Dengue and COVID-19, overlapping epidemics? An analysis from Colombia.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread throughout Latin America, a region swept by multiple previous and ongoing epidemics. There are significant concerns that the arrival of COVID-19 is currently overlapping with other viruses, particularly dengue, in various endo-epidemic regions across South America. In this report, we analyzed trends for both viral infections in Colombia during the first 20 epidemiological weeks (EWs) of 2020. From 1st January to 16th May 2020 (EWs, 1-20), a total of 52 679 cases of dengue and 14 943 cases of COVID-19 have been confirmed in Colombia. As both conditions may potentially lead to fatal outcomes, especially in patients with chronic co-morbidities, overlapping infections, and co-occurrence may increase the number of patients requiring intensive care and mechanical ventilation. In regions, such as Valle del Cauca, intensified preparation for such scenarios should be pondered, and further studies should be performed to address this critical issue in a timely matter.

Proof of Concept: Development of Snow Liquid Water Content Profiler Using CS650 Reflectometers at Caribou, ME, USA.

The quantity of liquid water in the snowpack defines its wetness. The temporal evolution of snow wetness's plays a significant role in wet-snow avalanche prediction, meltwater release, and water availability estimations and assessments within a river basin. However, it remains a difficult task and a demanding issue to measure the snowpack's liquid water content (LWC) and its temporal evolution with conventional in situ techniques. We propose an approach based on the use of time-domain reflectometry (TDR) and CS650 soil water content reflectometers to measure the snowpack's LWC and temperature profiles. For this purpose, we created an easily-applicable, low-cost, automated, and continuous LWC profiling instrument using reflectometers at the Cooperative Remote Sensing Science and Technology Center-Snow Analysis and Field Experiment (CREST-SAFE) in Caribou, ME, USA, and tested it during the snow melt period (February-April) immediately after installation in 2014. Snow Thermal Model (SNTHERM) LWC simulations forced with CREST-SAFE meteorological data were used to evaluate the accuracy of the instrument. Results showed overall good agreement, but clearly indicated inaccuracy under wet snow conditions. For this reason, we present two (for dry and wet snow) statistical relationships between snow LWC and dielectric permittivity similar to Topp's equation for the LWC of mineral soils. These equations were validated using CREST-SAFE in situ data from winter 2015. Results displayed high agreement when compared to LWC estimates obtained using empirical formulas developed in previous studies, and minor improvement over wet snow LWC estimates. Additionally, the equations seemed to be able to capture the snowpack state (i.e., onset of melt, medium, and maximum saturation). Lastly, field test results show advantages, such as: automated, continuous measurements, the temperature profiling of the snowpack, and the possible categorization of its state. However, future work should focus on improving the instrument's capability to measure the snowpack's LWC profile by properly calibrating it with in situ LWC measurements. Acceptable validation agreement indicates that the developed snow LWC, temperature, and wetness profiler offers a promising new tool for snow hydrology research.

Early postoperative complications of intracranial tumors in children.

BACKGROUND: The aim of this study was to describe the complications experienced by patients after central nervous system tumor resection during pediatric intensive care Unit (PICU) admission. Our attempt was to assess the association between epidemiological, clinical data and tumor characteristics prior to surgery and presence of postoperative complications. METHODS: We design an observational, descriptive and retrospective study by review of medical records. Patients aged 0-18 years, admitted to the PICU of our hospital, after surgery for tumor resection in the central nervous system. RESULTS: We collected a total of 145 postoperative. At PICU, 48.3% of the patients (70/145) had some type of postoperative complication. It they were, in order of frequency: a new neurological deficit at discharge (29%, 42/145), pneumocephalus (21%, 30/145), electrolyte disturbances (17.9%, 26), infection (16.6%, 24), anemia (8.3%, 12), seizures (7.6%, 11), endocrine disorders (7.6%, 11), intracranial hypertension (5.5%, 8) and stroke (7, 4.8%). One patient died. There was no difference in overall complication and the tumor site. However, supratentorial tumors had less need for MV (73% vs. 92%, P=0.002, OR 2.7 [1.2-6.1]), shorter duration for MV (11 hours vs. 48 hours, P=0.02), lower frequency of neurological deficit (22% vs. 37%, P=0.004, OR 1.4 [1-2.1]) and cerebrospinal fluid fistula (1% vs. 13%, P=0.004, OR 2.1 [1.6- 2.8]). They were more frequent seizures (13% vs. 2%, P=0.024, OR 1.8 [1.4-2.3]), central diabetes insipidus (17% vs. 0%, P<0.001, OR 4.3 [1.6-11.7]) and endocrine disruption (14% vs. 0%, P=0.001, OR 2 [1.7-2.4]). CONCLUSIONS: The intracranial tumors surgery requires monitoring in intensive care because the risk of postoperative complications is high. The tumor location is related to the occurrence of some of these complications.

