RESUMO
La aparición de complicaciones graves, como el neumotórax o las cavitaciones pulmonares, en pacientes con infecciones recientes por el SARS-CoV-2 aumenta la morbi-mortalidad, y supone un reto diseñar la estrategia terapéutica más adecuada que permita mejorar su pronóstico. Las cavitaciones pulmonares se suelen asociar a complicaciones secundarias como la hemoptisis y el neumotórax, y confieren mal pronóstico. Se presenta el caso de dos pacientes con enfermedad COVID-19 confirmada por PCR nasofaríngea y que, tras evolución inicialmente satisfactoria, reingresaron con afectación pulmonar compatible con cavitaciones pulmonares y con insuficiencia respiratoria. Las lesiones cavitadas pulmonares en pacientes que hayan sufrido COVID-19 deben identificarse de forma precoz y realizar las determinaciones y cultivos necesarios para descartar sobreinfecciones añadidas que puedan empeorar el pronóstico.(AU)
Patients who have recently suffered from SARS-CoV-2 infections may suffer serious complications, such as pneumothorax or pulmonary cavitations that increase morbi-mortality and imply a challenge for the design of the most appropriate therapeutic strategy to improve their prognosis. Pulmonary cavities are usually associated with secondary complications such as hemoptysis and pneumothorax, and so offer a poor prognosis. We present the case of two patients with COVID-19 disease confirmed by nasopharyngeal PCR who showed satisfactory evolution before readmission with pulmonary involvement compatible with pulmonary cavitation and respiratory failure. Cavitated lesions in the lungs of patients who recently suffered COVID-19 must be identified early in order to discard additional superinfections that may worsen the prognosis.(AU)
Assuntos
Humanos , Ciências da Saúde , Coronavirus , Cavitação , Coronavírus Relacionado à Síndrome Respiratória Aguda Grave , Superinfecção , PneumotóraxRESUMO
Patients who have recently suffered from SARS-CoV-2 infections may suffer serious complications, such as pneumothorax or pulmonary cavitations that increase morbi-mortality and imply a challenge for the design of the most appropriate therapeutic strategy to improve their prognosis. Pulmonary cavities are usually associated with secondary complications such as hemoptysis and pneumothorax, and so offer a poor prognosis. We present the case of two patients with COVID-19 disease confirmed by nasopharyngeal PCR who showed satisfactory evolution before readmission with pulmonary involvement compatible with pulmonary cavitation and respiratory failure. Cavitated lesions in the lungs of patients who recently suffered COVID-19 must be identified early in order to discard additional superinfections that may worsen the prognosis.
Assuntos
COVID-19 , Pneumotórax , COVID-19/complicações , Humanos , Pulmão , Pneumotórax/etiologia , SARS-CoV-2RESUMO
Catastrophic antiphospolipid syndrome (CAPS) is extremely rare antiphospolipid syndrome (APS) variety associated to higher mortality. When heart involvement appears has worsening pronostic. We reported a CAPS case, possibily afterward sting wasp triggering, with acute heart failure during evolution. The patient died despite angiographic stents, anticoagulation, corticoids and plasmaphereses treatment carried out.
Assuntos
Síndrome Antifosfolipídica/complicações , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/mortalidade , Doença Aguda , Evolução Fatal , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
Presence of central nervous system by extrapulmonary tuberculosis is an infrequent disease specially among non HIV infected patients, and it is associated with poor prognosis and high mortality rates. We report a case with a middle cerebral artery ischemic strocke as a first symptom of miliar tuberculosis.
