Leonardo Gilardi | Universidad de Buenos Aires (original) (raw)

Papers by Leonardo Gilardi

Cancer Biol Med, 2015

Objective: To study the main clinical and histopathological features of 12 patients with Hodgkin'... more Objective: To study the main clinical and histopathological features of 12 patients with Hodgkin's lymphoma (HL) diagnosed primarily from bone marrow (BM) involvement. Methods: We included 12 acquired immunodeficiency syndrome (AIDS) patients with HL assisted in the F. J. Muñiz Infectious Diseases Hospital since January 2002 to December 2013. The diagnosis of HL with primary BM involvement in patients was confirmed by clinical, histopathological, and immunohistochemical findings. Results: All patients presented "B" symptoms and pancytopenia. All of them had stage IV neoplasm disease because of BM infiltration. The median of CD4 + T-cell counts was 114 cells/μL, and mixed cellularity (MC) was the most frequent histopathological subtype of 92% cases. Conclusion: When other causes are excluded, BM biopsy should be performed in AIDS patients with "B" symptoms and pancytopenia to evaluate BM infiltration by atypical lymphocytes. KEYWORDS Acquired immunodeficiency syndrome (AIDS); Hodgkin's lymphoma (HL); bone marrow (BM)

Revista de la Sociedad Venezolana de Microbiología, Nov 26, 2012

Recibido 28 de septiembre de 2011; aceptado 4 de marzo de 2012 Resumen: La neurosífilis se asocia... more Recibido 28 de septiembre de 2011; aceptado 4 de marzo de 2012 Resumen: La neurosífilis se asocia con distintos síndromes clínicos neurológicos, en especial en enfermos con compromiso del sistema inmunitario. No obstante, la afección aislada del canal medular es poco frecuente. Se presenta una paciente inmunocompetente, con antecedentes de un parto reciente eutócico con pareja estable y sin epidemiología evidente para infecciones de transmisión sexual, que se presentó a la consulta con paraparesia asimétrica con hipoestesia agregada. Mediante pruebas complementarias se llegó al diagnóstico de neurosífilis. Se destaca la consideración de esta entidad entre los diagnósticos diferenciales del síndrome mielítico, incluso en sujetos sin alteraciones de la inmunidad.

Journal of family medicine and primary care, 2014

Clinical presentation of primary human immunodeficiency virus (HIV) infection includes a wide spe... more Clinical presentation of primary human immunodeficiency virus (HIV) infection includes a wide spectrum of manifestations from asymptomatic infection to a symptomatic and severe illness. Central nervous system involvement should be always considered as a severe clinical form of primary HIV infection. Physicians should be aware to the broad clinical spectrum of primary HIV infection. We report a case of a female with diagnosis of mononucleosis-like syndrome and acute aseptic meningoencephalitis during primary HIV infection.

$Research paper thumbnail of Refractory recurrent bleeding as a late mortal complication of chest wall irradiation$

Annals of Thoracic Medicine, 2011

Radiation therapy is used to treat breast malignancies. Old external radiotherapy protocols inclu... more Radiation therapy is used to treat breast malignancies. Old external radiotherapy protocols included high-dose schedules and were associated with late complications. We describe the case of a 72-year-old woman who was admitted with recurrent bleeding from chest wall. Arteriovenous fi stulae were diagnosed. Embolization therapy was initially successful, even though the bleeding episodes became recurrent. Arteriovenous fi stulae should be included among differential diagnosis of thoracic bleeding in patients with history of local radiation therapy. The prognosis is poor and endovascular treatment may be considered a fi rst-line treatment.