Decompressive craniectomy in 14 children with severe head injury: clinical results with long-term follow-up and review of the literature.

BACKGROUND: Decompressive craniectomy (DC) is a controversial therapeutic measure used in patients with intractable intracranial hypertension after severe head injury. This study describes the morbidity and mortality of DC in 14 children with a mean follow-up of 3.2 years. We review published evidence from the past 10 years on the indications for DC in pediatric brain trauma. We also examine timing, surgical technique, and the results of this procedure. METHOD: We retrospectively reviewed patients who underwent DC from 2002 to 2010. Clinical data were collected at admission, as were data on the indication for craniectomy, timing, and surgical technique. Perioperative intracranial pressure (ICP), complications of craniectomy, and Glasgow Outcome Scale score at 2 years were recorded as outcome variables. RESULTS: Fourteen craniectomies were performed. The median presenting Glasgow Coma Scale score was 6.5 (range, 4-15). Ten patients were presented with anisocoria. In 13 patients, craniectomy initially decreased ICP to <25 mm Hg. Two patients (14%) had a poor prognosis on admission and died. The most frequent complications were hygroma (8 patients) and infections (3 patients). The mean Glasgow Outcome Scale score at the 2-year follow-up visit was 4.4 (range, 4-5). Behavioral and psychiatric abnormalities and poor academic performance were frequent (82%). CONCLUSIONS: DC reduces ICP in pediatric patients with traumatic brain injury. The mortality rate is low and long-term prognosis in survivors is good. Complications related to surgery are frequent. Wide craniectomy with duraplasty seems to be the most common technique. Defining the most appropriate indications and timing for DC in pediatric patients should be the objective of future prospective studies.

Recovery of COVID-19 acute respiratory distress syndrome with tocilizumab: successful outcome in two critically ill patients.

Background: Severe pneumonia and acute respiratory distress syndrome (ARDS) due to COVID-19 is a challenge for nowadays medical practice. Although there is no clarity in the principal mechanism of lung damage and ARDS development, it has been suggested that one of the main reasons of this pathology is the hyperactivation of the immune system, better known as cytokine storm syndrome. Tocilizumab has been proposed to treat COVID-19 severe cases associated to ARDS. Results & methodology: Here we present two successful cases of tocilizumab administration in two COVID-19 patients with prior administration of antiviral therapy (hydroxychloroquine, azithromycin, lopinavir and ritonavir) with adequate response and resolution of ARDS, septic shock and severe pneumonia within the first 72 h. Discussion & conclusion: This case supports the usage of tocilizumab as an effective therapy in COVID-19 associated cytokine storm syndrome. Further studies should be done in order to assess its effectiveness and security.

Plasmodium vivax infection due to percutaneous exposure in non-endemic area.

Malaria is an acute febrile disease due to Plasmodium species widely distributed in tropical areas of the world and it is a leading cause of death in developing countries. In 2018, 62.141 confirmed cases of malaria were reported in Colombia with P. vivax and Plasmodium falciparum being the causal species. Vectorial transmission is the most common way of acquiring the infection, however it can also occur by blood transfusion, transplacental route and percutaneous exposure. We describe a case of P. vivax infection by needle stick injury in a laboratory technician in Bogotá, Colombia.

