Brugada Phenocopy Induced by a Lethal Methanol Intoxication.

Brugada phenocopies (BrP) are clinical entities that present with an ECG pattern identical to either the type 1 or type 2 Brugada pattern without true congenital Brugada syndrome. This ECG pattern is associated with an identifiable condition and normalizes upon resolution or treatment of the underlying cause. We present a case of a 54-year-old man with extreme metabolic acidosis, hyperkalaemia and a Brugada type 1 ECG pattern in the setting of a suicidal methanol (MeOH) poisoning. Upon correction of these metabolic derangements with bicarbonate infusions and continuous veno-venous haemodiafiltration (CVVH), the Brugada type 1 ECG pattern normalized. Unfortunately, the patient developed signs of cerebral herniation followed by brain death and died on the first day of ICU admission. LEARNING POINTS: Brugada-like ECG patterns are described in several metabolic conditions such as extreme hyperglycaemia, glucose/insulin challenge, isolated hyperkalaemia or in association with hyponatraemia and acidosis.Until now, there have been no published case reports of BrP in association with methanol intoxication.Correction of hyperkalaemia and acidosis and specific therapy for methanol intoxication leads to a complete resolution of a Brugada type 1 ECG pattern.

Hiperventilación central neurogénica en un paciente con encefalomielitis aguda diseminada posvacunal / Central neurogenic hyperventilation in a patient with post-vaccination acute disseminated encephalomyelitis

No disponible

Colitis grave por citomegalovirus en un paciente con linfocitopenia idiopática de CD4 / Severe colitis due to cytomegalovirus in a patient with idiopathic CD4 lymphocytopenia

No disponible

Fungemia due to Rhodotorula mucilaginosa in an immunocompetent, critically ill patient.

Infections due to the yeast Rhodotorula are rare in humans. R. mucilaginosa is responsible for the majority of human cases, and immunocompromised individuals with central venous catheters are at greatest risk. There are few reports of bloodstream infections due to R. mucilaginosa in immunocompetent patients. We present a case report of fungemia due to R. mucilaginosa in an immunocompetent, critically ill patient, with good evolution with catheter removal and fluconazole therapy. We briefly review the spectrum of infections due to R. mucilaginosa and the management of bloodstream infections due to this yeast.

Biliotórax no secundario a fístula: una complicación infrecuente en las enfermedades biliares / Biliothorax unrelated to fistula: a rare complication in gallbladder disease

No disponible

No disponible

Hemobilia: una causa poco frecuente de hemorragia digestiva masiva / Hemobilia: a rare cause of massive gastrointestinal bleeding

No disponible

[Mesenteric vein thrombosis and protein C and S deficiency in a patient with chronic hepatitis C on treatment with interferon and ribavirin]. / Trombosis mesentérica y déficit de proteínas C y S en un paciente con hepatitis C crónica en tratamiento con interferón y ribavirina.

We describe the case of a 67 year old male with chronic hepatitis C on treatment with pegylated interferon and ribavirin who, after two and a half months of combined treatment, presented with a picture of acute mesenteric vein thrombosis that required urgent surgery. It re-occurred several days later and was his cause of death. In the thrombophilia study carried out immediately after surgery a decrease in protein C and S was considered as a cause of hypercoagulability. Protein C and S deficiency, natural anticoagulants synthesised in the liver, in patients without hepatic disease is a known cause of mesenteric thrombosis. Its decrease has also been described in the context of chronic hepatic diseases, including C virus chronic hepatitis, although it is not known for sure if this hypercoagulability state is a primary or secondary manifestation. Chronic hepatitis C and treatment with interferon has often been associated with a procoagulant state, and on many occasions due to different factors and mechanisms.

Trombosis mesentérica y déficit de proteínas C y S en un paciente con hepatitis C crónica en tratamiento con interferón y ribavirina / Mesenteric vein thrombosis and protein C and S deficiency in a patient with chronic hepatitis C on treatment with interferon and ribavirin

Describimos el caso de un varón de 67 años de edad, con una hepatitis C crónica en tratamiento con interferón pegilado y ribavirina, que presentó, tras 2,5 meses de terapia combinada, un cuadro de trombosis mesentérica aguda que requirió cirugía urgente; tuvo una recidiva días después, que fue la causa de su fallecimiento. En el estudio de trombofilia durante el postoperatorio inmediato se constató un descenso de las proteínas C y S como causa de hipercoagulabilidad. La deficiencia de proteínas C y S, anticoagulantes naturales sintetizados en el hígado, en pacientes sin hepatopatía es una causa conocida de trombosis mesentérica. También se ha descrito su disminución en el contexto de hepatopatías crónicas, entre ellas la hepatitis crónica por el virus C, aunque no se conoce con certeza si este estado de hipercoagulabilidad es un fenómeno primario o secundario. La hepatitis C crónica y el tratamiento con interferón se han asociado con frecuencia a un estado procoagulante por distintos factores y mecanismos

We describe the case of a 67 year old male with chronic hepatitis C on treatment with pegylated interferon and ribavirin who, after two and a half months of combined treatment, presented with a picture of acute mesenteric vein thrombosis that required urgent surgery. It re-occurred several days later and was his cause of death. In the thrombophilia study carried out immediately after surgery a decrease in protein C and S was considered as a cause of hypercoagulability. Protein C and S deficiency, natural anticoagulants synthesised in the liver, in patients without hepatic disease is a known cause of mesenteric thrombosis. Its decrease has also been described in the context of chronic hepatic diseases, including C virus chronic hepatitis, although it is not known for sure if this hypercoagulability state is a primary or secondary manifestation. Chronic hepatitis C and treatment with interferon has often been associated with a procoagulant state, and on many occasions due to different factors and mechanisms

Idiopathic eosinophilia associated with portal vein and massive thrombosis: successful thrombolysis with streptokinase.

BACKGROUND: Portal vein thrombosis in adults is usually related to cirrhosis. There are several possible therapies. including anticoagulation, transjugular intrahepatic portosystemic shunt, balloon dilatation, local and systemic fibrinolytics agents. Hypercoagulable states are also reported in association with this disease entity. Eosinophilia may activate platelets and promote thrombosis due to proteins contained in intracytoplasmic granules, such as eosinophil cationic protein and major basic protein. There is only one paper in the medical literature linking eosinophilia and portal vein thrombosis. CASE REPORT: We present here the case of a middle-age woman with idiopathic eosinophilia and acute portal vein thrombosis with massive venous thrombosis, involving the mesenteric, splenic, inferior cava, iliac and femoral veins, successfully treated with systemic streptokinase. CONCLUSIONS: Acute portal vein thrombosis with associated mesenteric and splenic vein thrombosis is a potentially lethal coagulation disorder that can be treated successfully with systemic streptokinase.

Síndrome coronario agudo secundario a disección coronaria espontánea / Acute coronary syndrome caused by spontaneous coronary artery disection

No disponible

No disponible