ABSTRACT
El eritema multiforme es una reacción inmunomediada que envuelve la piel y algunas veces a la mucosa. Las infecciones y medicamentos constituyen las causas más comunes. Típicamente se presenta como lesiones "en diana" sobreelevadas con centro pálido y borde eritematoso o lesiones atípicas como vesículas o ampollas. Se presenta el caso de una mujer de 68 años que acude por tumoración a nivel del antebrazo derecho con signos inflamatorios más fiebre, se constata por ecografía aneurisma micótico en dicho miembro y se realiza ecocardiografía transtorácica donde se observan vegetaciones en válvulas aortica y mitral. Durante la internación presenta aparición de lesiones ampollosas con bordes eritematosos distribuidas en tronco y brazos con biopsia que informa erupción liquenoide ampollosa compatible con eritema multiforme minor.
Erythema multiforme is an immune-mediated reaction that involves the skin and sometimes the mucosa. Infections and medications are the most common causes. Typically presents as raised "target" lesions with a pale center and erythematous border or atypical lesions such as vesicles or bullae. We present the case of a 68-year-old woman who presented with a tumor on the right forearm with inflammatory signs plus fever, a mycotic aneurysm was confirmed by ultrasound in the limb and a transthoracic echocardiography was performed where vegetations were observed on the aortic and mitral valves. During hospitalization, she presented bullous lesions with erythematous borders distributed on the trunk and arms with a biopsy that reported bullous lichenoid eruption compatible with erythema multiforme minor.
ABSTRACT
El aneurisma micótico surge de la destrucción infecciosa de la pared arterial y se diagnostica cuando hay un aneurisma en el contexto de inflamación y hemocultivos o biopsia positivos, aunque esto no es un requisito excluyente. Los agentes etiológicos de mayor frecuencia son bacterias (Staphylococcus, Salmonella)2 pero también se han notificado hongos (Aspergillus niger). La tuberculosis puede afectar cualquier órgano de la economía, el compromiso arterial es una complicación rara y potencialmente mortal, puede ocurrir por extensión directa de un foco adyacente o por diseminación hematógena o linfangítica de lesiones primarias. El compromiso en los grandes vasos puede presentarse de diversas formas, incluyendo pólipos, aortoarteritis estenosante y formación de aneurismas o pseudoaneurismas, siendo esta última la más común. Presentamos el diagnóstico de aneurisma de aorta abdominal infrarrenal con trombo intramural y pseudoaneurisma de aorta renal izquierda como hallazgo incidental en una paciente con tuberculosis ganglionar.
The mycotic aneurysm arises from the infectious destruction of the arterial wall and is diagnosed when there is an aneurysm within the context of inflammation and positive blood cultures or biopsies, though this is not an essential requirement. The most common etiologic agents are bacteria (Staphylococcus, Salmonella)2, but fungi have also been reported (Aspergillus niger). Tuberculosis may affect any organ of the body; arterial compromise is a rare and potentially mortal complication that may occur by direct extension of an adjacent infected site or by bloodstream or lymphangitic dissemination of primary lesions. The great vessels may be compromised in different ways, including polyps, stenotic aortoarteritis and formation of aneurysms or pseudoaneurysms, being the latter the most common one. We present the diagnosis of infrarenal abdominal aortic aneurysm with intramural thrombus and left renal aortic pseudoaneurysm as incidental finding in a patient with nodal tuberculosis.
Subject(s)
Aortic Aneurysm, Abdominal , Tuberculosis , Aneurysm, Infected , Aneurysm, FalseABSTRACT
Abstract Candida is a rare cause of infected aortic aneurysms. We report the case of a diabetic patient with end stage kidney disease who underwent repair of a leaking abdominal aortic aneurysm. He was on long-term antibiotic treatment for malignant otitis externa. Candida albicans was isolated from the culture of the excised aneurysm wall. An infected aortic aneurysm due to Candida has not been previously reported in a patient with malignant otitis externa. This case report aims to highlight that Candida should be suspected as a cause of infected aortic aneurysms in patients with debilitation and chronic immunosuppression. Management of such cases can be extremely challenging, especially in resource-poor settings, and we will be touching upon the advantages and disadvantages of various treatment options.