Clinical relevance of Zika symptoms in the context of a Zika Dengue epidemic.

BACKGROUND: The clinical characteristics of the most frequent arbovirosis (Dengue, Zika, Chikungunya) are very similar, which is a diagnostic challenge for clinicians. OBJECTIVE: To identify the presence of clinical characteristics related to Zika virus infection confirmed by the laboratory in patients during an epidemic of co-infection with Zika and Dengue viruses. METHOD: Cross-sectional descriptive study of patients with clinical - epidemiological suspicion of Zika virus infection, who were admitted in the Hospital "Joaquín Albarrán" (La Habana, Cuba), during June 1 to October 31 of 2017. Demographic and symptoms and signs were recorded. By PCR for Zika virus (in blood or urine) the disease was confirmed. RESULTS: 1541 patients were studied. The most frequent symptoms and signs were rash (93.8%), pruritus (77.9%), arthralgia (60.0%), headache (50.8%), myalgia (46.1%), fever (34.7%), asthenia (31.7%), and conjunctivitis (27.9%). Zika virus infection was confirmed in 279 patients (18.1%). Greater frequency of arthralgia, asthenia, and diarrhea was demonstrated in Zika confirmed patients. CONCLUSION: Minor clinical relevance was observed in the symptoms or signs of arboviral disease to support the clinical diagnosis of Zika virus infections by clinician during a Zika-Dengue epidemic. The assessment of the temporality of the onset of Zika and Dengue symptoms of these infections is recommended to assist clinicians in the differential diagnosis.

[Probabilistic spatial-temporal prediction of total and severe epidemic of dengue in Colombia]. / Predicción espacio-temporal probabilista de la epidemia de dengue total y grave en Colombia.

OBJECTIVE: To establish a new predictive methodology to determine the proportion of severe dengue with respect to the annual total of dengue infections per department based on the probability theory. MATERIALS AND METHODS: Based on annual data on the number of infected persons by department in the period 2005-2010, the proportion of cases of severe dengue was calculated with respect to the total for each year. Probability spaces were constructed to evaluate these events in the ranges 0.5 and 0.3. Sets of ranges were determined and probability, mean square deviation and the difference between them were estimated. A prediction of the range of infected people for 2011 was made using the arithmetic average of the values of the last two years. RESULTS: The range in which the proportion of the number of people infected with severe dengue is included with respect to the total amount in each department was correctly predicted, with an effectiveness of 93.3% for the 0.5 range and 86.7% for the 0.3 range. CONCLUSION: A mathematical spatial-temporal self-organization was found in the proportion of severe dengue with respect to the total, which allows establishing useful predictions for decision-making in public health.

OBJETIVO: Establecer una nueva metodología predictiva de la proporción de dengue grave respecto al total anual de infectados de dengue por departamento con base en la teoría de la probabilidad. MÉTODOS: Con base en los datos anuales de número de infectados por departamentos en el periodo 2005 -2010, se calculó la proporción entre casos de dengue grave respecto al total para cada año, y se construyeron espacios de probabilidad que evalúan estos eventos en rangos de 0,5 y 0,3. Se determinaron conjuntos de rangos y se calculó probabilidad, desviación media cuadrática y la diferencia entre ellas. Se realizó una predicción del rango de infectados para el 2011 con el promedio aritmético de los valores de los últimos dos años. RESULTADOS: Se predijo correctamente el rango en el que se encuentra incluida la proporción de número de infectados de dengue grave sobre el total en cada departamento con una efectividad del 93,3% para el rango de 0,5 y de 86,7% para el de 0,3. CONCLUSIÓN: Se evidenció una autoorganización matemática espacio temporal en la proporción de dengue grave respecto al total que permite establecer predicciones de utilidad para la toma de decisiones de salud pública.

Epididymo-orchitis caused by Histoplasma capsulatumin a Colombian patient.

