RESUMO
A Pileflebite é uma rara e grave complicação de diversas infecções intra-abdominais e pélvicas. Inicia-se através de uma tromboflebite de pequenos vasos que drenam uma área infectada e tem, como principais manifestações, a dor abdominal e a febre. É descrito caso de trombose séptica de veia porta em uma paciente do sexo feminino, 70 anos, hipertensa, obesa, portadora de neoplasia maligna de uretra e tabagista, que apresentou episódio de diverticulite aguda complicada com pileflebite. Tratamento realizado com antibioticoterapia e anticoagulação.
The pylephlebitis is a rare and serious complication of various abdominal and pelvic infections. It begins with thrombophlebitis of small vessels that drain an infected area, and has abdominal pain and fever as main manifestations. It describe the case of portal vein septic thrombosis in a female patient, 70 years, smoker, suffering from systemic hypertension, obesity and malignant neoplasm of urethra, who had an episode of acute diverticulitis complicated by pylephlebitis. Treatment instituted with antibiotics and anticoagulation.
Assuntos
Humanos , Feminino , Idoso , Veia Porta , Tromboflebite , Doença Diverticular do Colo , Infecções Intra-Abdominais/complicaçõesRESUMO
Pneumatose intestinal (PI) consiste em um achado de imagem correspondente à presença de ar na parede intestinal. É um sinal infrequente, mais comum em idosos e sem predileção por sexo. Existem várias causas relatadas na literatura, sendo alguns casos reportados como idiopáticos. A modalidade diagnóstica de maior sensibilidade é a tomografia computadorizada de abdome. A maioria dos casos é assintomática, porém, uma pequena parcela pode evoluir com complicações graves, necessitando de intervenções imediatas. A inexistência de um consenso a respeito do manejo dos pacientes com PI, somada ao pouco conhecimento dos médicos acerca dessa enfermidade, resulta em um cenário clínico delicado. O objetivo deste artigo é relatar o caso de um paciente com PI, destacando o manejo terapêutico adotado.
Pneumatosis intestinalis (PI) consists in an image finding corresponding to the presence of air in the intestinal wall. It is an infrequent sign, more common in the elderly and without gender predilection. There are numerous causes described in the literature, and some cases are referred as idiopathic. The diagnostic modality with the highest sensibility is the computed tomography of the abdomen. The majority of cases are asymptomatic, but a small portion can evolve with severe complications, needing immediate interventions. The lack of a consensus regarding PI patients' management, along with the low knowledge level of physicians about the existence of this disorder, results in a delicate clinical scenario. The objective of this article is to report the case of a patient with PI, highlighting the adopted therapeutic management.
Assuntos
Humanos , Masculino , Idoso de 80 Anos ou mais , Pneumatose Cistoide Intestinal , Pneumatose Cistoide Intestinal/diagnóstico por imagem , Trato GastrointestinalRESUMO
CONTEXT: Tumor necrosis factor-alpha (TNF-α) inhibitor therapy plays a pivotal role in the management of moderate to severe inflammatory bowel disease. Because of the role of TNF-α in the host defenses, anti-TNF therapy has been associated with an increase the risks of granulomatous infections. OBJECTIVE: To report the first case of adalimumab-associated invasive histoplasmosis presenting as an acute hepatitis-like syndrome and febrile pneumonitis in a patient with Crohn's disease. METHOD: Case report of a patient with progressive histoplasmosis confirmed by percutaneous fine needle aspiration biopsy lung and urine Histoplasma antigen. RESULTS: We present the case of a young man with CD who developed pneumonia and acute hepatitis-like features caused by Histoplasma capsulatum infection during adalimumab therapy. To the best of our knowledge, this acute hepatitis-like manifestation has never been reported as a presentation of the histoplasmosis in patients with Crohn's disease. CONCLUSIONS: This case underscores the potential risk for serious infection that may arise in this setting and should alert clinicians to the need to consider the histoplasmosis diagnosis in patients presenting with acute hepatitis-like syndrome associated with prolonged febrile illness or pneumonitis during therapy with anti-TNF-α antibodies.
