RESUMO
A 76-year-old Malay female presented with 2 days history of fever and vomiting. She was found to have Escherichia coli and Klebsiella pneumoniae bacteraemia with no clear intra-abdominal cause on the initial computed tomography of the abdomen and pelvis (CTAP). She clinically improved with 2 weeks duration of intravenous meropenem. She subsequently developed septic shock and a repeated CTAP demonstrated increased hepatic parenchymal density with extensive parenchymal calcifications. Curvilinear calcifications were seen in the paraspinal and pelvic musculature.
Assuntos
Calcinose , Humanos , Feminino , Idoso , Calcinose/diagnóstico por imagem , Sepse/microbiologia , Tomografia Computadorizada por Raios X , Hepatopatias/diagnóstico por imagem , Klebsiella pneumoniae/isolamento & purificação , Infecções por Klebsiella/diagnóstico , Infecções por Klebsiella/complicações , Infecções por Klebsiella/tratamento farmacológico , Infecções por Escherichia coli/complicações , Infecções por Escherichia coli/diagnóstico , Infecções por Escherichia coli/tratamento farmacológico , Doenças Musculares/diagnóstico por imagem , Antibacterianos/uso terapêutico , Meropeném/uso terapêutico , Meropeném/administração & dosagemRESUMO
Hypereosinophilic syndrome (HES) is a rare but life-threatening multi-organ disease which can be complicated by stroke, with devastating outcomes. Eosinophils can accumulate in multiple organs, most commonly involving the heart, skin, lungs, spleen, and liver. Neurological end-organ complications in hypereosinophilic syndrome are unusual and have been established to be of three types: brain infarction, encephalopathy and sensory polyneuropathy. We present a case where acute ischaemic stroke and encephalopathy are early manifestations of Idiopathic HES. It is important to consider HES as an aetiology for stroke and a high eosinophil count is an initial diagnostic clue. Early initiation of steroid therapy can potentially prevent disease progression.