Although histoplasmosis is generally a self-limited disease, disseminated infection can occur in patients lacking effective cell-mediated immunity, reaching virtually every organ, even the genitourinary tract in rare cases. We report a case of epididymo-orchitis in an immunocompetent 38-year-old bricklayer from the rural area of Villeta, Cundinamarca, Colombia. The patient presented with testicular pain and macroscopic scrotal changes requiring a left orchiectomy, with microbiological isolation and molecular confirmation of Histoplasma capsulatum.

[Dynamics of the malaria epidemic in Colombia: temporal probabilistic prediction]. / Dinámica de la epidemia de malaria en Colombia: Predicción probabilística temporal.

OBJECTIVE: To predict the dynamics of the malaria epidemic of 2007 in Colombia. MATERIALS AND METHODS: Based on a random walk, the geometric dynamics of the number of annual cases of malaria registered in Colombia during the period 1960-2006 was studied by analyzing the probabilistic behavior of consecutive increases and decreases, as well as the probabilistic behavior of cases during consecutive year ranges, in order to make a temporary prediction of the cases. RESULTS: A simple and acausal methodology that predicts the extreme values for the number of infected people in 2007 was developed; the prediction was refined by the analysis of the annual variations, obtaining a value of 104098 corresponding to the number of infected population in 2007. This prediction was corroborated later against the information of Instituto Nacional de Salud de Colombia (National Institute of Health), finding a 95.6 % correspondence with the number of reported cases. CONCLUSION: Understanding the acausal phenomenon based on a probabilistic random walk allows making temporal, simple and practical predictions that are directly verifiable and applicable, economizing time and sources.

OBJETIVO: Realizar una predicción de la dinámica de la epidemia de malaria para el 2007 en Colombia con base en el análisis de la dinámica geométrica de 1960-2006 como una caminata al azar probabilista. MATERIALES Y MÉTODOS: Basados en la caminata al azar probabilística se estudió la dinámica geométrica del número de casos anuales de malaria registrados en Colombia durante los años 1960-2006, analizando el comportamiento probabilístico de aumentos y disminuciones consecutivos, y el comportamiento probabilístico de casos durante rangos de años consecutivos, para así realizar una predicción temporal de los casos. RESULTADOS: Se desarrolló una metodología sencilla y acausal que predice los valores extremos 81 003 y 104 098 para el número de infectados en el año 2007, predicción que fue refinada con el análisis de las variaciones anuales obteniendo un valor de 104 098 para el número de infectados en el año 2007. Esta predicción fue posteriormente corroborada con los datos del Instituto Nacional de Salud de Colombia, correspondiendo al 95,6 % respecto al número de casos reportados. CONCLUSIÓN: La comprensión del fenómeno acausal a partir de la caminata al azar probabilística permite realizar predicciones temporales, simples y prácticas, directamente comprobables y aplicables, economizando tiempo y recursos.

Caracterización clínica y tratamiento de pacientes ingresados por la COVID-19 en terapias intensivascubanas

RESUMEN Introducción: La pandemia por la COVID-19 fue declarada emergencia de salud pública internacional. El conocimiento de los síntomas, comorbilidades y el riesgo según el tratamiento recibido puede contribuir a una mejor clasificación y atención de los pacientes. Objetivo: Caracterizar clínicamente a los pacientes de COVID-19 atendidos en las unidades de terapia intensiva cubanas. Métodos: Estudio observacional retrospectivo de todos los pacientes atendidos en las unidades de terapia intensiva de Cuba en el periodo comprendido entre el 11 de marzo y el 30 de julio de 2020. Se recolectaron datos demográficos, clínicos y de resultados. Se compararon los pacientes fallecidos y recuperados de acuerdo a la prevalencia de las covariables a través de una prueba estándar de chi-cuadrado. Se realizó regresión logística para evaluar las variables predictoras de la mortalidad hospitalaria. Resultados: Se atendieron 175 pacientes, de ellos 106 graves y 69 críticos. Predominó el sexo masculino (52,0 %), mayores de 60 años (67,2 %) con hipertensión arterial (57,0 %). La edad (mayores de 80 años, OR= 9,62, IC95%: 3,16-29,2), el estado al ingreso (OR= 8,32, IC95%: 2.30-30,10) y la inestabilidad hemodinámica (OR=6,9, IC95%:2,96-16,37), se asociaron a un mayor riesgo de fallecimiento. Los pacientes tratados con kaletra, cloroquina, itolizumab o jusvinza incrementaron la supervivencia. El riesgo de fallecimiento en los críticos disminuyó de 80 a 25% con el uso de jusvinza. Conclusiones: La caracterización clínica realizada demuestra la efectividad de los protocolos clínicos empleados en las unidades de terapia intensiva del país.

