Pulmonary paracoccidioidomycosis associated with septic shock in an immunocompetent patient. case report

ABSTRACT Introduction. Paracoccidioidomycosis (PCM) is a chronic granulomatous disease caused by the dimorphic fungus known as Paracoccidioides brasiliensis. This entity compromises mainly the lungs, but can spread to other organs, with particular trophism, through oral mucosa, adrenal glands, lymph nodes, among others. Case presentation. This paper reports the case of a male patient with pulmonary PCM treated at the Hospital Universitario de Santander. The patient was admitted with initial suspicion of active pulmonary tuberculosis due to the presence of multiple cavitations and nodules of random distribution in the lung parenchyma observed in the chest tomography, and subsequent isolation of yeasts compatible with Paracoccidioides. Amphotericin B deoxycholate was administered without favorable outcomes and development of septic shock by extended spectrum Klebsiella pneumoniae. In spite of multi-conjugate antibiotic management, the patient presented multiple organ failure syndrome with fatal outcome at 21 days of hospitalization. Conclusion. Pulmonary PCM is an endemic disease that leads to an inadequate immune response of the host that -along with risk factors such as smoking, alcohol abuse, malnutrition and low socioeconomic status- facilitates the onset of life-threatening infections or coexisting diseases. Timely diagnosis based on early clinical suspicion potentially influences the patient's survival.

Radiología intervencionista en trauma vascular periférico: Serie de casos / Interventional Radiology for the Management of Peripheral Vascular Trauma: Case Series

Antecedentes: El trauma es la tercera causa de mortalidad en la población mundial y la primera en el grupo etario de adultos menores de 44 años; de esta cifra, el 40-70 % se atribuyen al trauma vascular periférico. Tradicionalmente, el manejo quirúrgico ha sido la primera opción de tratamiento. No obstante, con los recientes avances tecnológicos y el auge de la radiología intervencionista, se han obtenido resultados exitosos a partir de opciones terapéuticas como las endoprótesis. Objetivo: Mostrar tres experiencias exitosas en el manejo con endoprótesis del trauma vascular de cuello, miembro superior e inferior, en un hospital de alta complejidad de Colombia. Casos clínicos: Se trata de tres pacientes con trauma vascular periférico producto de heridas por arma cortopunzante, en dos hombres, y por proyectil de arma de fuego en una mujer. En dos de los casos se evidenciaron pseudoaneurismas. En los tres casos se obtuvo adecuada resolución y exclusión de la circulación de las lesiones. Conclusión: El compromiso vascular ha aumentado su frecuencia en el contexto del trauma, por lo cual, es de importancia conocer su manejo óptimo. Actualmente, la reparación endovascular con endoprótesis en el trauma vascular periférico es un procedimiento mínimamente invasivo y con excelentes desenlaces para pacientes adecuadamente seleccionados.

Background: Trauma is the third leading cause of death among the world population and the first in adults under 44 years; from this, 40-70% is represented by peripheral vascular trauma. Traditionally, surgical management has been the first choice of treatment. However, with the technological advances in interventional radiology, successful outcomes have been obtained from therapeutical options such as with stent placement. Objective: To present three successful experiences after stent placement for the treatment of neck, upper and lower limbs vascular trauma at a high complexity hospital from Colombia. Clinical Cases: Three patients presented with peripheral vascular trauma, two men were wounded by sharp weapons men and one woman by a gunshot. In two of them, there was evidence of pseudoaneurysms. In the three cases, adequate resolution and exclusion from circulation were achieved. Conclusion: Vascular trauma has an increased frequency in general trauma context; hence, it is important to recognize its ideal management. Currently, stent placement for the management of peripheral vascular trauma is a minimally invasive procedure with excellent outcomes for properly selected patients.