ABSTRACT
Reportamos el caso de un hombre de 42 años, seronegativo para VIH, con fiebre de origen desconocido (FOD), asociada a elevación de transaminasas y fosfatasas alcalinas con patrón colestásico e imágenes hepáticas hipodensas en la tomografía axial computada. La biopsia hepática demostró la presencia de granulomas tuberculosos con visualización de un bacilo con alcohol-ácido resistencia. El cuadro respondió al tratamiento con fármacos antituberculosos presentando caída de curva febril, mejoría del estado general y normalización de parámetros de laboratorio.
We report a 42 years old HIV negative male admitted for fever of unknown origin. Initial laboratory evaluation showed elevated hepatic transaminases and alkaline phosphatase and an hipodense hepatic imagen was visualized in the CT scan. Hepatic biopsy demonstrated tuberculous granulomas and alcohol fast acid rods with Ziehl Neelsen stain. Anti-tuberculous treatment resulted in resolution of fever, improvement of general condition and normalization of laboratory parameters.
Subject(s)
Humans , Male , Adult , Antitubercular Agents/therapeutic use , Mycobacterium tuberculosis/isolation & purification , Tuberculosis, Hepatic/diagnosis , Tuberculosis, Splenic/diagnosis , Biopsy , Fever of Unknown Origin/microbiology , Tomography, X-Ray Computed , Tuberculosis, Hepatic/drug therapy , Tuberculosis, Splenic/drug therapyABSTRACT
Renal transplantation can be done in patients with neurogenic bladder and clean intermittent sel catheterization maintains renal function. To retrospective assess the results of renal transplantation in patients with neurogenic bladder. The medical records of seven patients aged 10 to 22 years old (3 female) followed during 7 to 32 months were reviewed. All patients had urinary tract infection prior to transplantation, were instructed to self catheterization and received tri-associated immunosupression. Grafts came from alive related donors in 5 patients and from cadavers in 2. Prior to transplantation, 3 patients were subjected to nephrectomy and 3 to bladder enlargement, leaving a pigtail catheter. After transplantation, one lymphocele was drained, one uretherostomy due to an impacted lithiasis and one nephrectomy plus vesical enlargement due to intravesical pressures over 40 cm H2O, were done. One uretheral stricture was treated with dilatation. Seven episodes of pyelonephritis, 19 urinary tract infections and 77 asymptomatic bacteriurias were documented. Serum creatinine at the end of follow up ranged from 0.7 to 2.1 mg/dl. There were 0.7 acute rejection episodes per patient and all grafts survived. Renal transplantation in patients with neurogenic bladder is feasible, performing a vesical enlargement. There is however a high frequency of infectious episodes