ABSTRACT
Austrian syndrome is a triad characterized by pneumonia, meningitis and endocarditis, as a result of a Streptococcus pneumoniae bacteremia. We report a previously healthy 49 year-old male, who consulted at the emergency care unit with a history of one week of pleuritic pain, fever leading to an altered level of consciousness and seizures. A diagnosis of community-acquired pneumonia and meningitis was reached, isolating Streptococcus pneumoniae in the cerebrospinal fluid and blood cultures. Antibiotic treatment was started but the patient had an unsatisfactory response. During hospitalization a new heart murmur was found in the physical examination. An echocardiography was performed and a massive aortic valve insufficiency was found along with vegetations and a perforation of the same valve. The valve was replaced by a prosthetic one and the patient responded satisfactorily to the surgical and antibiotic treatment, without complications.
Subject(s)
Humans , Male , Middle Aged , Pneumonia, Pneumococcal/microbiology , Streptococcus pneumoniae/isolation & purification , Meningitis, Bacterial/microbiology , Endocarditis, Bacterial/microbiology , Pneumonia, Pneumococcal/surgery , Pneumonia, Pneumococcal/diagnostic imaging , Syndrome , Tomography, X-Ray Computed , Meningitis, Bacterial/surgery , Meningitis, Bacterial/diagnostic imaging , Endocarditis, Bacterial/surgery , Endocarditis, Bacterial/diagnostic imagingABSTRACT
Marantic or nonbacterial thrombotic endocarditis is characterized for the presence of vegetations formed by a meshwork of fibrin and other cellular material similar a blood clot, without the presence of microorganisms. It is often related with tumors and chronic inflammatory states. We report a 49 years old female with a history of weight loss and asthenia, presenting with multiple cerebrovascular attacks and fever. Blood cultures were negative and the fever did not subside with antibiotic treatment. Trans esophageal echocardiogram showed a mitral valve vegetation and thickening of the free edge of both leaflets. In search of the etiology of such a case, a primary pancreatic cancer with distant metastases was found. We cannot rule out the differential diagnosis with bacterial endocarditis with negative blood cultures, although the clinical context supports a non-infectious etiology.
Subject(s)
Humans , Female , Middle Aged , Endocarditis, Non-Infective/pathology , Endocarditis, Non-Infective/diagnostic imaging , Pancreatic Neoplasms/diagnostic imaging , Magnetic Resonance Imaging , Radiography, Thoracic , Tomography, X-Ray Computed , Fatal Outcome , Stroke/diagnostic imaging , Diagnosis, DifferentialABSTRACT
La perforación septal corresponde a la comunicación entre ambas fosas nasales por un defecto del tabique nasal. Si bien la mayoría son asintomáticas, pueden presentarse como una rinitis costrosa, obstrucción nasal, epistaxis recidivante o sibilancias nasales. Su origen es predominantemente iatrogénico o idiopático, no obstante pueden presentar diversas etiologías. Es necesario determinar esto para resolver la necesidad de cirugía y definir la técnica quirúrgica más adecuada. En el siguiente trabajo presentamos 2 casos clínicos de perforación septal manejados con la técnica de avance de colgajos de mucosa de Fairbanks modificada, interponiendo además cartílago tragal.
The septal perforation is a communication between both nostrils through a nasal septal defect. Most of these defects are asymptomatic, although some may present as crusty rhinitis, nasal obstruction, recurrent epistaxis or nasal wheeze. Its origin is predominantly iatrogenic or idiopathic; however it may have several etiologies. It's fundamental to determine the cause of the septal perforation, in order to address the need for surgery and define the most appropriate surgical technique. We report 2 cases of septal perforations which were resolved with modified Fairbanks technique interposing tragal cartilage.
Subject(s)
Humans , Male , Adult , Surgical Flaps , Endoscopy/methods , Nasal Septal Perforation/surgery , Nasal Septal Perforation/etiologyABSTRACT
El síndrome de Sneddon es una vasculitis sistémica, que se caracteriza por accidente cerebrovascular isquémico y livedo reticularis. Es una enfermedad rara, que se da principalmente en mujeres jóvenes. Presentamos el caso de una mujer de 20 años con el diagnóstico de Síndrome de Sneddon, tratada en forma oportuna y con una evolución favorable en el hospital Doctor Hernán Henríquez Aravena de Temuco (HHHA).
Sneddon's syndrome is a systemic vasculitis, characterized by ischemic stroke and livedo reticularis. It is a rare disease that occurs mainly in young women. We report the case of a 20 year old woman diagnosed with Sneddon syndrome, treated in time and with a favorable outcome at Dr. Hernán Henríquez Aravena Hospital (HHHA) of Temuco