Tuberculosis gastrointestinal como causa de hemorragia digestiva masiva en un paciente con infección por VIH / Gastrointestinal tuberculosis as a cause of massive gastrointestinal bleeding in a patient with HIV infection

Resumen La tuberculosis (TBC) gastrointestinal es una complicación infrecuente y fatal en pacientes con infección por VIH. Se presenta en 3-16% de las formas extrapulmonares y su principal localización es la válvula ileocecal y colon. La hemorragia digestiva baja con presencia de una o múltiples úlceras en colon es una presentación muy inusual de TBC intestinal. El diagnóstico se confirma por biopsia y cultivo del tejido intestinal. La cirugía en caso de perforación intestinal sigue siendo el tratamiento de elección. Se presenta el caso de un paciente con infección por VIH, sin tratamiento anti-retroviral, quien desarrolló una TBC diseminada con perforación intestinal y hemorragia digestiva masiva de curso fatal.

Gastrointestinal tuberculosis is a rare and fatal complication in patients with HIV infection. It occurs in 3%-16% of extra pulmonary forms. The main location in 90% of cases is the ileocecal valve and colon. The most unusual presentation of gastrointestinal tuberculosis is massive bleeding with the presence of one or multiple ulcers in the colon. The diagnosis can be confirmed by biopsy and by culture of intestinal tissue. Surgical resection is the treatment of choice. We report a case of a HIV-infected patient, who did not receive antiretrovirals, and who developed disseminated tuberculosis with intestinal perforation, presenting a fatal massive intestinal bleeding.

Enfermedad hidática diseminada con localización mediastinal como causa de síndrome de vena cava superior / Disseminated hydatidic illness with mediastinal location causing superior cave syndrome

Hydatidic illness is a frequent parasitic zoonosis in our country whose more frequent localization is the liver and the lungs. However other many sites have been described, depending their symptoms on the cyst's size, localization and effect on next structures, being sometimes its evolution fatal. This is a 52 year-oldfemale patient admitted at emergency room for dysfunction of sensory and neurological localization. She had a previous history of surgery many years ago by abdominal tumor. We found a collateal circulation on right hemithorax and facial arms edema at exam. The cerebral CT showed extensive left parietal parenchymal hemorrhage. Thoracoabdominal CT revealed multiple cystic masses of diverse sizes in the mediastinum, lungs, liver and other places. The patient's evolution was torpid, theneurological compromise didn't improve in spite of the treatment against the intracranial hypertension (EH), being also adde a nosocomial pneumonia. The patient died after several days. Necropsy revealed presence of cystic lesions in mediastinum, heart's great vessels, pericadium, lungs, liver, spleen and omentum, as well as intra and extraparenchymal hemorrhages of hipertensive cause in brain, not beig cystic lesions in central nervous system. We concluded that it was disseminated hydatidic illnes, cysts in themediastinum caused comprenssion of the heart's great vessels, causing a superior cave vin syndrome.