S92 Abstracts from 8th Congress of the European Federation of Internal Medicine / European Journal of Internal Medicine 20S (2009), S1–S283 lower total lymphocyte count (878±518 vs 1230±697; p=0.003). Mortality was higher among patients with severe undernutrition grade. Conclusions: CONUT is useful for early detection of undernutrition and predicts mortality during admission for patients with AF. Keywords: Nutrition. Atrial fibrillation P0261 CHOROID PLEXUS CARCINOMA – A CLINICAL CASE Pedro Figueiredo , Corinna Lohmann, Henrique Santos. Hospital Garcia De Orta - Serviço De Medicina 1 - Almada/Portugal A 75 year old caucasian woman with a history of Sjogren Syndrome, osteo- porosis and head trauma, was admitted for a two -month history of weight loss, dysarthria, dysphagia, convergent strabismus and walking incapacity. MRI and CT-scan of the head showed a mass involving the majority of the cerebellar surface, following the course of the fifth and seventh nerves towards the para-sellar regions and along the infundibulum. The Cerebrospinal fluid showed a predominance of small lymphocytes, without clonal characteristics, investigation for cerebral and pulmonary tuberculosis was negative. The patient had been started on antibacilar and dexamethasone therapy, need- ing ventilatory support because of progressive deterioration of mental and clinical status, with consequent death. Autopsy was performed, revealing macroscopically white nodules of soft consistency and irregular size, involving the cerebellar peduncles, the upper portion of the brain stem (exit of cranial nerves) and the sella turca/optic chiasm. Further macroscopic examination of solid organs showed no evidence of malignancy. The immunohistochemical and cytokeratin analysis, in consideration of the lack of evidence of solid organ malignancy, suggests Choroid Plexus carci- noma (CPC). The CPC is an uncommon, aggressive, malignant tumour of the central nervous system and is associated with a poor prognosis. The presentation of this case is illustrated by explicit images of the autopsy and the histological exams. P0262 SKIN INVOLVEMENT IN SARCOIDOSIS Pedro Figueiredo , Corinna Lohmann, Henrique Santos. Departamento De Medicina Interna - Serviço De Medicina 1, Hospital Garcia De Orta, Almada, Portugal Sarcoidosis is a multisystemic granulomatous disease of unknown etiology, appears in young adults (20-40 years), histologically characterized by the presence of non-caseating granulomas in the organs involved. The isolated skin involvement occurs in 1/3 of patients at the time of presentation, the in- volvement of other organs comes after several months. The lesions frequently present in the form of erythema nodosum (15-34%), usually associated with bilateral hilar adenopathy and polyarthralgia - Löfgren syndrome. The authors describe a case of a female patient, Caucasian race, 55-year-old clerk, married, no children, no smoking. No allergies. Personal background of: Dyslipidemia, Hypertention, polio in childhood (sequelae in the right lower limb). Medical consultation observed in about 3 years by myalgia and increase of transaminases, was discharged keeping with usual medication sinvastatin. It was sent by your family doctor for the consultation of the plastic surgery in my hospital with the diagnosis of synovial cyst. Excision of the tumor allowed for the right wrist on 04/04/2008, the piece was sent for histopathological examination, with the result of granulomatous dermatitis compatible with sarcoidosis. The patient was referred to the consultation of Internal Medicine for additional study and follow. Of tests: TAC chest with discrete granulomas dispersed. Broncho-alveolar lavage with bronchial lining cells, alveolar macrophages, neutrophils and lymphocytes. Bronchial biopsy, outbreaks of metaplasia decks and mild nonspecific chronic inflammatory infiltrate. With this event aims to present a rare form of cutaneous involvement of this disease, that the biopsy allows the diagnosis. The decision to treat the skin manifestations depend on the location and nature of injuries. When it requires an attitude therapy, corticosteroids are the drugs of choice. The presentation of this case is illustrated by explicit images of the histological exams. P0263 INFECTIOUS DISEASES IN A HOME CARE UNIT Maria Jose Esquillor 1 , Jorge Gutierrez 1 , Aitziber Etxeberria 1 , Ruth Caballero 1 , Maria Teresa Rubio 1 , Catalina Isabel Gonzalez 1 , Valentina Fernandez 2 . 