Assuntos
Anestesia Obstétrica/métodos , Deficiência do Fator VII/complicações , Deficiência do Fator VII/tratamento farmacológico , Fator VIIa/uso terapêutico , Complicações Hematológicas na Gravidez/tratamento farmacológico , Feminino , Humanos , Hemorragia Pós-Parto/prevenção & controle , Gravidez , Adulto JovemRESUMO
We report a patient who presented a severe Panton-Valentine-secreting methicillin-susceptible Staphylococcus aureus pneumonia with threatening multi-organ failure including acute respiratory distress syndrome, cardiac failure, renal failure and disseminated intravascular coagulation. Clinical and biological disease course using empiric therapy with treatment directed against toxin production (linezolid, clindamycin and intravenous immunoglobulins) was found to be quickly effective.
Assuntos
Anti-Infecciosos/uso terapêutico , Toxinas Bacterianas/biossíntese , Exotoxinas/biossíntese , Imunoglobulinas Intravenosas/uso terapêutico , Leucocidinas/biossíntese , Pneumonia Bacteriana/tratamento farmacológico , Infecções Estafilocócicas/tratamento farmacológico , Acetamidas/uso terapêutico , Adulto , Clindamicina/uso terapêutico , Humanos , Linezolida , Masculino , Insuficiência de Múltiplos Órgãos/tratamento farmacológico , Insuficiência de Múltiplos Órgãos/etiologia , Oxazolidinonas/uso terapêutico , Síndrome do Desconforto Respiratório/tratamento farmacológico , Síndrome do Desconforto Respiratório/etiologiaRESUMO
Staphylococcus aureus is responsible for two main clinical presentations in humans: suppurative infections and toxigenic diseases. A small percentage of S. aureus strains secrete Panton-Valentine leukocidin (PVL). This toxin is implicated in skin infections, furunculosis, osteoarticular infections, and particularly, in serious pulmonary infections known as necrotizing pneumonia, which affect immunocompetent patients with no comorbidity. A clear outline of the clinical presentation was described recently. Necrotizing pneumonia caused by PVL-secreting S. aureus strains is characterized by a combination of fever, hemoptysis, multilobar alveolar infiltrations, and leukopenia. The disease usually progresses to toxic shock or refractory hypoxemia. A number of interesting therapies targeting leukocidin have been proposed over the past few years based on in vitro data. This review focuses on the physiopathological basis and on the therapeutic relevance of various drugs.
Assuntos
Antitoxinas/uso terapêutico , Toxinas Bacterianas/toxicidade , Exotoxinas/metabolismo , Leucocidinas/metabolismo , Pneumonia Estafilocócica/tratamento farmacológico , Staphylococcus aureus/efeitos dos fármacos , Adulto , Antitoxinas/toxicidade , Criança , Humanos , Pneumonia Estafilocócica/complicaçõesRESUMO
A 54-years-old patient coming from Guinea, who presented fever, diarrhoea, consciousness disorders and severe haemolytic anaemia, was admitted to resuscitation unit in France. Despite many explorations carried out (evaluation of traumatic causes, infection, neoplasia, vascular, toxic causes, vitamin deficiency), it was not possible to explain neurological symptomatology. Besides, haemolytic anaemia was due to the ingestion of metamizole in a context of glucose-6-phosphate dehydrogenase deficit. This drug's marketing has been suspended in France since 2006. Despite appropriate treatment, after seven days of hospitalization, the patient died of multi-organ failure and hemophagocytic syndrome. This clinical case illustrates the difficulties encountered to set a diagnosis and manage patients coming from overseas. Uncommon aetiologies for French healthcare professionals should be evoked in the absence of comprehensive clinical information.
Assuntos
Anemia Hemolítica/etiologia , Antitireóideos/efeitos adversos , Deficiência de Glucosefosfato Desidrogenase/diagnóstico , Metemoglobinemia/induzido quimicamente , Metimazol/efeitos adversos , Agitação Psicomotora/etiologia , Diagnóstico Diferencial , Diarreia/etiologia , Evolução Fatal , Deficiência de Glucosefosfato Desidrogenase/complicações , Guiné/etnologia , Cefaleia/etiologia , Humanos , Linfo-Histiocitose Hemofagocítica/etiologia , Malária Falciparum/diagnóstico , Masculino , Metemoglobinemia/etiologia , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologia , Paris , Convulsões/etiologia , Vômito/etiologiaRESUMO
Ethylene glycol intoxication is one of the most serious acute poisonings due to the high toxicity that can result in death if not treated rapidly. We report the case of a patient who presented to the intensive care unit with a hypertensive crisis associated to a renal insufficiency. Laboratories investigations which revealed metabolic acidosis and elevated anion gap, highlighted an unexpected ethylene glycol intoxication. Clinical and psychiatric feature lead to suspect a chronic ingestion. Spontaneous recovery occured without specific treatment.
Assuntos
Etilenoglicol/intoxicação , Dor Abdominal/induzido quimicamente , Acidose/induzido quimicamente , Adulto , Feminino , Humanos , Remissão EspontâneaAssuntos
Doenças do Nervo Hipoglosso/etiologia , Intubação Intratraqueal/efeitos adversos , Síndromes de Compressão Nervosa/etiologia , Adulto , Anti-Inflamatórios/uso terapêutico , Transtornos da Articulação/etiologia , Implante Mamário , Transtornos de Deglutição/etiologia , Feminino , Humanos , Doenças do Nervo Hipoglosso/tratamento farmacológico , Metilprednisolona/uso terapêutico , Síndromes de Compressão Nervosa/tratamento farmacológicoRESUMO
We report the case of an 18-year-old man with pulmonary leptospirosis presenting as an atypical pneumonia with alveolar haemorrhage, without icterus. Has he developed ARDS the patient was admitted in intensive care unit. This patient was contaminated when swimming in a lake. The purpose of this article is to remind doctors that in patient presenting atypical pneumopathy with haemoptysis, the pulmonary leptospirosis should be considered.