ABSTRACT Introduction: COVID-19 pandemic was declared an international public health emergency. The knowledge of the symptoms, comorbidities, and the risk associated with the treatment received could contribute to better classification and care of patients. Objective: To clinically characterize COVID-19 patients admitted to the Cuban intensive care units Methods: A retrospective observational study of all patients treated in the Cuban intensive care units from March 11 to July 30, 2020. Demographic, clinical and outcome data were collected. The prevalence of fatal and recovery cases was compared by covariables using the standard chi-square test. A logistic regression was performed to evaluate the predictor variables for in-hospital mortality. Results: A total of 175 patients were treated, including 106 acutely ill and 69 critically ill. Patients were predominantly male (52.0%), over 60 years old (67.2%) and had hypertension (57.0%). Age (over 80 years old, OR= 9.62, 95% CI: 3.16-29.2), health status at admission (OR= 8.32, 95% CI: 2.30-30.10), and hemodynamic instability (OR=6.9, 95% CI: 2.96-16.37) were associated with an increased risk of death. Patients treated with Kaletra, chloroquine, Itolizumab, or Jusvinza increased survival. Mortality risk in critically ill patients decreased from 80% to 25% with the use of Jusvinza. Conclusions: The clinical characterization performed demonstrates the effectiveness of the clinical protocols used in the country's intensive care units.

[Pasteurella canis hemorragic sepsis and empyema]. / Septicemia hemorrágica y empiema pleural por Pasteurella canis.

We report the case of a 56-year-old female patient, with a three-day history of hematemesis, melena, abdominal wall hematoma and epistaxis associated with thrombocytopenia and anemia. Idiopathic thrombocytopenic purpura was diagnosed and she was treated with dexamethasone for four days. The patient developed acute respiratory failure with signs of systemic inflammatory response. Blood and pleural fluid cultures grew Pasteurella canis. This is the first case, to our knowledge, of P. canis empyema associated with hemorrhagic septicemia without epidemiological background and the third case of septicemia caused by P. canis reported in the literature.

Infections with biological therapy: strategies for risk minimization in tropical and developing countries.

In recent decades, biological therapy has enabled disease activity control and improved quality of life in patients with autoimmune diseases. These therapies that are involved in immune response modifications and change multiple immunological pathways induce an incremental risk for certain infectious diseases. Though there have been recent advances in risk assessment for biological therapy, there is a lack of data and recommendations for assessing risks in populations with high prevalence of infectious diseases, such as those located in tropical areas and developing countries. We performed a review on infections with biological therapy as well strategies for risk minimization in areas with a high prevalence of tropical diseases.

Propuesta de acciones para la formación de la habilidad diagnóstica en residentes de Anatomía Patológica / Proposal of actions to develop the diagnosis skills in Pathology residents

RESUMEN Introducción: el diagnóstico es una de las tareas fundamentales de los médicos en general y de los patólogos en particular, es la actividad que ocupa el mayor tiempo de este especialista. Objetivo: diseñar un sistema de acciones para optimizar el proceso de formación de la habilidad diagnóstica en los residentes de Anatomía Patológica. Métodos: se realizó una investigación descriptiva y cualitativa a través de acciones estratégicas encaminadas al perfeccionamiento del proceso de formación de la habilidad diagnóstica en los residentes de la especialidad de Anatomía Patológica de la Universidad de Ciencias Médicas de Pinar del Río. Resultados: se constató que la formación de la habilidad diagnóstica no se encuentra debidamente estructurada, se realiza de manera espontánea, no secuenciada y no posibilita que el residente sistematice las acciones necesarias para su dominio. La estrategia se estructuró a través de la capacitación al colectivo pedagógico de la carrera y talleres profesionales integradores para los residentes de cada año. Conclusiones: se diseñó un sistema de acciones dirigidas a docentes y residentes de Anatomía Patológica, lo que permitió estimular el perfeccionamiento del proceso de formación de la habilidad diagnóstica morfológica, elevar la responsabilidad ante la docencia, el aprendizaje y el nivel de compromiso social con esta función, donde los residentes deben ser capaces de integrar y aplicar los conocimientos adquiridos en los diferentes módulos para la resolución de problemas propios de la profesión.

