Factors related to deep vein thrombosis in patients with cellulitis/erysipelas at two high-complexity facilities. A case-control study

Lower extremity venous thromboembolism in the presence of soft tissue infection (cellulitis/erysipelas) is difficult to diagnose using clinical findings alone. This leads to an overuse of Doppler ultrasound, which is unnecessary in many cases. In Colombia, there are no studies to date reporting the simultaneous prevalence of these two conditions. Objective: to determine which factors are related to deep vein thrombosis in patients with lower extremity cellulitis/erysipelas. Materials and methods: a case-control study. Patients seen at Hospital Pablo Tobón Uribe and the university hospital between January 2018 and December 2019 who were diagnosed with cellulitis/erysipelas and underwent lower extremity venous Doppler. Demographic, clinical, laboratory and imaging variables were considered. Results: altogether, 637 patients with a diagnosis of lower extremity cellulitis and erysipelas were found during the study period in both institutions. Of these, 18.5% (118 patients) had a lower extremity Doppler ultrasound ordered to rule out deep vein thrombosis, finding a total of 25 positive studies (21.19%). Out of the total sample, 56 (47.4%) were male, with a mean age of 65 years. Most of the cases (55.08%) had an intermediate risk according to the Wells scale. The most common patient factors related to thrombosis were: immobility 33%, lymphedema 29.66%, and chronic kidney disease 23.73%. Neoplasms were the factor which showed statistical significance for the presence of thrombosis OR 5 (1.64-15.16) (P=0.0056). Conclusions: cellulitis is not a unique finding to justify carrying out a Doppler test, and the routine use of this imaging technique in the diagnostic approach is not justified if there are no other risk factors for thrombosis. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2109).

El diagnóstico de enfermedad tromboembólica venosa de miembros inferiores en presencia de infección de tejidos blandos (celulitis/erisipela): es difícil de determinar con sólo los hallazgos clínicos, lo que lleva a un sobreuso de la ecografía Doppler que resulta innecesaria en muchos casos. En Colombia a la fecha no hay estudios que reporten la prevalencia simultánea de éstas dos condiciones. Objetivo: determinar cuáles son los factores que se relacionan con trombosis venosa profunda (TVP) en pacientes con celulitis/erisipela en miembros inferiores. Materiales y métodos: estudio de casos y controles. Pacientes atendidos en el Hospital Pablo Tobón Uribe y la IPS universitaria entre enero de 2018 y diciembre de 2019 con diagnóstico de celulitis/erisipela y a quienes se les realizó Doppler venoso de miembros inferiores. Se consideraron variables demográficas, clínicas, paraclínicas e imagenológicas. Resultados: en total se identificaron 637 pacientes con diagnóstico de celulitis y erisipela de miembros inferiores en el periodo de estudio en ambas instituciones. De estos en 18.5% (118 pacientes) se solicitó ecografía Doppler de miembros inferiores para descartar trombosis venosa profunda, encontrando un total de 25 estudios positivos (21.19%). Del total de esta muestra fueron 56 hombres (47.4%) con una media de edad de 65 años. La mayoría de casos (55.08%), tuvieron riesgo intermedio según la escala de Wells. Los antecedentes más frecuentes relacionados con trombosis fueron: inmovilización 33%, linfedema 29.66%, enfermedad renal crónica 23.73%. La presencia de neoplasia fue el antecedente que demostró significancia estadística para la presencia de trombosis OR 5 (1.64-15.16) (P=0.0056). Conclusiones: la presencia de celulitis no es un hallazgo único que justifique la realización de Doppler, y el uso de imagen de rutina dentro del abordaje diagnóstico no está justificado si no existen otros factores de riesgo de trombosis. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2109).

Vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic syndrome (VEXAS syndrome) with prominent supraglottic larynx involvement: a case-based review.

Vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic syndrome (VEXAS syndrome) is a recently described genetic disorder that gathers autoinflammatory symptoms and myeloid dysplasia. The first description was reported in 2020, and subsequently, a growing number of cases have been described worldwide. Herein, we describe a case of a 72-year-old male patient with VEXAS syndrome with p.Met41Val mutation of the UBA1 gene, prominent supraglottic larynx involvement, and costochondritis. To our knowledge, this is the first report of VEXAS syndrome in Colombia and South America. This disease could present features of relapsing polychondritis, polyarteritis nodosa, giant cell arteritis, and Sweet syndrome, associated with hematologic involvement, including cytopenias, myelodysplastic syndrome, or thromboembolic disease. Supraglottic larynx chondritis and costochondritis are atypical manifestations. These features were proposed previously to differentiate relapsing polychondritis from VEXAS syndrome but are not entirely reliable like in the case described. A diagnosis of VEXAS should be considered in male patients with incomplete or complete features of the previously described conditions, refractory to treatment, requiring high-dose glucocorticoids, and associated progressive hematologic abnormalities. Key Points • VEXAS syndrome is a recently described genetic (somatic mutations in UBA1 gene) disorder that gathers autoinflammatory and hematologic manifestations. • VEXAS syndrome should be considered in male patients with incomplete or complete features of relapsing polychondritis, polyarteritis nodosa, giant cell arteritis, and Sweet syndrome, refractory to treatment, associated with hematologic involvement, including cytopenias, myelodysplastic syndrome, or thromboembolic disease. • Glucocorticoids ameliorate symptoms effectively. However, other treatment options are limited due to a lack of evidence. Traditional immunosuppressants and biological therapy have been used empirically with limited efficacy and a transient effect. Bone marrow transplant offers a curative approach, but it has high morbidity and mortality.

It is time to adapt the definition of chronic kidney disease according to age

Abstract Chronic kidney disease is a condition with high morbidity, mortality and healthcare costs which affects all population groups, having a significant impact on their quality of life. Its classification has been modified over time and there is still no universal consensus to differentiate a physiological change in kidney clearance from a pathological change. Below, we will discuss the importance of reconsidering the definition and classification in the general population according to age, including children and adults. (Acta Med Colomb 2021; 46. DOI:https://doi.org/10.36104/amc.2021.2080).