Assuntos
Isquemia Encefálica/microbiologia , Infarto da Artéria Cerebral Média/microbiologia , Tuberculose Miliar/complicações , Adulto , Feminino , HumanosRESUMO
El síndrome antifosfolípido catastrófico (SAPC) es una variedad del síndrome antifosfolípido (SAP), altamente infrecuente, asociada a mayor mortalidad. La aparición de afectación cardiaca, todavía más infrecuente, empobrece el pronóstico del mismo. Exponemos un caso de SAPC, posiblemente secundario a una picadura de avispa. Durante la evolución desarrolló un shock cardiogénico que a pesar de coronariografía, implantación de stents además de tratamiento con corticoides, anticoagulación y plasmaféresis, le produjo la muerte
Catastrophic antiphospolipid syndrome (CAPS) is extremely rare antiphospolipid syndrome (APS) variety associated to higher mortality. When heart involvement appears has worsening pronostic. We reporteda CAPS case, possibily after ward sting wasp triggering, with acute heart failure during evolution. The patient died despite angiographic stents, anticoagulation, corticoids and plasmaphereses treatment carried out
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Síndrome Antifosfolipídica/diagnóstico , Síndrome Antifosfolipídica/mortalidade , Choque Cardiogênico/complicações , Corticosteroides/uso terapêutico , Plasmaferese , Anticoagulantes/uso terapêutico , Dor Abdominal/diagnóstico , Anticorpos Anticardiolipina , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/terapia , Heparina/uso terapêutico , Dor Abdominal/etiologia , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/mortalidade , Síndrome Antifosfolipídica/complicaçõesRESUMO
La afectacion vascular del SNC por la TBC extrapulmonar no es una patología muy frecuente en ausencia de VIH, siendo un factor predictivo de mal pronóstico, comportando una mayor morbimortalidad. Exponemos el caso de una paciente que presenta afectación nerviosa en forma de isquemia en el territorio de la arteria cerebral media como forma de presentación de una TBC miliar
Presence of central nervous system by extrapulmonary tuberculosis is an infrequent disease specially among non HIV infected patients, and it is associated with poor prognosis and high mortality rates. We report a case with a middle cerebral artery ischemic strocke as a first symptom of miliar tuberculosis
Assuntos
Humanos , Masculino , Adulto , Infarto da Artéria Cerebral Média/complicações , Infarto da Artéria Cerebral Média/diagnóstico , Infarto da Artéria Cerebral Média/terapia , Tuberculose Miliar/complicações , Tuberculose Miliar/diagnóstico , Tuberculose Meníngea/complicações , Tuberculose Meníngea/patologia , Metilprednisolona/uso terapêutico , Isoniazida/uso terapêutico , Tuberculose Miliar/patologia , Tuberculose Miliar , Sistema Nervoso Central/patologia , Tomografia Computadorizada de Emissão/métodos , Rifampina/uso terapêutico , Pirazinamida/uso terapêutico , Etambutol/uso terapêutico , Intubação Intratraqueal/métodosRESUMO
No disponible
Assuntos
Humanos , Feminino , Adulto , Tuberculose Miliar/complicações , Tuberculose Miliar/diagnóstico , Infarto da Artéria Cerebral Média/complicações , Infarto da Artéria Cerebral Média/diagnóstico , Infarto da Artéria Cerebral Média/mortalidade , Lúpus Eritematoso Sistêmico/complicações , Infarto Cerebral/mortalidade , Infarto da Artéria Cerebral Média/tratamento farmacológico , Infarto da Artéria Cerebral Média/epidemiologiaAssuntos
Quadriplegia/etiologia , Neoplasias da Medula Espinal/complicações , Vértebras Cervicais , Humanos , Laminectomia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias da Medula Espinal/diagnóstico , Neoplasias da Medula Espinal/cirurgia , Resultado do TratamentoRESUMO
La endocarditis infecciosa (EI) es una de las complicaciones más severas en la población adicta a drogas por vía parenteral (ADVP). La infección por el VIH incrementa el riesgo de aparición en los pacientes que además son ADVP. La EI en ambas poblaciones posee una especial tendencia a infectar las válvulas del hemicardio derecho, siendo infrecuente la afectación aórtica. Se expone el caso un paciente VIH y ADVP, que ingresa por síndrome febril, con Rx de tórax inicial normal y hemocultivos negativos. CD490 mm3. Imposible realizar ecocardiograma transesofágico (ETE), revelando el transtorácico (ETT) una insuficiencia aórtica moderada con función sistólica conservada. A pesar de antibioterpia de amplio espectro,antifúngico y tratamiento antirretroviral (TAR) presentó SDRA por lo que es intubado. Se realizó ETT apreciando una gran desestructuración aórtica y una fístula aorto-pulmonar secundaria a una EI izquierda. Posteriormente solo un hemocultivo fue positivo para S. aureus. Fue desestimado el tratamiento quirúrgico. El paciente falleció tras 3 semanas de evolución
