Miocarditis por fiebre Q: presentación de un caso / Myocarditis for Q fever: presentation of one case

La miocarditis por Coxiella burnetii es una forma rara depresentación clínica de la fiebre Q aguda, y, al igual que la pericarditis,sola o asociadas, se detecta en alrededor del uno porciento de los casos de fiebre Q aguda. Se presenta un caso demiocarditis por fiebre Q aguda, en un varón de 55 años, que ingresócon clínica de insuficiencia cardíaca congestiva, tras síndromefebril autolimitado. La ecocardiografía reveló un ventrículoizquierdo muy dilatado con hipoquinesia difusa y fracciónde eyección del 45 por ciento. El cateterismo cardíaco confirmódichos hallazgos, siendo las coronarias normales. El estudio serológicofue compatible con fiebre Q aguda. La evolución contratamiento con furosemida, espirolactona, captopril, acenocumaroly doxiciclina fue favorable, y la ecocardiografía al cabode 11 meses puso de manifiesto importante mejoría de las alteracionescardíacas, persistiendo en dicho momento criterios serológicosde fiebre Q aguda

The myocarditis by Coxiella burnetii is a rare form of clinicalpresentation of acute Q fever, and, with the pericarditis, onlyor in association, is detected in one per cent of cases of acute Qfever. A case of myocarditis by acute Q fever is showed, in a man55-year-old who was admitted with congestive heart failure clinical,after self-limited febrile syndrome. The echocardiographyrevealed a very dilated left ventricle with a global decreaseof the mobility and ejection fraction of 45 percent. Thecardiac catheterization confirmed these findings. The coronaryarteries were normal. The serologic study was compatible withacute Q fever. The evolution with treatment with furosemide,spirolactone, captopril, acenocumarol and doxycycline was favourable,and the echocardiography after 11 months showedimportant improvement of the cardiac alterations, persisting inthis moment serology of acute Q fever

Hipertensión arterial de reciente diagnóstico secundaria a síndrome de Cushing ectópico agudo: presentación de un caso / Recently diagnosed hypertension secondary to acute ectopic Cushing's syndrome: a case study

Se trata de un hombre de 73 años que ingresó en nuestro hospital para evaluación de debilidad generalizada, hipertensión arterial de reciente comienzo e hipocaliemia. Durante su estancia hospitalaria se demostró hipocaliemia intensa y refractaria, reacción leucoeritroblástica en sangre periférica y enfermedad pulmonar intersticial. La actividad de renina plasmática basal y aldosteronemia fueron normales y los valores de hormona adrenocorticotrópica (ACTH) y cortisol en orina mostraron criterios bioquímicos de síndrome de Cushing ACTH-dependiente. Por biopsia de médula ósea se demostró metástasis de carcinoma de células pequeñas de probable origen pulmonar, y tras ello se procedió a seguimiento paliativo. Se comenta la rareza del síndrome y las peculiaridades de la asociación de hipertensión arterial con hipocaliemia (AU)

[Invasive infection by Aspergillus terreus treated successfully with liposomal amphotericin B]. / Infección invasiva por Aspergillus terreus tratada con éxito con anfotericina B liposomal.

A woman of 75 years old was admitted at our hospital for evaluation of worsening and weakness in inferior limbs. Several vertebral fractures by crushing, one doubtful discitis, an infiltrate with cavitation in the right superior lobe and one infiltrate in the left superior lobe were detected. In the biopsy of the consolidation a filamentous fungus was watched and in the bronchial washing specimen culture grew Aspergillus terreus. The infiltrates disappeared with liposomal Amphotericin B remaining with oral Itraconazol during three months more. The clinical and analytical data demonstrate the existence of a Overlap syndrome associate to antiphospholipid-antibody syndrome. We comment the peculiarity of the infection by Aspergillus terreus in patients who have not been in critical care and the good response at treatment with liposomal Amphotericin B. It contrasts with the high mortality referred in a recent review. Other aspects to comment are the coexistence with a collagen vascular and an antiphospholipid-antibody syndrome with the higher titles of IgM ACA that we have found in literature.

Peritonitis espontánea por Rhodococcus equi / Presentation of one case of spontaneous peritonitis by Rhodococcus equi

Una mujer de 79 años ingresó en nuestro hospital para evaluación de distensión abdominal y cuadro constitucional. Se objetivó ascitis y cavernomatosis portal por ecografía, revelando el cultivo del líquido ascítico crecimiento de Rhodococcus equi. A pesar del tratamiento experimenta deterioro, y tras exitus se realiza necropsia, que demuestra carcinoma pancreático extenso. Se comenta la rareza de la infección peritoneal por Rhodococcus equi y la insistencia de la literatura en considerar a este germen como contaminante (AU)

[Cardiopathy and human immunodeficiency virus infection: report of 2 cases]. / Cardiopatía e infección por el virus de la inmunodeficiencia humana: presentación de dos casos.

Two patients with immune deficiency virus infection and cardiac manifestation are presented. The first was admitted by encephalopathy. On the first days of hospital stay were observed episodes of supraventricular tachycardia with echocardiography normal. An initial improvement made us suppose the clinical context in relationship to toxoplasmosis. Subsequently the patient experienced neurological deterioration and pericardial effusion was evidenced. Therapeutic trials with ceftriaxone and tuberculostatics were useless. The postmortem pericardial aspiration showed signs of acute inflammation, but germs were not identified. The second case was admitted for longstanding fever. Because of epigastric pain an electrocardiogram was done, which revealed suggestive alterations of pericarditis. The echocardiography demonstrated the presence of pericardial effusion. The positive serology for toxoplasmosis, the bone marrow biopsy which showed reactivity with hemophagocytosis and the presence of myeloid metaplasia in the liver biopsy were the most relevant data. On the fifth day of hospital stay and second of the tuberculostatic treatment the patient expired unexpectedly.

[Liver fibrosis associated with hepatorenal polycystosis in adults]. / Fibrosis hepática asociada a poliquistosis hepatorrenal del adulto.

OBJECTIVE: A case of hepatic fibrosis in adult polycystic liver disease is reported. This association, commonly present in infancy, is exceptional in the adult polycystic liver disease. PATIENT: We report a 69-years-old female with adult polycystic kidney and liver disease with fatal hepatic failure, portal hypertension and renal failure. An autopsy was performed showing hepatic and renal polycystic disease with hepatic fibrosis. CONCLUSION: Hepatic fibrosis is a rarely associated phenomenon with adult polycystic liver disease. This data may suggest a relation of this entity with infancy fibropolycystic liver disease.

[Tuberculosis as risk factor for venous thrombosis]. / La tuberculosis como factor de riesgo de trombosis venosa.

Over a 2-year period, 3 patients with deep venous thrombosis associated to advanced pulmonary tuberculosis have been observed. One of them died suddenly, probably due to thromboembolic complications. In the other two cases, a triggering factor of venous thrombosis, probably related to tuberculosis, was detected and their evolution was satisfactory. The high frequency of antiphospholipid antibodies detected in the tuberculosis and the potential relationship between these and deficit of protein S is mentioned. Advanced pulmonary tuberculosis is described as a risk factor for the development of venous thrombosis in patients with negative serology for human immunodeficiency virus type 1 and 2. We recommend not to use deep venous catheters and we stress the potential value of heparin prophylactic therapy in order to prevent venous thrombosis and its complications.