Subject(s)
Spider Bites , Spider Venoms , Animals , Brown Recluse Spider , Spider Bites/complications , Spider Bites/diagnosis , Humans , Female , Adult , SpidersABSTRACT
Austrian syndrome corresponds to the triad of meningitis, pneumonia, and endocarditis caused by Streptococcus pneumoniae, there is no global or local incidence given the infrequency of entity. Scarce cases are published in Latin America, with none of them in Colombia. A case of Austrian syndrome by penicillin-resistant S. pneumoniae in an immunocompetent patient is presented. Aortic valve is the most frequent site involved in Austrian syndrome; this patient had an unusual localization of the vegetation on the right coronary artery ostium. The prognosis is poor with a mortality rate of 30% or higher, this patient survived despite systemic complications. Vaccination status impacts in prevention and severity of cases because responsible serotypes are often included in available vaccines. The patient had a serotype covered by available vaccines; however, her vaccination status was unknown. Thus, we present the first case reported in Colombia of Austrian syndrome by a penicillin-resistant S. pneumoniae, in a patient with no identified comorbidities or toxicological history, with a successful evolution.
ABSTRACT
La cromoblastomicosis es una micosis subcutánea crónica de presentación clínica heterogénea que afecta principalmente a poblaciones de escasos recursos, lo que sumado al acceso limitado a los servicios de salud condiciona el retraso en el diagnóstico y tratamiento, ocasionando secuelas físicas graves. Se describe el caso de un hombre de 50 años con lesiones cutáneas verrugosas y cicatriciales de 30 años de evolución en la extremidad inferior y mano izquierda, además en cara en los últimos cinco años. Se realizó el diagnóstico de cromoblastomicosis de presentación multifocal y clínica mixta, con examen directo e histopatología compatibles, y cultivo para hongos positivo para Fonsecaea pedrosoi. Se indicó tratamiento oral con itraconazol y seguimiento clínico. Reconocer esta entidad es crucial para un diagnóstico y tratamiento oportunos, con el fin de evitar secuelas físicas y estigmatización secundaria. Se debe fortalecer en la atención primaria el reconocimiento de patologías desatendidas y de incidencia subestimada en Colombia, con una presentación multifocal mixta atípica y de un tiempo de evolución prolongado. El examen directo KOH es un herramienta accesible y económica en los primeros niveles de atención que puede contribuir al enfoque diagnóstico.
Chromoblastomycosis is a chronic subcutaneous mycosis with heterogeneous clinical presentation. It mainly affects low-income populations, which added to limited access to health services delays diagnosis and treatment, causing serious physical sequelae. We describe the case of a 50-year-old man with warty and cicatricial skin lesions of 30 years of evolution, at the level of left lower limb and left hand, with face involvement in the last five years. A diagnosis of chromoblastomycosis with multifocal and mixed clinical presentation was made, based on compatible direct examination and histopathology, and positive fungal culture for Fonsecaea pedrosoi. Oral treatment with itraconazole and clinical followup were stablished. Recognizing this entity is crucial for timely diagnosis and treatment, to avoid physical sequelae and secondary stigmatization. Primary health care should be strengthened for the recognition of neglected diseases whose incidence is underestimated in Colombia, with an atypical mixed multifocal presentation and a long evolution time. The KOH direct examination is an accessible and economical tool in the first levels of care that can contribute to the diagnostic approach.
