrics and functional outcome (measured using the modified Rankin Scale at three months). Results: The number of consultations per day and patients transferred per day for endovascular therapy increased 8.2% and 12.9% during the COVID-19 period, respectively. The period between symptom onset/last known well (LKW) moment and admission to the primary hospital (LKW – Door 1 interval) increased by 95.8 minutes (159.5 vs 255.3, p<0.01), as well as the period between admission to the primary hospital and the tertiary hospital (Door1 – Door 2 interval): an increase in 18.5 minutes; 205.6 vs 224.1, p=0.04. The Door 2 - groin puncture interval decreased by 6.7 minutes (49.4 vs 42.7, p=0.08) and the Door 2 – reperfusion period decreased by 24.2 minutes (101.9 vs 77.7, p<0.01). The functional outcome of transferred patients was not affected by the pandemic (OR 0.66 [95%CI 0.7-1.3], p=0.79). Conclusion: This study showed divergent results in different domains of the stroke care chain. Our results support the relevance of well-established telestroke networks in acute stroke care, especially during periods of high pressure on the public health systems.

A síndrome de DRESS (drug rash with eosinophlia and systemic symptoms) trata-se de uma reação de hipersensibilidade induzida por fármacos, rara, complexa e potencialmente fatal. Geralmente evolui com erupção cutânea, alterações hematológicas, linfadenopatia, com envolvimento de órgãos. Os autores apresentam o caso clínico de um homem caucasiano de 79 anos que deu entrada no serviço de urgência devido a uma queimadura no tórax e abdómen após férias e exposição solar sem proteção solar. A sua medicação habitual há 2 anos é: perindopril+amlodipina, sinvastatina e alopurinol. Apresentava também um eritema maculopapular pruriginoso no dorso e erupção eritematosa confluente nos membros inferiores, semelhantes a lesões purpúricas. Dados laboratoriais demonstraram linfopenia e elevação das enzimas hepáticas. De acordo com o score RegiSCAR, este caso classifica-se como provável síndrome de DRESS. O alopurinol foi suspenso imediatamente e foi iniciada prednisolona. Foi observado um mês depois, com melhoria progressiva das lesões. O diagnóstico da síndrome de DRESS é desafiante e deve-se suspeitar do seu diagnóstico num doente sob fármacos de alto risco com clínica característica. A abordagem inicial consiste no tratamento de suporte e na suspensão imediata do fármaco. No caso apresentado, o doente queixava-se de queimadura, mas apresentava uma toxidermia por alopurinol que se manifestou de forma bizarra.

Bone metastasis might be associated with several tumors; however, the association between gastric malignant neoplasms and bone secondary lesions is very rare, with the osteoblastic form having the rarest presentation. In fact, osteoblastic lesions, as the first presentation of gastric adenocarcinomas, are even rarer and known to have a very poor prognosis associated with them. Therefore, we present a clinical case of a patient with lower back pain as the first symptom, which led to the diagnosis of osteoblastic lesions of the spine and iliac bones, suggested as secondary lesions. Later, the investigation of the primary tumor led to the diagnosis of a gastric adenocarcinoma (stage IV disease). In this report, we highlight the steps taken for the etiological study course and the challenges associated with them from the beginning. We also emphasize the very unfavorable evolution of our patient, with the inability to carry out targeted treatment, neither curative nor palliative, due to the advanced stage of the disease and the very poor survival time associated with it.

Celiac disease is a relatively common autoimmune disease that affects the gut's ability to process gluten. It is frequently associated with other autoimmune diseases. In this article, the authors present a clinical case of a 65-year-old female patient with a history of celiac disease and autoimmune hypothyroidism. This patient was admitted to the emergency room with generalized edema and chronic diarrhea with mucus as well as reports of unusual weight loss. A requested fecal analysis tested positive for fecal calprotectin. An endoscopic study further displayed flattening of the intestinal villi. A subsequent biopsy expressed overlapping evidence for both celiac disease and lymphocytic colitis. This case illustrates how a diagnosis of microscopic colitis should be explored when celiac patients with a history of a stable gluten-free diet display a sudden onset of chronic diarrhea. As the symptoms associated with this disease can often become debilitating, an early diagnosis and treatment are crucial.

