RESUMO
Resumen: La tuberculosis típicamente se considera una enfermedad crónica, aunque puede manifestarse de forma aguda, cuya manifestación se revisa en este caso clínico. La patogenia de la tuberculosis aguda suele estar relacionada con factores epidemiológicos y genéticos del huésped. El choque séptico debido a Mycobacterium tuberculosis es poco frecuente, pero está bien reconocido, se comporta de manera similar al choque séptico bacteriano, conocido como sepsis tuberculosa gravissima. Nuestra paciente ingresó con afectación hemodinámica y diagnóstico de choque séptico que evolucionó a insuficiencia multiorgánica; a pesar del tratamiento antimicrobiano y antituberculoso establecido, falleció a los cinco días del ingreso a la unidad de cuidados intensivos. El espectro de la enfermedad por M. tuberculosis dificulta el diagnóstico, a menos que la sospecha clínica sea alta, pero la alta mortalidad exige su consideración. El inicio temprano del tratamiento es decisivo para optimizar el resultado clínico.
Abstract: Tuberculosis is typically considered a chronic disease, although it can be manifested acutely, whose form is reviewed in this clinical case. The pathogenesis of acute tuberculosis is usually related to epidemiological and genetic factors of the host. Septic shock due to Mycobacterium tuberculosis is rare, but it is well recognized, behaving similarly to bacterial septic shock, known as sepsis tuberculosa gravissima. Our patient was admitted with hemodynamic compromise and diagnosis of septic shock that evolved to multiorganic failure; despite antimicrobial and antituberculous management, patient died five days after admission to the intensive care unit. The spectrum of M. tuberculosis disease makes diagnosis difficult, unless clinical suspicion is high, but high mortality requires consideration. The early start of therapy is decisive to optimize the clinical outcome.
RESUMO
UNLABELLED: We present the clinical case of a 28-year old male with pulmonary and extrapulmonary tuberculosis in absence of HIV infection; who also presented a left iliac psoas abscess of torpid evolution simulating an strangulated hernia and died of a sepsis due to colonic perforations by anaerobics and E. histolytica. MATERIAL AND METHODS: Histological sections of the autopsy were studied with hematoxilin-eosin, Gram and Ziehl-Neelsen stains. RESULTS: Autopsy study showed bilateral cavitated tuberculosis, Pott disease of thoracic spine and a cold tuberculous abscess on both psoas muscle and the lower third of the left thigh. Descending colonic perforation were identified, the responsible microorganism were Staphylococcus albus, Klebsiella sp, and E. coli.