Infective endocarditis (IE) is the most severe complication in intravenous drug abusers (IVDAs). HIV infection increases the risk of IE in IVDAs too. IE in both population are special tendency to infect the rigthsided heart, but unusual infective aortic valve. We report a case of HIVand IVDA patient admitted in hospital due to fever syndrome, with X-ray test normal and the first blood cultures negatives. CD4 count cell 90 mm3. It was impossible doing a transesophageal echocardiography (TEE) and transtoracic echocardiogramma (TTE) only showed a moderate aortic insufficiency with conserved systolic function. Despite using antibiotics, antifungals and highly active antirretroviral therapy, he developed ARDS, and mechanical ventilation should be performed. At that moment, TEE showed an aorto pulmonary fistula due to left-sided IE. Further cultures was undergone and only one blood culture was positive to Staphylococcus aureus. Cardiac surgery was not indicated. The patient died 3 weeks later
Assuntos
Humanos , Adulto , Fístula Arteriovenosa/etiologia , Endocardite Bacteriana/etiologia , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Endocardite Bacteriana/diagnóstico , Transtornos Relacionados ao Uso de Substâncias , Staphylococcus aureus/patogenicidadeRESUMO
No disponible
Assuntos
Pessoa de Meia-Idade , Humanos , Paresia/complicações , Paresia/diagnóstico , Laminectomia/métodos , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/diagnóstico , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/diagnóstico , Hemiatrofia Facial/complicações , Tomografia Computadorizada de Emissão/métodos , Paresia/radioterapiaRESUMO
Rhodococcus equi is an unusual cause of infection in humans. Infection in immunocompetent host is extremely rare. This report describes a case of 57 years old patient Rhodococcus brain and pulmonary infection in a patient who did not have HIV or otherwise immunocompromised (either from disease, immunosuppressive medications, or both). He was admitted in the hospital due to neurological symptoms, and diagnosed after undergoing medical tests (brain CT scan and MR) with an intracranial neoplasia. No other disorders in the physical exploration or laboratory findings, included chest X ray were found. After this, he was admitted in Intensive Care Unit due to a respiratory failure, performing CT lung that showed pulmonary nodules. An stereoataxic brain biopsy was performed due to patient worsening. Pulmonary and brain cultures isolated Rhodococcus equi both. He was treated with intravenous vancomycin, cotrimoxazole and rifampicin. Despite the mortality rate among immunocompetent patients is really uncommon, the patient died.
Assuntos
Infecções por Actinomycetales/diagnóstico , Abscesso Encefálico/diagnóstico , Rhodococcus equi , Soronegatividade para HIV , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Transient apical dysfunction syndrome, ballooning or Takotsubo cardiomyopathy is a recently described syndrome. It is a disease with a partially known mechanism, characterized by the morphology adopted by the left ventricle secondary to hypokinesis and dyskinesis of the apical segments and hypercontractibility of the basal segments. In most of the cases published, it is a syndrome with ST segment elevation in the precordial leads, whose presentation form is also thoracic pain or dyspnea, with the possible existence of moderate elevation of cardiac biomarkers. On the contrary to the acute coronary syndrome, patients with left ventricle dysfunction do not have atherothrombotic disease in the coronary arteries. Furthermore, the alterations described have a reversible character. Some diagnostic clinical criteria have been proposed and there is presently some controversy on them and on the complementary examination needed to diagnose it.
Assuntos
Cardiomiopatias , Disfunção Ventricular Esquerda , Cardiomiopatias/diagnóstico , Cardiomiopatias/tratamento farmacológico , Humanos , Síndrome , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/etiologiaRESUMO
El síndrome de disfunción apical transitoria, ballooning o cardiomiopatía de Takotsubo es un síndrome de reciente descripción. Se trata de una entidad de mecanismo parcialmente conocido, caracterizada por la morfología que adopta el ventrículo izquierdo secundaria a la hipocinesia o discinesia de los segmentos apicales e hipercontractilidad de los basales. En la mayoría de los casos publicados se trata de un síndrome con elevación del segmento ST en las derivaciones precordiales, cuya forma de presentación es también el dolor torácico o la disnea, pudiendo existir una moderada elevación de los biomarcadores cardíacos. A diferencia del síndrome coronario agudo, los pacientes con disfunción del ventrículo izquierdo no presentan enfermedad aterotrombótica en las arterias coronarias; además, las alteraciones descritas poseen un carácter reversible. Se han propuesto unos criterios clínicos diagnósticos, existiendo en la actualidad cierta controversia en los mismos, así como en las exploraciones complementarias necesarias para realizar su diagnóstico