Resumo A cândida é uma causa rara de aneurismas da aorta infecciosos. Relatamos o caso de um paciente diabético com doença renal terminal, que foi submetido a reparo de aneurisma da aorta abdominal com vazamento. Ele estava em tratamento de longo prazo com antibióticos para otite externa maligna. A Candida albicans foi isolada da cultura da parede do aneurisma que sofreu a excisão. Não há relatos prévios de aneurisma da aorta infeccioso causado por cândida em pacientes com otite externa maligna. Este relato de caso visa reforçar que a cândida deve ser uma das suspeitas de causa de aneurisma da aorta infeccioso em pacientes debilitados e com imunossupressão crônica. O manejo desses casos pode ser extremamente desafiador, principalmente em contextos em que os recursos são escassos, e mencionaremos as vantagens e desvantagens das diversas opções de tratamento.
Subject(s)
Humans , Male , Aged , Otitis Externa/complications , Aneurysm, Infected/complications , Aortic Aneurysm, Abdominal/complications , Aneurysm, Infected/etiology , Candida albicans/pathogenicity , Aortic Aneurysm, Abdominal/therapy , Immune Tolerance/immunology , Anti-Bacterial Agents/adverse effectsABSTRACT
Resumen La hemorragia digestiva alta se define como el sangrado originado en el tracto digestivo superior, proximalmente al ángulo de Treitz, y constituye la urgencia gastroenterológica más importante. Tiene una incidencia que varía, según el área estudiada, entre 48 y 160 casos por 100 000 habitantes y año. Aunque puede ser causada por numerosas etiologías, no debemos olvidar aquellas menos comunes, ya que pueden condicionar una alta mortalidad, como es el caso de la rotura de un aneurisma de la arteria hepática. A continuación, mostramos un caso representativo.
Abstract Upper gastrointestinal bleeding is defined as bleeding originating in the upper digestive tract proximal to the Treitz angle and is the most important gastroenterological emergency. Its incidence varies, depending on the area studied, between 48 and 160 cases per 100,000 inhabitants per year. Although it can be caused by numerous etiologies, we must not forget the less common ones such as a ruptured hepatic artery aneurysm since they can condition high mortality. We present a representative case.
Subject(s)
Humans , Male , Middle Aged , Rupture , Abdominal Pain , Gastrointestinal Tract , Hemorrhage , Hepatic Artery , AneurysmABSTRACT
Resumen Objetivo: Presentar un caso clínico infrecuente, con una resolución novedosa. Caso Clínico: Paciente con aneurisma micótico de la arteria mesentérica superior manejado satisfactoriamente en forma endovascular. Los aneurismas micóticos viscerales son entidades infrecuentes, con alta morbimortalidad. Es por ello que su manejo debe ser multidisciplinario y considerar diferentes factores al momento de tomar decisiones. En el contexto de la continua mejoría y disponibilidad de las técnicas endovasculares, estas han emergido como una opción terapéutica válida, con posiblemente menos complicaciones. Conclusión: La resolución endovascular del aneurisma micótico visceral es factible, pero su indicación y el manejo completo es aún caso a caso.
Objective: to discuss an infrequent vascular case with a novel resolution. Case Report: Superior mesenteric artery mycotic aneurysm successfully managed with coil embolization. A visceral mycotic aneurysm is an infrequent vascular pathology with high risk of complications and mortality. The endovascular management might offer a treatment option with lower morbimortality rates in selected cases. Conclusion: Endovascular resolution of mycotic visceral aneurysms is both feasible and secure but it must be done in a case to case basis.
Subject(s)
Humans , Male , Aged , Aneurysm, Infected/therapy , Mesenteric Artery, Superior/pathology , Embolization, Therapeutic/methods , Endovascular Procedures/methods , Aneurysm, Infected/etiology , Mesenteric Artery, Superior/diagnostic imagingABSTRACT
Os aneurismas de aorta abdominal infecciosos (AAAIs) são raros e apresentam uma alta mortalidade devido à septicemia e ao risco de ruptura. A opção terapêutica consagrada consiste na correção aberta com ressecção do aneurisma, debridamento e reconstrução com veia autóloga. Mais recentemente, alguns grupos vêm relatando séries de casos nas quais se realizou tratamento endovascular. Em ambas as opções, a antibioticoterapia adjuvante é imperativa. Relatamos um caso ilustrativo em que o tratamento de escolha foi a cirurgia aberta com reconstrução utilizando-se veia autóloga.