Revista De Neurologia, 2003

Journal of Orthopaedics, Trauma and Rehabilitation, Jun 1, 2011

Global dermatology, 2016

Introduction: Epidemic AIDS-associated Kaposi´s sarcoma (KS) is the most aggressive form of this ... more Introduction: Epidemic AIDS-associated Kaposi´s sarcoma (KS) is the most aggressive form of this neoplasm and is strongly associated with the reactivation of human herpesvirus type 8 (HHV-8), particularly among men who have sex with men. Objectives: To evaluate the presence of HHV-8 DNA in the biopsy smears of 31 patients with different clinical forms of AIDS-associated KS. Materials and methods: Epidemiologic, clinic, immunologic and virologic characteristics of 31 HIV infected patients with KS were included in this descriptively and retrospectively analysis from 2010 to 2013. KS was classified in four clinical forms including only cutaneous lesions, only mucosal involvement, mucocutaneous compromise and disseminated disease. The detection of DNA HHV-8 was performed by polymerase chain reaction (PCR) in all biopsy smears by tissue disruption to perform the DNA extraction, DNA purification by spectrophotometry analysis and DNA amplification with specific oligonucleated primers. Results: Thirty patients were male, the median of age was 34 years and the most frequent risk factor for HIV infection was unprotected sexual contact (90%). The median of time between HIV infections to neoplasm diagnosis was 6 years. In 11 patients (35%) KS was the first defining illness. The median of CD4 T cell count at the time of neoplasm diagnosis was 39 cell/µL. The majority of patients (84%) were not receiving highly active antiretroviral therapy (HAART). Clinical forms includes 12 patients with cutaneous KS, 8 patients with mucosal KS, 7 patients with disseminated disease and 4 patients with mucocutaneous involvement. PCR HHV-8 was positive in 24 (77%) biopsy smears. When we analyzed this group the median of age was 34 years, the median of time between HIV infection to neoplasm diagnosis was 9 years, the median the median of CD4 T cell count was 39 cell/µL and only 5 patients were receiving HAART at the time of diagnosis. No significant difference was observed between the HHV-8 positive and negative probable due to the small size of the cohort. Conclusion: Although HHV-8 DNA was detected in a high number of patients in these series, it is possible that other mechanisms may be involved in the pathogenesis of AIDS-associated KS.

Annals of Tropical Medicine and Public Health, 2012

Background: Tuberculosis (TB) is an emerging health problem despite the advances in the methods o... more Background: Tuberculosis (TB) is an emerging health problem despite the advances in the methods of diagnosis and treatment. The resurgence of tuberculous spondilodiscitis (TBSD) or Pott's disease can be expected to be associated with a concomitant increase in the incidence of extra-pulmonary TB. Aim: To describe the clinical features, imaging findings, and laboratory diagnosis in a group of patients with TBSD. Materials and Methods: From January 1 st 2000 to December 31 st 2010, we retrospectively reviewed 22 cases of spinal TB. Only those with positive culture results and/or characteristic clinical and pathological findings were enrolled. Demographic data, comorbilities, clinical manifestations, time up to the definitive diagnosis, outcome and sequelae were considered. Results: During the study period, 22 patients were diagnosed with TBSD; 14 were men and 8 women with a median of age of 34 years at the time of diagnosis. The median duration of symptoms before the TBSD diagnosis was 120 days (range 30 to 360 days). At the time of diagnosis, fever and back pain were the most common clinical symptoms; 7 patients (32%) had fever and 21 (95%) had spinal pain; eleven patients (50%) had constitutional symptoms; 6 (27%) had respiratory symptoms and 3 (13.6%) had neurological manifestations. Magnetic resonance imaging (MRI) was performed in 9 (40%) cases, computed tomography (CT) in 7 patients (32%), and abdominal ultrasound in 6 cases (27%). The lumbar spine was the most commonly involved site (14 patients, 64%); thoracic spine was involved in 2 patients (9%); dorsolumbar spine was compromised in 4 cases (18%). Cervical spine was only involved in one patient (4.5%) and the last patient (4.5%) presents a global spinal involvement (cervical-thoracic and lumbar spine). Conclusion: Insidious clinical course and ambiguous manifestations of TBSD often delay the accuracy of diagnosis. Spinal TB should be included in the differential diagnosis of patients with prolonged back pain and fever.

Revista Chilena De Infectologia, Aug 1, 2011

Hepatic abscess as fi rst manifestation of pneumococcal invasive disease Pneumococcal invasive di... more Hepatic abscess as fi rst manifestation of pneumococcal invasive disease Pneumococcal invasive disease is an important cause of morbidity and mortality in different population groups. Most cases originate from an airway infection. We describe a patient with diabetes mellitus who presented a liver abscess as fi rst manifestation of pneumococcal invasive disease, without respiratory symptoms. The patient was treated with percutaneous drainage and systemic antibiotics with good results. Streptococcus pneumoniae should be considered among the possible etiologies of hepatic abscess, even in absence of respiratory symptoms.

