RESUMO
A 75-year-old woman is hospitalised for sepsis. The diagnosis of cholecystitis is made and an antibiotic therapy is debuted. The clinical worsening leads to realise an urgent cholecystectomy. A sepsis like shock persisted. The antibiotherapy was changed and a second abdominal look made. A severe lactic acidosis persisted since the cholecystectomy despite a continuous hemofiltration. The diagnosis of type B lactic acidosis secondary to malignancy was suspected. An osteomedullar biopsy revelled B-cell lymphoma EBV induced.
Assuntos
Acidose Láctica/etiologia , Neoplasias Hematológicas/complicações , Linfoma de Células B/complicações , Acidose Láctica/diagnóstico , Idoso , Antibacterianos/uso terapêutico , Colecistite/complicações , Infecções por Vírus Epstein-Barr/complicações , Feminino , Neoplasias Hematológicas/diagnóstico , Hemofiltração , Humanos , Linfoma de Células B/diagnóstico , Sepse/complicaçõesRESUMO
A 58-year-old man was admitted to our hospital for septic shock and meningitis. He had undergone, three weeks earlier, a radiofrequency ablation for drug-refractory atrial fibrillation. A polymicrobian septicemy suggested a digestive etiology. A CT scan suggested an atrio-oesophageal fistula with cerebral and renal emboli. The patient deceased from brain death. The diagnosis of atrio-oesophageal fistula was confirmed by autopsy.
Assuntos
Fibrilação Atrial/terapia , Ablação por Cateter/efeitos adversos , Fístula Esofágica/etiologia , Autopsia , Fístula Esofágica/diagnóstico por imagem , Fístula Esofágica/patologia , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Ondas de Rádio , Radiografia TorácicaRESUMO
Mucormycosis are opportunist infections occurring usually among predisposed patients. We report a case of an 18-year-old male with a severe thoracic trauma who developed an Absidia infection on his contused pulmonary parenchyma, without presenting the usual risk factors (diabetes mellitus, immunodeficiency). The early diagnosis using bronchoscopy has probably improved the outcome by allowing a faster treatment. After 18-months, the infectious process resolved thanks to a combination of a medical treatment composed of high-dose amphotericin B lipid formulation, itraconazole and a complementary surgical treatment.
Assuntos
Absidia/isolamento & purificação , Pneumopatias Fúngicas/etiologia , Mucormicose/etiologia , Traumatismo Múltiplo/complicações , Adolescente , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Ciclismo/lesões , Dano Encefálico Crônico/etiologia , Lesões Encefálicas/complicações , Tronco Encefálico/irrigação sanguínea , Hemorragia Cerebral/etiologia , Terapia Combinada , Quimioterapia Combinada , Humanos , Itraconazol/uso terapêutico , Abscesso Pulmonar/tratamento farmacológico , Abscesso Pulmonar/etiologia , Abscesso Pulmonar/cirurgia , Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/cirurgia , Masculino , Mucormicose/tratamento farmacológico , Mucormicose/cirurgia , Pneumonectomia/métodos , Traumatismos Torácicos/complicações , Vancomicina/uso terapêuticoRESUMO
The authors reported a case involving a young patient with a cardiogenic shock associated to an acute pulmonary oedema. According to the seriousness of the shock, an external ventricular assist device (VAD) was initially inserted and replaced thereafter because of the cardiovascular instability, by an external pneumatic biventricular assist device. A cardiogenic shock induced by an acute adrenergic myocarditis due to a phaeochromocytoma was diagnosed. The patient was weaned from the VAD on day 84 and was scheduled for elective surgery of the phaeochromocytoma on day 93. The authors discussed the time of the surgery according to the anticoagulation therapy necessary to the VAD and the necessary caution taken if a cardiogenic shock appeared around surgery.
