Bronconeumonitis por virus herpes simple en paciente con fallo respiratorio postoperatorio / Herpes simplex virus bronchopneumonitis in patient with acute respiratory failure after surgery

La bronconeumonitis por virus herpes simple (VHS) es una entidad clínica descrita en pacientes críticos, asociada clásicamente a estados de inmunosupresión. Estudios recientes han demostrado una elevada frecuencia de detección del virus en muestras del tracto respiratorio inferior (obtenidas por lavado broncoalveolar [BAL]) de pacientes críticos inmunocompetentes ventilados mecánicamente, lo que indicaría su papel como sustrato patogénico independiente. Presentamos el caso de una paciente que ingresa tras intervención quirúrgica de neoplasia de recto, con sospecha de broncoaspiración durante la inducción anestésica. Presenta evolución clínica marcada por fiebre persistente pese a tratamiento antibiótico de amplio espectro, ausencia de crecimiento bacteriano en los cultivos obtenidos, sin claros infiltrados radiológicos y ventilación mecánica prolongada con reiterados fracasos en el destete, y que precisa traqueostomía percutánea. Se realiza broncoscopia con BAL y se detecta VHS (a nivel microbiológico e histológico), por lo que se inicia tratamiento con aciclovir con mejoría clínica y retirada del soporte ventilatorio (AU)

Herpes simplex virus bronchopneumonitis is a clinical entity described in critically ill patients and classically associated to immunosuppression. Recent reports have shown a higher frequency of virus detection from samples obtained by bronchoalveolar lavage of immunocompetent critically ill patients undergoing mechanical ventilation. This fact suggests its role as an independent pathogenic substrate. We report the case of a female patient who was admitted after an elective surgery of rectal tumor with suspected bronchoaspiration during anesthetic induction. The patient presented persistent fever despite broad spectrum antibiotic treatment. All cultures were negative for bacterial growth. The chest X-ray did not show opacifities. Prolonged mechanical ventilation with repeated failures to wean made it mandatory to perform percutaneous tracheostomy. A fibrobronchoscopy with bronchoalveolar lavage, performed previously, showed positive result for herpes simplex virus (PCR and specific nuclear inclusions in cells). Thus, treatment was initiated with acyclovir, with clinical improvement and weaning from mechanical ventilation (AU)

[Herpes simplex virus bronchopneumonitis in patient with acute respiratory failure after surgery]. / Bronconeumonitis por virus herpes simple en paciente con fallo respiratorio postoperatorio.

Herpes simplex virus bronchopneumonitis is a clinical entity described in critically ill patients and classically associated to immunosuppression. Recent reports have shown a higher frequency of virus detection from samples obtained by bronchoalveolar lavage of immunocompetent critically ill patients undergoing mechanical ventilation. This fact suggests its role as an independent pathogenic substrate. We report the case of a female patient who was admitted after an elective surgery of rectal tumor with suspected bronchoaspiration during anesthetic induction. The patient presented persistent fever despite broad spectrum antibiotic treatment. All cultures were negative for bacterial growth. The chest X-ray did not show opacifities. Prolonged mechanical ventilation with repeated failures to wean made it mandatory to perform percutaneous tracheostomy. A fibrobronchoscopy with bronchoalveolar lavage, performed previously, showed positive result for herpes simplex virus (PCR and specific nuclear inclusions in cells). Thus, treatment was initiated with acyclovir, with clinical improvement and weaning from mechanical ventilation.

[Refractory epilepsy status in Reye's syndrome in an adult. A case report]. / Estado epiléptico refractario en un síndrome de Reye en el adulto. A propósito de un caso.

INTRODUCTION: Reye s syndrome (RS) is a potentially fatal disease described in 1963 by Reye, Morgan and Baral as an acute encephalopathy associated with a lipid degeneration of the liver. It affects children of all ages, with a peak incidence between 5 and 15 years old, but on rare occasions it can also affect adults. Its aetiology is not known, but is has been linked with viral infections and with the ingestion of salicylates. Its occurrence in adults is not at all frequent and only 27 cases have been recorded in the literature. CASE REPORT: We report the case of a 33 year old primiparous patient who, during lactation, began suffering from epilepsy and a lowered level consciousness in the course of an infection of the pharynx and tonsils, and died on the 12th day after admission to the ICU. Anamnesis revealed she had taken ASA for the first time in her life, which guided diagnosis, and this was confirmed post mortem in the anatomopathological examination. CONCLUSION: RS in adults occurs only rarely but should be a part of the differentiating diagnosis of any encephalopathy of unknown origin and especially of the epileptic status of an adult, above all if there is a history of ingestion of salicylates, previous viral infection and vomiting.

Estado epiléptico refractario en un síndrome de Reye en el adulto.A propósito de un caso / Refractory epilepsy status in reye's syndrome in an adult. A case report

Introducción. El síndrome de Reye (SR) es una enfermedad potencialmente letal, descrita en 1963 por Reye, Morgan y Baral como una encefalopatía aguda asociada a una degeneración grasa del hígado. Afecta a niños de todas las edades, con un pico de incidencia entre los 5 y los 15 años, pero en raras ocasiones también puede ocurrir en adultos. Su etiología es desconocida, pero se ha relacionado con infecciones víricas y con la ingesta de salicilatos. La presentación en adultos es rara y sólo hay 27 casos recogidos en la literatura. Caso clínico. Presentamos el caso de una paciente de 33 años de edad, primípara, que en el período de lactancia se inició con un status epiléptico y una disminución del nivel de conciencia en el seno de una infección faringoamidgalar, y falleció al 12.º día de su ingreso en la UCI. En la anamnesis se recoge una ingesta de AAS por primera vez en su vida, lo que orientó el diagnóstico, que se confirmó postmortem en el examen anatomopatológico. Conclusión. El SR del adulto es una entidad rara y poco frecuente, pero debería formar parte del diagnóstico diferencial de cualquier encefalopatía de causa desconocida y en particular del status epiléptico en un adulto, sobre todo si hay antecedentes de ingesta de salicilatos, infección vírica previa y vómitos (AU)

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