ABSTRACT Introduction: diagnosis is one of the main activities of physicians in general and of pathologists in particular, and is the activity that occupies most of this specialist's time. Objective: to design a system of actions to optimize the training process for the development of diagnosis skills in Pathology residents. Methods: a descriptive and qualitative research was conducted by means of strategic actions aimed at improving the training process for the development of diagnosis skills in Pathology residents at Pinar del Rio University of Medical Sciences. Results: it was confirmed that the training for the development of diagnosis skills is not properly structured, without any planning, not arranged and it does not make possible the resident to systematize the required actions for the mastery of these skills. The strategy was structured through the training of the teaching staff of these specialty and comprehensive professional workshops for the residents of each academic year. Conclusions: a system of actions was designed to train the teaching staff and residents of Pathology, which allowed encouraging strategic actions to improve the teaching-learning process for the development of diagnosis-morphological skills and increase the responsibility toward the teaching-leaning activity, and the level of social commitment in relation to this function, where the residents should be able to integrate and apply the knowledge acquired by means of the different modules for the characteristic problem-solving of this profession.

Predicción temporal de CD4+ en 80 pacientes con manejo antirretroviral a partir de valores de leucocitos / CD4+ temporal prediction in 80 patients with antiretroviral management from leukocyte counts

Objetivo: establecer una metodología predictiva de aplicación clínica de recuentos de CD4+ en rangos de interés clínico a partir del recuento absoluto de leucocitos. Metodología: a partir de los valores secuenciales de leucocitos y linfocitos CD4+ de 9 pacientes, se observaron patrones matemáticos que posteriormente fueron aplicados en un estudio ciego con 71 casos para confirmar su capacidad predictiva, midiendo porcentajes de especificidad y sensibilidad. Resultados: se determinaron cinco patrones matemáticos que predicen en el 99% de los casos los distintos recuentos de CD4+ a partir de recuentos de leucocitos con valores de especificidad y sensibilidad del 99%. Conclusiones: los patrones matemáticos encontrados entre recuento de leucocitos y CD4+ sugieren que este fenómeno prácticamente es determinista.

Objective: To establish a predictive methodology of CD4+ counts for clinical application in ranges of clinical interest based on the absolute leukocyte count. Methodology: From sequential values of leukocytes and CD4+ lymphocytes of nine patients, mathematical patterns were observed and applied in a blind study with 71 cases to confirm their predictive capacity, measuring percentages of specificity and sensitivity. Results: Five mathematical patterns were determined that predict 99% of the cases in which CD4+ counts are obtained from leukocyte counts with specificity and sensitivity values of 99%. Conclusions: The mathematical patterns found between leukocytes and CD4 counts suggest that this phenomenon is practically deterministic.

Occupational exposure to blood borne pathogens among healthcare workers: a cross-sectional study of a registry in Colombia.

BACKGROUND: Occupational exposure to blood borne pathogens caused by percutaneous injuries or mucosal contamination is frequent among Healthcare Workers (HCW). METHODS: A cross-sectional analysis of HCW with an occupational exposure to blood reported to professional risk insurance agencies between 2009 and 2014 was performed. Comparisons between groups according to exposure level (mild, moderate, and severe) were evaluated. RESULTS: Two thousand, four hundred three reports were classified according exposure as mild 2.7 %, moderate 74.8 %, severe 21.9 %. Factors related: health sciences student with mild exposure events [adjusted odds ratio (AOR) 11.91, 95 % CI 5.13-27.61, p < 0.00001], and physician with moderate exposure events (AOR 1.90, 95 % CI 1.17-3.07, p = 0.009). Factors inversely related: physician with severe exposure events (AOR 0.54, 95 % CI 0.32-0.91, p = 0.02) and health sciences student with moderate exposure events (AOR 0.08, 95 % CI 0.04-0.15, p < 0.00001). It was found an important relationship between severe events with infectious diseases specialist assessment, and follow-up adherence. Additionally, a case of Human Immunodeficiency Virus seroconversion was presented (0.0004 %), no other seroconversions were observed. CONCLUSIONS: Occupational exposure events must be managed according to established protocols, but adherence failure was evident with the exception of severe exposure cases. Thus, interventions to enhance occupational safety are required. Occupation must be considered as a risk factor during initial assessment of events.

Giant Molluscum Contagiosum in an HIV positive patient.

Molluscum Contagiosum (MC) is a skin infection caused by a double-stranded DNA virus of the family Poxviridae that replicates in the human epidermis, affecting mainly children and young sexually active adults and causing flesh colored papular lesions with central umbilication with an average size of 3-5mm, although atypical lesions that reach great size (Giant Molluscum Contagiosum), 10-15mm, can be seen in almost any immunodeficiency condition. We report the case of a 35 year old male patient with C3 HIV disease with an abdominal pathology associated to skin lesions predominantly in the forehead and scalp that reached sizes over 5mm, diagnosed as Giant Molluscum Contagiosum by skin biopsies.

Feocromocitoma maligno de presentación retroperitoneal / Retroperitoneal Malignant Pheochromocytoma

RESUMEN Introducción: la neoplasia más común y mejor conocida de la médula adrenal es el feocromocitoma benigno, que puede definirse como un paraganglioma de la médula suprarrenal, el cual puede secretar catecolaminas del tipo, norepinefrina, epinefrina o ambas. Presentación de caso: paciente femenina de 36 años, de raza blanca, con antecedentes de salud, valorada por dolor lumbar no irradiado, que se aliviaba espontáneamente, con cifras tensionales al ingreso de 170/100 mm de Hg, la ecografía informa la presencia de tumor retroperitoneal, se realiza exéresis quirúrgica del tumor, durante el transoperatorio la paciente sufre inestabilidad hemodinámica, con hipotensión, taquicardia y parada cardiorrespiratoria, que logra recuperarse. La paciente fallece en las primeras seis horas del postoperatorio en un cuadro de shock. Conclusiones: el feocromocitoma maligno constituye solo el 10 % de estas neoplasias, siendo una tumoración infrecuente en nuestro medio, motivo por el cual se consideró pertinente su presentación. El diagnóstico se realizó por estudio histológico, planteándose el feocromocitoma maligno. Se presentó un caso clínico de feocromocitoma maligno suprarrenal, pretendiendo con ello aportar un mayor conocimiento de esta neoplasia.

ABSTRACT Introduction: the most common and best-known neoplasm of the adrenal medulla is benign pheochromocytoma, which can be defined as a paraganglioma of the adrenal medulla, which may secrete catecholamine of the types of norepinephrine, epinephrine, or both. Clinical case: a 36-year-old, white race, female patient with a health history, assessed for a non-irradiated lumbar pain, which was spontaneously relieved, a blood pressure of 170/100 mm Hg at admission, the ultrasound reported the presence of a retroperitoneal tumor, the surgical exeresis of the tumor was performed, during the trans-operative stage the patient suffered from hemodynamic instability, hypotension, tachycardia and cardio-respiratory arrest, which was managed to her recovery. The patient dies in the first 6 hours as a consequence of a postoperative shock. Conclusions: malignant pheochromocytoma constitutes only 10 % of these types of neoplasm, being an infrequent tumor in our environment; its report was significant to be presented. The diagnosis was made by histological study, considering malignant pheochromocytoma. A clinical case of adrenal malignant pheochromocytoma was reported, with the intention of contributing to the acquisition of a better management in relation to this type of neoplasm.