Infected abdominal aortic aneurysms are rare and have high mortality due to sepsis and the possibility of rupture. The treatment of choice is open repair with aneurysm resection, debridement and reconstruction with an autologous vein graft. More recently, case series have been described in which the endovascular approach was the first option. With both approaches adjuvant antibiotic therapy is imperative. We report an illustrative case in which the treatment was open surgery reconstruction using an autologous vein graft.
Subject(s)
Humans , Aortic Aneurysm, Abdominal , Aortic Aneurysm, Abdominal/rehabilitation , Aortic Aneurysm, Abdominal/therapy , Salmonella , Ciprofloxacin/administration & dosage , Tomography, X-Ray Computed , Lower Extremity , InfectionsABSTRACT
O número de intervenções percutâneas com implante de stents tem aumentado dramaticamente nos últimos anos, apesar da frequência no uso do dispositivo nos relatos de infecções serem extremamente raros. Neste artigo relatamos dois casos de aneurisma micótico após implante de stents com diferentes apresentações clínicas e evolução.
The number of percutaneous interventions with stent implantation has increased dramatically in recent years, although the frequent use of this device in reports of infections is extremely rare. In this article we report two cases of mycotic aneurysm after implantation of stents with different clinical presentations and outcomes.
El número de intervenciones percutáneas con implantación de stents ha incrementado dramáticamente en los últimos años, a pesar del gran auge del dispositivo los reportes de infecciones son extremadamente raros. En el presente artículo reportamos dos casos de aneurismas micoticos luego de la implantación de stents con presentación y evolución clínicas diferentes.
Subject(s)
Aged , Humans , Male , Middle Aged , Aneurysm, Infected , Coronary Aneurysm/microbiology , Coronary Aneurysm , Drug-Eluting Stents/adverse effects , Staphylococcus aureus/isolation & purification , Stents/adverse effects , Aneurysm, Infected/microbiology , Coronary Aneurysm/etiology , Fatal OutcomeABSTRACT
Los aneurismas de la arteria pulmonar son poco frecuentes en niños. Entre sus principales causas se encuentran procesos infecciosos como la endocarditis, que favorece el desarrollo de aneurismas micóticos, en especial en pacientes con defectos cardíacos congénitos y en aquellos con adicción a drogas de uso endovenoso (sobre todo en adultos), y lleva al desarrollo de aneurismas micóticos. Las opciones de tratamiento dependen de las características de la lesión y de la condición clínica del paciente. Se presenta el caso de una paciente de siete años, quien fue referida para evaluación por endocarditis infecciosa de la válvula tricúspide debida a Staphylococcus aureus. Desarrolló aneurismas bilaterales en ramas lobulares de la arteria pulmonar secundarios a la infección valvular. El aneurisma del lado derecho era de gran tamaño y con alto riesgo de ruptura, razón de peso para que se le efectuara embolización con coils. El procedimiento fue exitoso y no se documentaron complicaciones. La lesión del lado izquierdo se trató de forma expectante teniendo en cuenta que era de menor tamaño. En la actualidad la paciente está en seguimiento ambulatorio con el fin de vigilar la evolución del aneurisma del lado izquierdo.
Pulmonary artery aneurysms are infrequent in children. Among its main causes are infectious processes such as endocarditis which favors the development of mycotic aneurysms especially in patients with congenital heart defects and in those with endovenous drug addiction (mainly in adults) that develop mycotic aneurysms. Treatment options depend on the characteristics of the lesion and the clinical condition of the patient. We present the case of a seven year old female patient who was referred for evaluation of infectious endocarditis of the tricuspid valve due to Staphylococcus aureus. She developed bilateral aneurysms in lobular branches of the pulmonary artery secondary to the valve infection. The right aneurysm was large and had a high risk of rupture, and for this reason an embolization with coils was performed. The procedure was successful and no complications were documented. Given that the left side lesion was smaller, it received an expectant management. At present, the patient has ambulatory follow-up in order to monitor the evolution of the left side aneurysm.