RESUMO
We describe the case of a 67-year-old male with liver cirrhosis who presented with fever and neck pain. Magnetic resonance imaging of the spine detected cervical vertebral osteomyelitis, and enhanced CT of the neck and spine revealed retropharyngeal abscess. The patient was treated with empirical antimicrobial therapy and surgical drainage due to significant airway involvement. Escherichia coli was cultured from the blood and pus in inferior cervical vertebrae which was a rare pathogen. Haematogenous spread may have resulted in cervical vertebral osteomyelitis and retropharyngeal abscess. With high mortality rates, early diagnosis of retropharyngeal abscess is required to avoid debilitating complications such as airway obstruction.
Assuntos
Vértebras Cervicais/microbiologia , Discite/etiologia , Infecções por Escherichia coli/etiologia , Cirrose Hepática Alcoólica/complicações , Abscesso Retrofaríngeo/etiologia , Idoso , Obstrução das Vias Respiratórias/etiologia , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/etiologia , Cefalosporinas/uso terapêutico , Discite/microbiologia , Discite/cirurgia , Suscetibilidade a Doenças , Drenagem , Substituição de Medicamentos , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Cervicalgia/etiologia , Osteomielite/tratamento farmacológico , Osteomielite/microbiologia , Osteomielite/cirurgia , Oxigenoterapia , Abscesso Retrofaríngeo/diagnóstico por imagem , Abscesso Retrofaríngeo/microbiologia , Abscesso Retrofaríngeo/cirurgia , Tomografia Computadorizada por Raios XRESUMO
We experienced a case of Kounis syndrome with cardiopulmonary arrest and severe coronary spasm. A 70-year-old man with cardiac pacemaker and chronic dialysis was treated for angina pectoris of the right coronary artery. After diagnostic coronary angiography of the right coronary artery, optical coherence tomography was performed with contrast medium and low-molecular-weight dextran. The patient's blood pressure unexpectedly dropped to 40 mmHg and erythema of the breast was noted. Electrocardiogram showed remarkable ST elevation in II, III, aVF leads. Coronary angiography showed total occlusion of the proximal right coronary artery. Although intracoronary infusion of sodium nitrate did not dilate the coronary artery promptly, coronary balloon angioplasty recovered the artery flow. Since severe anaphylaxis-related shock was contemplated, methyl prednisolone and epinephrine were administered intravenously. We could not introduce percutaneous cardiopulmonary support due to kinking of the vein. After 1 hour of cardiopulmonary resuscitation with frequent ventricular fibrillation and direct current shock, the sinus rhythm and blood pressure recovered. Following 2 months of intensive care treatment for other complications, including infection, the patient was discharged from hospital without any residual disability.
