Tapia's Syndrome: A Comprehensive Analysis of a Rare Intensive Care-Associated Complication.

Tapia's syndrome is a rare complication of airway manipulation, involving the simultaneous paralysis of the hypoglossal nerve and the recurrent laryngeal nerve. The etiological mechanism is commonly attributed to compression or stretching during airway manipulation. An efficient recognition of this condition is pivotal for a comprehensive multidisciplinary approach and optimized recovery time. The presence of persistent dysphagia and dysphonia, coupled with observable deviation or restriction of tongue movement, not only after oral endotracheal intubation for surgical interventions with general anesthesia but also after a prolonged orotracheal intubation period in the intensive care, should heighten the suspicion of this syndrome. This report details a case of Tapia's syndrome emerging as a complication of airway manipulation and prolonged intubation in the intensive care unit.

[Fulminant Emphysematous Pyelonephritis Secondary to Urothelial Neoplasia with Reno-Colic Fistula]. / Pielonefrite Enfisematosa Fulminante Secundária a Neoplasia Urotelial com Fístula Renocólica.

The emphysematous pyelonephritis is a uncommon and potentially fatal entity. The recognition of this condition enables the early correct management of patients. Diabetes and ureteral obstruction are the main risk factors identified. We present the case of a patient with no relevant risk factors or prior medical history, in which the reason of admission to the emergency department was back pain, eventually evolving into septic shock in the early hours. The imaging tests identified the presence of peri-renal and subcutaneous gas which guided the medical team to the right diagnosis (emphysematous pyelonephritis secondary to fistulized urothelial neoplasia) and the optimal surgical treatment. However, in the post-operative period the patient died, as the clinical condition and laboratory test results performed during the admission were predicting. It should also be mentioned that this same case illustrated a bacteraemia by Sphingomonas Paucimobilis (acquired in the community) with cavitated damage to lungs (probable septic embolism).

A pielonefrite enfisematosa é uma entidade pouco frequente e potencialmente fatal. O reconhecimento desta patologia permite a correta orientação precoce dos doentes. A diabetes e a obstrução ureteral são os principais fatores de risco identificados. Apresenta-se o caso de uma doente saudável, sem fatores de risco conhecidos, em que o motivo de ida ao serviço de urgência foi apenas uma dor lombar, acabando por evoluir com quadro de choque séptico nas primeiras horas. Os exames imagiológicos permitiram identificar a presença de gás perirrenal e subcutâneo o que orientou o correto diagnóstico (pielonefrite enfisematosa secundária a neoplasia urotelial fistulizada) e tratamento cirúrgico. Contudo, e como o estado clínico e analítico à admissão e no pós-operatório faziam prever a doente acabou por falecer. De referir ainda que este mesmo caso documenta uma bacteriemia por Sphingomonas paucimobilis (adquirida na comunidade) com lesões cavitadas a nível pulmonar (provável embolismo séptico).