ABSTRACT
A 70-year-old mapuche female presented with a 1 year history of weight loss, bilateral red painful eyes and corneal ulcer that evolved into perforation and uveal herniation with complete visual loss. Reddish and painful nodules appeared on the distal aspect of both lower extremities, that ulcerated after months. A thoracic CT scan showed multiple pulmonary nodules. Infectious diseases were ruled out. An open lung biopsy and a skin biopsy were performed and both showed non-caseating necrotizing granulomas and granulomatous arteritis. Steroids and cyclophosphamide were started with complete regression of skin and pulmonary lesions within a month. Corneal transplantation was done. After 6 months follow-up, the patient is on low-dose of steroids, free of disease with partial vision recovery.
Mujer mapuche de 70 años quien en el curso de 1 año presentó baja de peso, ojo rojo bilateral y úlcera corneal que evolucionó hacia la perforación con herniación uveal y pérdida de la visión. Posteriormente se agregaron lesiones nodulares, violáceas, sensibles, algunas ulceradas en las zonas distales de ambas extremidades inferiores. La TAC de tórax demostró múltiples nódulos pulmonares. Tras un estudio exhaustivo se descartaron la tuberculosis y otras infecciones. Tanto la biopsia de las lesiones cutáneas como la biopsia pulmonar obtenida mediante toracotomía confirmaron la presencia de granulomas necrotizantes no caseificantes y arteritis granulomatosa. Se trató con esteroides y ciclofosfamida con mejoría de su condición general y regresión de las lesiones cutáneas y pulmonares en menos de 1 mes. Se realizó un trasplante de cornea. A los seis meses de seguimiento continúa en tratamiento, no ha presentado recaídas y tiene recuperación parcial de la visión.
Subject(s)
Humans , Female , Aged , Granuloma/diagnosis , Sarcoidosis, Pulmonary/diagnosis , Vasculitis/diagnosis , Skin Diseases/etiology , Granuloma/pathology , Necrosis , Radiography, Thoracic , Sarcoidosis, Pulmonary/immunology , Sarcoidosis, Pulmonary/pathology , Tomography, X-Ray Computed , Vasculitis/pathologyABSTRACT
Background: Enterococcus is a bacterial genus with low virulence. However, in the last years, the importance of some enterococcus species as nosocomial pathogens has increased, specially due to their resistance to some antimicrobial. Aim: To identify enterococcus strains using classical biochemical techniques and genomic amplification with Polymerase Chain Reaction (PCR). Material and methods: Three hundred and five enterococcus strains, isolated between 1996 and 1999, from different clinical specimens in hospitals and other centers of the VIIIth Region of Chile, were studied. The isolates were identified, to the species level, according to the scheme proposed by Carvalho et al. Identification of some strains was confirmed by PCR. Results: Eighty nine percent of isolates were identified as E fócalis, 10.2 percent as E fócium and 3.3 percent as other species. Conclusions: PCR is a fast and promising technique, useful in the identification of Enterococcus species