Lymphomas result from the proliferation of malignant lymphocytes, which can affect lymph nodes, blood, and other organs. Primary involvement of the spine by haematological diseases is rare. Non-Hodgkin's lymphoma with an extranodal location most frequently involves the gastrointestinal tract and airways, affecting the bone, muscle, and nervous system. We present a clinical case of an atypical form of non-Hodgkin's lymphoma. A 78-year-old woman was admitted to the hospital with complaints of pain in the lumbar region, hip, and left leg for the last month. Computed tomography of the lumbar spine revealed a mass of left paravertebral tissue with involvement from L3 to L5. Thoraco-abdominal CT-guided biopsy revealed diffuse large-cell non-Hodgkin B lymphoma. The remainder of the study did not show lymphatic involvement, so a diagnosis of primary extranodal large cell non-Hodgkin B lymphoma was made.

Background: Blood pressure variability (BPV) is a predictor of short- and long-term disability in patients with acute ischemic stroke (AIS). Its effect on more immediate functional outcomes has been seldom studied, and the results are inconsistent. We aimed to determine the role of BPV during the first 5 days of hospitalization in functional status at the time of discharge of patients with AIS. Methods: We enrolled 134 patients diagnosed with AIS and BPV using standard deviation and coefficient of variation (CV %). These were associated with the dichotomized modified Rankin Scale at discharge using logistic regression. Results: Patients with unfavorable outcomes were significantly older (P=0.014), had a lower body mass index (P=0.001), were less likely to present with dyslipidemia (P=0.001), had lower serum triglyceride levels (P=0.012), had a longer hospitalization period (P<0.001), and had a higher mean National Institutes of Health Stroke Scale score at admission (P<0.001). After adjusting for multiple confounders, the CV % of systolic blood pressure (SBP) in the first 120 hours after admission had a significant effect on functional disability at discharge. Conclusion: Variability in SBP in the first 5 days of hospitalization had a deleterious effect on the functional outcomes at discharge of patients with AIS. The role of diastolic BPV seems to be significant only in the first 24 hours of admission; however, further research is required.

Ramsay Hunt syndrome is a rare complication of herpes zoster that results from reactivation of varicella-zoster virus in the geniculate ganglion of the VII cranial nerve. Immunosuppression can lead to reactivation of latent varicella-zoster virus, resulting in herpes zoster. Here, we present a case of Ramsay Hunt syndrome in a patient with ulcerative colitis under treatment with infliximab. Learning points: Ramsay Hunt syndrome is a rare form of herpes zoster and characterized by the presence of otalgia, facial palsy, vertigo and vesicular rash in the external ear or on the oropharynx.Treatment with TNF inhibitors increases the risk of its development.Although not generally recommended, vaccination may reduce the risk of herpes zoster recurrence during TNF inhibitor therapy.

Cutaneous infections caused by the Mycobacterium chelonae complex show a heterogeneous clinical presentation, which varies according to the patient's immune status. Most standard antimycobacterials have no effect against these species. Clarithromycin alone was shown to provide adequate treatment, although resistance has been reported. Consequently, the literature supports multi-drug therapy to combat resistant strains. Here, we describe the case of a 59-year-old man under systemic immunosuppressive therapy who developed cutaneous lesions whose evolution was highly suggestive of atypical infection. Learning points: Mycobacterium chelonae is a ubiquitous species of mycobacteria found in the environment; cutaneous infections by the M. chelonae complex show a heterogeneous clinical presentation.The combination of linezolid and clarithromycin has been used in some cases, with rapid clinical resolution and less or no relapse observed after long-term follow-up.Internal Medicine is the appropriate speciality to treat particularly complex or multisystem diseases, such as infections in immunocompromised patients.

A síndrome de Löfgren é uma forma de apresentação aguda da sarcoidose que ocorre em até metade dos indivíduos com esta doença. O seu diagnóstico é mais frequente em mulheres caucasianas até aos 35 anos. Caracteriza-se pela tríade: eritema nodoso, linfadenopatias hilares bilaterais e poliartralgias.A sarcoidose nodular trata-se de uma variante rara da sarcoidose cujo padrão, por mimetizar outras patologias, atrasa o diagnóstico de sarcoidose.Descrevemos o caso de uma mulher caucasiana, de 30 anos, que recorreu ao Serviço de Urgência por edema dos membros inferiores e artralgias com seis dias de evolução. Analiticamente, apresentava elevação dos parâmetros inflamatórios, da velocidade de sedimentação e anemia. Radiografia torácica com alargamento dos hilos. A tomografia computorizada do tórax mostrou vários nódulos mediastínicos, hilares e pulmonares.Apresentamos a marcha diagnóstica de uma variante rara de sarcoidose com uma apresentação clínica típica.