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1.
J Med Case Rep ; 18(1): 12, 2024 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-38195538

RESUMO

BACKGROUND: Intravesical Bacillus Calmette-Guérin (BCG) is used as a standard adjuvant therapy for non-muscle invasive urothelial cancer. Most patients tolerate the treatment well, with mild side effects. Systemic complications are extremely rare, occur due to BCG dissemination and are associated with immunocompromised state and urothelial breach. CASE PRESENTATION: We present a case of a 78-year-old male, a former smoker, with history of non-muscle invasive urothelial carcinoma status post partial resection followed by intravesical BCG therapy. An autopsy was performed due to the sudden nature of his death. Autopsy showed multiple necrotizing granulomas in the brain, atrium, ventricles, lungs, kidneys, and urinary bladder. Stains for acid-fast bacilli and fungi were negative. In addition, bilateral lungs showed evidence of bronchopneumonia secondary to cytomegalovirus. CONCLUSION: Granulomatous myocarditis arising from BCG therapy is extremely rare. Our patient with urothelial cancer treated with BCG developed multiorgan granulomas, most likely due to a hypersensitivity reaction to intravesical BCG. Arrhythmia induced by granulomatous myocarditis was the cause of his death. Although there have been few cases of systemic BCG-osis causing fatal sepsis leading to death, a cardiac cause of death is unique.


Assuntos
Vacina BCG , Carcinoma de Células de Transição , Miocardite , Neoplasias da Bexiga Urinária , Idoso , Humanos , Masculino , Autopsia , Vacina BCG/efeitos adversos , Carcinoma de Células de Transição/tratamento farmacológico , Granuloma/induzido quimicamente , Miocardite/induzido quimicamente , Neoplasias da Bexiga Urinária/tratamento farmacológico , