[Pulmonary cavitations, late complication of COVID-19].

Patients who have recently suffered from SARS-CoV-2 infections may suffer serious complications, such as pneumothorax or pulmonary cavitations that increase morbi-mortality and imply a challenge for the design of the most appropriate therapeutic strategy to improve their prognosis. Pulmonary cavities are usually associated with secondary complications such as hemoptysis and pneumothorax, and so offer a poor prognosis. We present the case of two patients with COVID-19 disease confirmed by nasopharyngeal PCR who showed satisfactory evolution before readmission with pulmonary involvement compatible with pulmonary cavitation and respiratory failure. Cavitated lesions in the lungs of patients who recently suffered COVID-19 must be identified early in order to discard additional superinfections that may worsen the prognosis.

[Middle cerebral artery ischemic stroke presentation of miliar tuberculosis]. / Infarto de la arteria cerebral media como forma de presentación de la tuberculosis miliar.

Presence of central nervous system by extrapulmonary tuberculosis is an infrequent disease specially among non HIV infected patients, and it is associated with poor prognosis and high mortality rates. We report a case with a middle cerebral artery ischemic strocke as a first symptom of miliar tuberculosis.

[Mortality due to heart involvement in the catastrophic antiphospholipid syndrome]. / Mortalidad por afectación cardiaca en el síndrome antifosfolípido catastrófico.

Catastrophic antiphospolipid syndrome (CAPS) is extremely rare antiphospolipid syndrome (APS) variety associated to higher mortality. When heart involvement appears has worsening pronostic. We reported a CAPS case, possibily afterward sting wasp triggering, with acute heart failure during evolution. The patient died despite angiographic stents, anticoagulation, corticoids and plasmaphereses treatment carried out.

[Aorto pulmonary fistula: left-sided infective endocarditis in HIV and intravenous drugs abuser patient. Review of the literature]. / Fístula aorto pulmonar: endocarditis izquierda en paciente VIH y ADVP. Revisión de la literatura.

Infective endocarditis (IE) is the most severe complication in intravenous drug abusers (IVDAs). HIV infection increases the risk of IE in IVDAs too. IE in both population are special tendency to infect the right-sided heart, but unusual infective aortic valve. We report a case of HIV and IVDA patient admitted in hospital due to fever syndrome, with X-ray test normal and the first blood cultures negatives. CD4 count cell 90 mm3. It was impossible doing a transesophageal echocardiography (TEE) and transtoracic echocardiogramma (TTE) only showed a moderate aortic insufficiency with conserved systolic function. Despite using antibiotics, antifungals and highly active antiretroviral therapy, he developed ARDS, and mechanical ventilation should be performed. At that moment, TEE showed an aorto pulmonary fistula due to left-sided IE. Further cultures was undergone and only one blood culture was positive to Staphylococcus aureus. Cardiac surgery was not indicated. The patient died 3 weeks later.

[Cerebral abscess by Rhodococcus equi in a HIV-negative patient]. / Absceso cerebral por Rhodococcus equi en paciente no VIH.

Rhodococcus equi is an unusual cause of infection in humans. Infection in immunocompetent host is extremely rare. This report describes a case of 57 years old patient Rhodococcus brain and pulmonary infection in a patient who did not have HIV or otherwise immunocompromised (either from disease, immunosuppressive medications, or both). He was admitted in the hospital due to neurological symptoms, and diagnosed after undergoing medical tests (brain CT scan and MR) with an intracranial neoplasia. No other disorders in the physical exploration or laboratory findings, included chest X ray were found. After this, he was admitted in Intensive Care Unit due to a respiratory failure, performing CT lung that showed pulmonary nodules. An stereoataxic brain biopsy was performed due to patient worsening. Pulmonary and brain cultures isolated Rhodococcus equi both. He was treated with intravenous vancomycin, cotrimoxazole and rifampicin. Despite the mortality rate among immunocompetent patients is really uncommon, the patient died.

["Aborted" Ballooning syndrome]. / Síndrome de Ballooning "abortado".

We describe a patient with previous transient left ventricular apical balloonig three months ago, who had got a new chest ischemic-like pain associated to an important dynamic left ventricular intracavitary obstruction which disappeared after betablockers treatment.

[Takotsubo cardiomyopathy: transient apical dysfunction of the left ventricle]. / Cardiomiopatía de Takotsubo: disfunción transitoria apical de ventrículo izquierdo.

Transient apical dysfunction syndrome, ballooning or Takotsubo cardiomyopathy is a recently described syndrome. It is a disease with a partially known mechanism, characterized by the morphology adopted by the left ventricle secondary to hypokinesis and dyskinesis of the apical segments and hypercontractibility of the basal segments. In most of the cases published, it is a syndrome with ST segment elevation in the precordial leads, whose presentation form is also thoracic pain or dyspnea, with the possible existence of moderate elevation of cardiac biomarkers. On the contrary to the acute coronary syndrome, patients with left ventricle dysfunction do not have atherothrombotic disease in the coronary arteries. Furthermore, the alterations described have a reversible character. Some diagnostic clinical criteria have been proposed and there is presently some controversy on them and on the complementary examination needed to diagnose it.