Exoftalmos unilateral de corta evolución. Una forma de debut de un neuroblastoma / Unilateral exophthalmos with short evolution. One way to debut a neuroblastoma

El neuroblastoma (NB) es el tumor extracraneal sólido más frecuente en la infancia. Representa el 7% de los cánceres pediátricos. Se origina de la cresta neural, y puede aparecer en cualquiera de los sitios anatómicos a lo largo de la cadena ganglionar simpática, así como en la glándula suprarrenal. El 90% ocurre en menores de 5 años. Presenta un amplio espectro de comportamiento clínico. Los estudios muestran metástasis orbitarias en el 10-20% de los casos. La proptosis y equimosis periorbitaria son consideradas dos de los signos clásicos del neuroblastoma en niños. Presentamos el caso de una paciente de 4 años de edad con un neuroblastoma metastásico que se manifestó como una proptosis de corta evolución al diagnóstico, sin otro tipo de sintomatología ni hallazgos en la exploración física. Tras las pruebas complementarias, se la diagnosticó de neuroblastoma estadio IV de la INSS (The International Neuroblastoma Staying System). No se localizó el tumor primario. Se realizó tratamiento con quimioterapia de inducción, terapia de acondicionamiento y trasplante autólogo de progenitores hematopoyéticos, entrando en remisión completa. Posteriormente inmunoterapia, manteniendo enfermedad residual negativa. Queremos destacar la importancia de un diagnóstico precoz en esta patología de cara a la supervivencia del paciente, y que siempre debe considerarse el diagnóstico de NB ante un exoftalmos en un paciente previamente sano. El tratamiento de los pacientes con neuroblastoma de alto riesgo es multimodal, habiendo mejorado el pronóstico el uso combinado de inmunoterapia, ácido 13 cis-retinoico y trasplante autólogo de médula ósea

Neuroblastoma (NB) is an extracranial solid brain tumor found most frequently during childhood. It represents 7% of the pediatric cancers. It originates in the neural crest and can appear in any part of the anatomy along the ganglionic sympathetic chain, as well as in the adrenal gland. 90% of cases occur en children under the age of 5. It presents a broad spectrum of behavior. Studies have shown orbital metastases in 10-20% of cases. Proptosis and ecchymosis periorbitary are considered two classic signs of neuroblastoma in children. We are presenting a case of a 4 year old female patient with metastatic neuroblastoma that manifested like a proptosis of short evolution to its diagnosis, without any other type of symtomatololgy or findings in the physical exploration. After complementary tests she was diagnosed with stage IV neuroblastoma in the INSS (The International Neuroblastoma Staying System). The primary tumor was not located. Complete remission was obtained using induction chemotherapy, conditioning therapy and autologous hematopoietic progenitors transplant. After immunotherapy negative residual disease was maintained. We would like to highlight the importance of early diagnosis in this pathology facing the patient’s survival and must always consider the NB diagnosis when an exophthalmos presents in a previously healthy patient. Treatment in patients with high risk neuroblastoma is multimodal, having improved the prognosis by using a combination of immunotherapy, 13-cis-retinoic acid and the autologous bone marrow transplant

Tos ferina maligna en un neonato de 25 días / Malignant pertussis in a 25-day-old newborn

Se presenta el caso de una niña de 25 días con tos ferina maligna, con una sintomatologfa clínica al ingreso compatible con bronquiolitis, que presentó, entre otras complicaciones, neumonía secundaria, encefalopatía e hipertensión pulmonar(HTP), si bien evolucionó posteriormente de forma favorable. El interés de este caso radica en la presentación atípica de la tos ferina en los lactantes de corta edad, así como en su gravedad

We present the case of a 25-day-old infant with malignant pertussis, who was admitted to the hospital with a presumptive diagnosis of bronchiolitis. She presented several complications, such as secondary pneumonia, encephalopathy and pulmonary hypertension, despite which the outcome was favorable. This case is interesting because of the atypical clinical presentation of pertussis in an infant of less than 6 months of age, as well as its severity

[Anisakiasis gastrointestinal manifestations: description of 42 cases]. / Manifestaciones digestivas de la anisakiasis: descripción de 42 casos.