Global dermatology, 2018

as solar lentigo; both photoprotection and repeated humectation of skin were prescribed. Lesions ... more as solar lentigo; both photoprotection and repeated humectation of skin were prescribed. Lesions sharply improved and treatment with methotrexate and adalimumab were continued (Figure 1). Discussion Simple lentigo and solar lentigo are benign skin diseases. During natural history of both conditions, hyperpigmented lesions persist even if sunlight exposure is interrupted, so local dermatological treatment is usually required. Lentigines may evolve over years or even decades, or they may be eruptive and appear rather suddenly. Pigmentation may be homogeneous or heterogeneous, ranging from brown to black. Solar

Brazilian Journal of Infectious Diseases, Nov 1, 2012

Most head and neck infections are due to odontogenic ethiologies. 1 Complications may include loc... more Most head and neck infections are due to odontogenic ethiologies. 1 Complications may include locoregional collections and systemic dissemination, but scientific publications concerning the role of the Internal Medicine Service in diagnosis and treatment are lacking. We present a retrospective review of medical records from June 2005 to May 2009 from a tertiary care hospital in Buenos Aires. The inclusion criterion was hospitalization for an odontogenic infection in adult patients with normal immune function. In the study period, 18 patients (44% males) were identified, and represented 0.1% of all admissions during the study period. Median age was 28 years and mean length of stay (LOS) was 3.72 ± 1.74 days; both were significantly lower than the respective values for the entire admitted population. All patients were evaluated by a trained odontologist before admission. Trismus was the only symptom that was consistently present in all patients. Localized collections were diagnosed by computed tomography in seven patients. In six cases, infection originated in the lower third molars (17 th or 32 nd tooth in the Universal Numbering System). Initial white blood cell (WBC) count was significantly correlated with LOS and need for surgical drainage. Hemocultures and abscess cultures were negative. All patients were treated with systemic corticosteroids and ampicillin-sulbactam, except for a subject with penicillin allergy history, who received clindamycin. No other complications or death were recorded. No tooth extraction was performed during hospitalization; all subjects underwent this procedure during outpatient follow-up. An interdisciplinary approach should be considered because odontogenic infections may be associated with high morbidity rates. 2 Patients included in this study were significantly younger than the population admitted for all causes, which is consistent with previous research. 3 The most frequently involved teeth were the lower third molars, as previously cited. LOS was shorter than in other similar case studies 2,3 and correlated significantly with total WBC count at admission. However, we could not exclude bias due to corticoids administration before hospitalization, based on lack of data. Neither hemocultures nor abscess cultures were useful tools for choosing or modifying antibiotic treatment. Aminopenicillins may be considered the gold standard of treatment. 4 Lack of utility of microbial cultures is a relevant issue with potential impact in terms of healthcare resources. Conclusions should be confirmed in larger prospective studies at the tertiary care level.

Revista De Neurologia, 2010

International Archives of Otorhinolaryngology, Oct 1, 2015

Introduction Plasmablastic lymphoma is a rare entity that was first described in the jaws and the... more Introduction Plasmablastic lymphoma is a rare entity that was first described in the jaws and the oral cavity of patients with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). Plasmablastic lymphoma is considered as a diffuse, large, B-cell lymphoma with a unique phenotype and a predilection for the oral cavity. Objective The authors describe a case of an aggressive plasmablastic lymphoma of the oral cavity as the primary manifestation of AIDS. Resumed Report We report a case of plasmablastic lymphoma involving only the oral cavity as the first manifestation of AIDS. Diagnosis was confirmed by the oral lesion biopsy and the histopathologic examination that showed a dense infiltrate composed of atypical lymphocytes with numerous plasmocytes that expressed the plasma cell markers MUM-1 and CD138 and that were negative for the B-cell markers CD3, CD20, and CD45. Immunohistochemical and in situ hybridization revealed the Epstein-Barr virus genome in the atypical cells. Polymerase chain reaction was also positive for human herpesvirus-8 RNA. Conclusion The HIV serologic status should be evaluated in all patients with plasmablastic lymphoma of the oral cavity or extraoral sites.

Revista Clinica Espanola, Jul 1, 2012

Archivos argentinos de pediatría

Revista de Neurología, 2003

Revista de Neurología, 2010