Maria Isabel Sanchez-oro Vallés (Spain)
Institut Catala de la Salut CAP Sant PereAuthor Of 2 Presentations
ACHENBACH SYNDROME
Abstract
Abstract Body
Background and purpose
Paroxysmal hematoma of the fingers refers to a clinical picture where patients suffer sudden episodes of pain and edema of one or more fingers with subsequent appearance of predominantly hematomas in the palmar region of the proximal phalanges. It is a rare and benign process of unknown etiology. The first symptoms are severe pain, tingling and itching prior to the change in skin color. There is self-limited subdermal bleeding that disappears in the following days. The diagnosis is clinical with normal complementary tests. The main differential diagnosis is with acute ischemic processes because they have a similar presentation. Its evolution is benign and resolves without leaving sequel.
Methods and results
A 64-year-old female patient,without allergies, non-smoker, with a history of hypertension, dyslipidemia and anxiety. Current treatment, alprazolam 0.25mg/8 hours, bisoprolol 5mg/24 hours, hydrosalurethyl 50mg/24 hours, simvastatin 20mg/24 hours.
Consulting for sudden and very intense pain with subsequent appearance of hematoma in the palmar region of the fourth finger of the right hand. At the time of the examination, she had no pain with correct mobility,we observed hematoma at proximal phalanx and the middle of the fourth finger. Good distal capillary filling, radial and ulnar pulse present. Analytical non-coagulation alterations rule out autoimmune diseases. Arterial echo Doppler of the upper limb without alterations. Evolutionary control in 5 days shows process in resolution.
Conclusion
Although it´s a rare entity to see in the consultory,it´s necessary for the general practitioner to be aware of it in order to be able to advise the patient correctly and avoid unnecessary complementary studies.
PERNICIOUS ANEMIA (PA)
Abstract
Abstract Body
Background and purpose
Pernicious anemia (PA), also known as Addison-Biermer disease, is a type of megaloblastic anemia caused by autoimmune gastritis or chronic atrophic gastritis type A, characterized by the destruction of the gastric mucosa, especially the fundic mucosa. The differential diagnosis includes Vitamin B12 deficiency and Celiac disease.
A 47-year-old patient who consulted for recurrent oral thrush for a year. Uninteresting personal history. First analysis: Hemogram: Hb 14.9g/dL; VCM 106 fL; VitB12 120*pg/ml; Folic 6.12 ng/mL; IgA 479 mg/dL; Anti-transglutaminase 1.5 U7mL. Physical examination: oral thrush, restless. Second analysis: Hb 10.8 g/dL, VCM 116 fL, VitB12 147.00*pg/ml.
Method and results
The case was addressed as a vitamin b12 deficiency due to diet (strict vegetarian), deciding to start treatment with oral vitamin b12 and reassess in 3 months. But the patient did not attend the consultation for a year and on his return he presented a feeling of fullness, early satiety, bloating, belching, nausea, and vomiting. Analytical control detected megaloblastic anemia. Given the high suspicion of PA, he was referred to hematology to request anti-intrinsic Facto and Anti-parietal cell antibodies. We started cyanocobalamin im. The results were positive for anti-intrinsic factor antibodies. The patient improved his symptoms while the diagnosis was confirmed.
Conclusion
PA is the most common cause of megaloblastic anemia in our surroundings. Its incidence increases with age and is rare in people under 30 years of age. Treatment with intramuscular cyanocobalamin is for life. It is related to an increase in the incidence of gastric neoplasms, and the general practitioner must search to avoid complications.