Transient apical dysfunction syndrome, ballooning or Takotsubo cardiomyopathy is a recently described syndrome. It is a disease with a partially known mechanism, characterized by the morphology adopted by the left ventricle secondary to hypokinesis and dyskinesis of the apical segments and hypercontractibility of the basal segments. In most of the cases published, it is a syndrome with ST segment elevation in the precordial leads, whose presentation form is also thoracic pain or dyspnea, with the possible existence of moderate elevation of cardiac biomarkers. On the contrary to the acute coronary syndrome, patients with left ventricle dysfunction do not have atherothrombotic disease in the coronary arteries. Furthermore, the alterations described have a reversible character. Some diagnostic clinical criteria have been proposed and there is presently some controversy on them and on the complementary examination needed to diagnose it
Assuntos
Humanos , Disfunção Ventricular Esquerda/fisiopatologia , Edema Pulmonar/complicações , Choque Cardiogênico/complicações , Catecolaminas , Diagnóstico DiferencialRESUMO
No disponible
Assuntos
Masculino , Idoso , Humanos , Traumatismos Torácicos/complicações , Esterno/lesões , Radiografia Torácica/métodosRESUMO
El Rhodococcus equi es una causa inusual de infección en los humanos. La infección en los pacientes inmunocompetentes es extremadamente rara. A continuación exponemos el caso de un paciente de 57 años con infección cerebral y pulmonar secundaria a Rhodococcus equi en ausencia de compromiso inmunitario. Inicialmente ingresado en el hospital debido a síntomas neurológicos y diagnosticado de un proceso cerebral neoplásico tras la realización de TAC y RNM. El resto de la exploración física y exploraciones complementarias fueron normales, incluyendo la Rx de tórax. Posteriormente es ingresado en la UCI debido a una insuficiencia respiratoria, por lo que se realizó TAC torácica mostrando nódulos pulmonares. Debido al empeoramiento del paciente se practicó una biopsia esteroatáxica. En los diferentes cultivos extraídos (lavado broncoalveolar, y cerebral) se aislo Rhodococcus equi. Fue tratado con vancomicina, sulfametoxazol y rifampicina intravenosas. A pesar de que la tasa de mortalidad entre los pacientes inmunocompetentes es muy infrecuente el paciente falleció
Rhodococcus equi is an unusual cause of infection in humans. Infection in immunocompetent host is extremely rare. This report describes a case of 57 years old patient Rhodococcus brain and pulmonary infection in a patient who did not have HIV or otherwise immunocompromised (either from disease, immunosuppressive medications, or both). He was admitted in the hospital due to neurological symptoms, and diagnosed after undergoing medical tests (brain CT scan and MR) with an intracranial neoplasia. No other disorders in the physical exploration or laboratory findings, included chest X ray were found. After this, he was admitted in Intensive Care Unit due to a respiratory failure, performing CT lung that showed pulmonary nodules. An stereoataxic brain biopsy was performed due to patient worsening. Pulmonary and brain cultures isolated Rhodococcus equi both. He was treated with intravenous vancomycin, cotrimoxazole and rifampicin. Despite the mortality rate among immunocompetent patients is really uncommon, the patient died
Assuntos
Masculino , Pessoa de Meia-Idade , Humanos , Rhodococcus equi/patogenicidade , Infecções por Actinomycetales/complicações , Abscesso Encefálico/microbiologia , Pneumonia Bacteriana/complicaçõesRESUMO
Infective endocarditis (IE) is the most severe complication in intravenous drug abusers (IVDAs). HIV infection increases the risk of IE in IVDAs too. IE in both population are special tendency to infect the right-sided heart, but unusual infective aortic valve. We report a case of HIV and IVDA patient admitted in hospital due to fever syndrome, with X-ray test normal and the first blood cultures negatives. CD4 count cell 90 mm3. It was impossible doing a transesophageal echocardiography (TEE) and transtoracic echocardiogramma (TTE) only showed a moderate aortic insufficiency with conserved systolic function. Despite using antibiotics, antifungals and highly active antiretroviral therapy, he developed ARDS, and mechanical ventilation should be performed. At that moment, TEE showed an aorto pulmonary fistula due to left-sided IE. Further cultures was undergone and only one blood culture was positive to Staphylococcus aureus. Cardiac surgery was not indicated. The patient died 3 weeks later.
Assuntos
Valva Aórtica , Endocardite Bacteriana/etiologia , Fístula/etiologia , Infecções por HIV/complicações , Doenças das Valvas Cardíacas/etiologia , Valva Pulmonar , Infecções Estafilocócicas/etiologia , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Evolução Fatal , Humanos , MasculinoRESUMO
We describe a patient with previous transient left ventricular apical balloonig three months ago, who had got a new chest ischemic-like pain associated to an important dynamic left ventricular intracavitary obstruction which disappeared after betablockers treatment.