1 Hospital Reina Sofia; 2 Hospital De Navarra Background: Nowadays, with the development of Units of Care Home, some infectious diseases, what traditionally they needed treatment in the hospital, can be managed in patient’s house. Those patients with known and steady diseases, are taken care better at home, avoiding hospital secondary effects and improving welfare patient. Aims: The primary end point was to know the activity and the kind of infectious pathology in the unit of Care home of Hospital Reina Sofia de Tudela during a period of 26 months. Methods: Between November 2006 and January 2009, we have collected data on infectious diseases from all consecutively enrolled patients who have been seen after the introduction of Care Home in our Health Area. It is a descriptive study and we have pick up the following information: age; sex; number of days in the unit, who has decided the admission in the Unit, diagnostic, treatment received and destination Results: During this period of time, 751 patients have been admitted in the Unit 322 with infectious diseases (55% men) with an average age: 76.16 years. The average stay in the Unit was 8.25 days. With respect the main infectious diseases were: Respiratory infections 243 admittances (124 of them with pneumonia), urinary infection: 21, cellulites: 14, infected of ulcers: 12 incidents, diverticulitis: 7, unknown origin fever: 8, infection of biliar tract: 6, septic arthritis: 5 (3 of them infection of knee prosthesis), hepatic abscess: 3, one patient with oral candidiasis, one with herpetic encephalitis and one with maxillary sinusitis. As regard the final destination: 20 patients (6.2%) were admitted in the hospital because getting worse or a new process, 23 (7%) patients died and the rest were discharged. Conclusions: Pneumonias and respiratory infection disease, with and without COPD, represent the most frequent infectious pathology (75.5%) of admitted patients in the Unit. Morbi – mortality is similarly to other series, with a mean significantly lower average stay. P0264 DRUG RASH WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS SYNDROME INDUCED BY SULFASALAZINE Gulistan Bahat 1 , Hulya Gamze Celik 2 , Bulent Saka 1 , Fatih Tufan 1 , Cemil Tascioglu 1 . 1 Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; 2 Institute of Cardiology, Istanbul University Introduction: Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a delayed idiosyncratic systemic hypersenstivity syndrome re- ported with the use of several drugs. It is a rare but serious reaction which may be cause visceral organ involvements. It is most commonly associated with anticonvulsants and antibacterial sulphonamides. Sulfasalazine is a drug com- monly prescribed in rheumatology and gastroenterology practice. Besides its common dose related non-serious side effects, it causes a rare but sometimes fatal immunoallergic reaction named DRESS syndrome. Case: A 68 year old woman presented with oliguric acute renal failure, hypotension, fever and widespread maculopapular rash. She had a three year history of bilateral knee pain. She was given sulfasalazine (1 g/d) and prednisolone (5 mg/d) with a presumptive diagnosis of rheumatoid arthritis seven weeks prior to admission. One week before her presentation she de- veloped acute tonsillopharyngitis with fever for which she was given peroral sulbactam-ampicillin. Three days later a maculopapular rash appeared on her back and spread upwards and downwards to the whole body. In follow-up, rash persisted despite withdrawal of ampicillin and salazopyrine, and she developed marked eosinophilia, atypical lymphocytosis, hypotension, acute renal failure and cytolytic hepatitis. Viral serology for CMV, EBV, HIV, HBV and HCV were negative. DRESS syndrome was considered and she responded very well to moderate dose of methyl prednisolone which was tapered and ceased at the end of fourth week. In the follow up she was free of symptoms and complete blood count, creatinine, liver enzymes and function tests and electrolytes were all within normal limits. Conclusion: We conclude that DRESS syndrome is a rare but serious compli- cation of sulfasalazine treatment. The genetic susceptibility, viral infections or additional antibiotic use may be involved in its pathopysiology. Its treatment mainly consist of discontinuation of sulfasalazine and administration of glu- cocorticoid therapy. Increased awareness of this syndrome is essential among