Síndrome hemolítico urémico por ingesta de veneno de una serpiente del género Bothrops: Reporte de un caso / Hemolytic uremic syndrome due to ingestion of venom from a snake of the genus Bothrops: Report of a case

Resumen El síndrome hemolítico urémico (SHU) es una enfermedad que se caracteriza por la tríada anemia hemolítica no inmune, trombocitopenia e insuficiencia renal aguda, en la que las lesiones subyacentes están mediadas por un proceso de microangiopatía trombótica (MAT) sistêmica. Existen distintas causas que pueden desencadenar el proceso de la MAT que caracteriza el SHU. Se describe el caso de una mujer, con antecedentes de diabetes mellitus e hipertensión arterial, quién ingirió veneno de serpiente del género Bothrops con fines medicinales y 72 horas después debió ser hospitalizada por edema de miembros inferiores, dolor abdominal, equimosis e ictericia. Al ingreso, se le realizó analítica sanguínea que constató trombocitopenia, elevación de azoados y anemia; de igual forma se documentaron datos de falla renal aguda, por lo que se diagnosticó con SHU secundario a la ingesta de veneno de serpiente. En el artículo se describen aspectos del diagnóstico y el manejo clínico que se realizó y se estable que el compromiso renal por veneno de serpiente Bothrops es una entidad poco frecuente que si no se maneja de manera adecuada puede ser letal, y más aún si existen comorbilidades predisponentes.

Abstract Hemolytic uremic syndrome (HUS) is a disease characterized by the triad of non-immune hemolytic anemia, thrombocytopenia, and acute renal failure, in which the underlying lesions are mediated by a process of systemic thrombotic microangiopathy (TMA). There are different causes that can trigger the MAT process that characterizes HUS. The case of a woman with a history of diabetes mellitus and arterial hypertension is described, who ingested snake venom of the genus Bothrops for medicinal purposes, and 72 hours later she had to be hospitalized for edema of the lower limbs, abdominal pain, ecchymosis and jaundice. Upon admission, he underwent blood tests that found thrombocytopenia, elevated nitrogen levels and anemia; Similarly, data on acute kidney failure were documented, for which HUS was diagnosed secondary to the ingestion of snake venom. The article describes aspects of the diagnosis, and the clinical management that was carried out and it was established that renal involvement by Bothrops snake venom is a rare entity, which if not managed properly can be lethal, and even more so if there are predisposing comorbidities.

Insuficiência tricúspide e fibrilação atrial associadas à contusio cordis: uma apresentação atípica / Tricuspid insufficiency and atrial fibrillation associated with contusio cordis: an atypical presentation

As lesões da valva tricúspide decorrentes de trauma torácico fechado são raras e frequentemente subdiagnosticadas. Relata-se o caso de paciente do sexo masculino de 42 anos de idade com sinais e sintomas de insuficiência cardíaca direita e fibrilação atrial (FA) persistente em anticoagulação oral com Varfarina. A história revelou trauma torácico há aproximadamente 11 anos, evoluiu com insuficiência tricúspide importante, disfunção biventricular e taquicardiomiopatia secundária à FA. Realizou-se efetivamente cirurgia cardíaca de troca valvar tricúspide com prótese biológica, sem intercorrências no pós-operatório imediato. O momento ideal para intervenção cirúrgica na insuficiência tricúspide traumática ainda é controverso e motivo de debate. A indicação tradicional de abordagem cirúrgica é a insuficiência cardíaca sintomática, e a realização precoce quando da identificação dos sintomas poderia prevenir remodelamento cardíaco adicional e preservar ou recuperar a função miocárdica...(AU)

Panniculitis: another clinical expression of gout.

Gouty panniculitis is an unusual clinical manifestation of gout, characterized by the deposition of monosodium urate crystals in the lobular hypodermis. Its pathogenesis is poorly understood but is associated with hyperuricemia, and the clinical presence of indurate subcutaneous plaques, which may precede or appear subsequently to the articular clinical expression of tophaceous gout. The aim of this report is to describe the clinical characteristics and potential risk factors for the development of lobular panniculitis secondary to chronic tophaceous gout. This is a retrospective clinical review of 6 patients with gouty panniculitis seen at the rheumatology service at the National University of Colombia. All cases fulfill diagnostic criteria for gout. The presenting clinical characteristics of each case were analyzed. All 6 patients were men, with an average age of 26 years. Two patients initially presented with cutaneous manifestations, and in the remainder 4 joint involvements preceded the cutaneous manifestations. Articular involvement first developed in lower extremities, of intermittent nature, and subsequent occurrence of polyarthritis of upper and lower extremities. A positive family history of gout was observed in half of the patients. Smoking and high alcohol intake were relevant risk factors. On physical examination, all exhibited the presence of erythematous, irregular surface, deep indurate subcutaneous plaques. Biopsy of skin and deep dermis including panniculus revealed the presence of granulomatous inflammatory changes with deposition of amorphous eosinophilic material surrounded by palisading histocytes and lymphocytes. Characteristic negative birefringent monosodium urate crystals were observed in the synovial fluid of patients with arthritis. All patients exhibited high levels of serum uric acid and were non-complaint to treatment with allopurinol, NSAIDs, and colchicine. Gouty panniculitis should be considered in the differential diagnosis of panniculitis, especially in the presence of high levels of uric acid. It is usually observed in the third decade of life and may appear prior to the inflammatory articular manifestations of tophaceous gout.