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O desafio diagnóstico da doença desmielinizante no lúpus eritematoso sistémico : a propósito de um caso clínico
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Um amplo espectro de manifestações neurológicas pode acometer doentes com Lúpus Eritematoso Sistémico (LES), impondo, frequentemente, dificuldades diagnósticas e terapêuticas. Entre estas, a síndrome desmielinizante é um fenómeno raro, revestindo-se de dificuldades diagnósticas importantes na distinção com outras patologias inflamatórias desmielinizantes do sistema nervosa central (SNC), como a Esclerose Múltipla (EM), e levantando questões terapêuticas relevantes. Apresenta-se um caso de síndrome desmielinizante ocorrendo desfasado de flare lúpico, questionando-se o envolvimento primário do SNC pelo LES ou a sobreposição entre EM e LES. Procede-se a uma breve revisão das características distintivas entre síndrome desmielinizante no contexto de LES e EM.
A wide range of neurologic manifestations may affect patients with Systemic Lupus Erythematosus (SLE), frequently with great diagnostic and therapeutic challenges. Among these clinical conditions, the demyelinating syndrome is a rare phenomenon that commonly raises important diagnostic difficulties in the differentiation with other central nervous system (CNS) demyelinating inflammatory pathologies, such as Multiple Sclerosis (MS), as well as relevant therapeutic issues. The author present a case of demyelinating syndrome occurring dissociated from lupus flare, raising the question of primary CNS involvement by SLE or an overlap between MS and SLE. A brief review of the distinctive characteristics between demyelinating syndrome in SLE and MS is presented.
A wide range of neurologic manifestations may affect patients with Systemic Lupus Erythematosus (SLE), frequently with great diagnostic and therapeutic challenges. Among these clinical conditions, the demyelinating syndrome is a rare phenomenon that commonly raises important diagnostic difficulties in the differentiation with other central nervous system (CNS) demyelinating inflammatory pathologies, such as Multiple Sclerosis (MS), as well as relevant therapeutic issues. The author present a case of demyelinating syndrome occurring dissociated from lupus flare, raising the question of primary CNS involvement by SLE or an overlap between MS and SLE. A brief review of the distinctive characteristics between demyelinating syndrome in SLE and MS is presented.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2016
Palavras-chave
Lúpus eritematoso sistémico Mielite transversa Manifestações neurológicas Esclerose múltipla Sistema nervoso central Doenças autoimunes