BASIS: Anisakiasis is an emerging parasitosis in our environment, although still scarcely known, mainly its gastrointestinal manifestations. PATIENTS AND METHODS: In this paper 42 cases of anisakiasis with gastrointestinal symptoms (with or without cutaneous allergic manifestations) are described; all cases were studied in our hospital between 1995 and May 2004. RESULTS: Thirty seven cases showed a gastric or gastroallergic form (6 confirmed with gastroscopy) and 5 suffered intestinal symptoms. In those in which endoscopy was not carried out, the diagnosis was done after clinical and biological findings. All patients were sensitized in the presence of Anisakis simplex. The 69% (29 cases) described raw anchovies ingestion or anchovies seasoned in vinegar ingestion some hours before the beginning of the clinical picture. The 59% showed allergic symptoms (gastroallergic anisakiasis); no patient with intestinal affectation showed allergic symptoms. Nausea (67%), vomiting (51%), and epigastralgia (50%) were the dominant symptoms in the group with gastric or gastroallergic anisakiasis without endoscopic confirmation; on the other hand, pain in right ileac fossa was the dominant symptom in the intestinal form. Fever was seen in two of the later patients (40%), but in no patient with gastric or gastroallergic anisakiasis. CONCLUSIONS: Gastrointestinal symptomatology after ingestion of fish suspiciously prepared should suggest anisakiasis, regardless if clinical picture includes allergic manifestations. In our study, pain in right ileac fossa, fever, and absence of allergic manifestations were typical of intestinal form.

Manifestaciones digestivas de la anisakiasis: descripción de 42 casos / Anisakiasis gastrointestinal manifestations: description of 42 cases

Fundamento. La anisakiasis es una parasitosis emergente en nuestro medio, aunque todavía escasamente conocida, principalmente en sus manifestaciones digestivas. Pacientes y métodos. Se describen 42 casos de anisakiasis con afectación digestiva (con o sin manifestaciones alérgicas cutáneas) estudiados en nuestro hospital entre 1995 y mayo de 2004. Resultados. Treinta y siete casos mostraban una forma gástrica o gastroalérgica (6 confirmados mediante gastroscopia) y 5 manifestaciones intestinales. En aquellos en que no se realizó endoscopia el diagnóstico se efectuó tras los hallazgos clínicos y biológicos. Todos los pacientes estaban sensibilizados frente a Anisakis simplex. El 69% (29 casos) referían ingesta unas horas antes de anchoas en vinagre o crudas. El 59% presentó clínica alérgica asociada (anisakiasis gastroalérgica), no presentando esta clínica ninguno de los casos con afectación intestinal. Las náuseas (67%), vómitos (51%) y epigastralgia (50%) fueron los síntomas dominantes en el grupo con anisakiasis gástrica o gastroalérgica sin confirmación endoscópica, mientras que el dolor en fosa ilíaca derecha lo fue en la forma intestinal. Dos de estos pacientes (40%) presentaron fiebre, aunque ninguno de los casos con anisakiasis gástrica o gastroalérgica. Conclusiones. La aparición de sintomatología digestiva después de la ingesta de pescado preparado de forma sospechosa debe hacer pensar en una posible anisakiasis, independientemente de que se asocien o no manifestaciones alérgicas. La presencia de dolor en fosa ilíaca derecha, fiebre y la ausencia de manifestaciones alérgicas fueron característicos de las formas intestinales

Basis. Anisakiasis is an emerging parasitosis in our environment, although still scarcely known, mainly its gastrointestinal manifestations. Patients and methods. In this paper 42 cases of anisakiasis with gastrointestinal symptoms (with or without cutaneous allergic manifestations) are described; all cases were studied in our hospital between 1995 and May 2004. Results. Thirty seven cases showed a gastric or gastroallergic form (6 confirmed with gastroscopy) and 5 suffered intestinal symptoms. In those in which endoscopy was not carried out, the diagnosis was done after clinical and biological findings. All patients were sensitized in the presence of Anisakis simplex. The 69% (29 cases) described raw anchovies ingestion or anchovies seasoned in vinegar ingestion some hours before the beginning of the clinical picture. The 59% showed allergic symptoms (gastroallergic anisakiasis); no patient with intestinal affectation showed allergic symptoms. Nausea (67%), vomiting (51%), and epigastralgia (50%) were the dominant symptoms in the group with gastric or gastroallergic anisakiasis without endoscopic confirmation; on the other hand, pain in right ileac fossa was the dominant symptom in the intestinal form. Fever was seen in two of the later patients (40%), but in no patient with gastric or gastroallergic anisakiasis. Conclusions. Gastrointestinal symptomatology after ingestion of fish suspiciously prepared should suggest anisakiasis, regardless if clinical picture includes allergic manifestations. In our study, pain in right ileac fossa, fever, and absence of allergic manifestations were typical of intestinal form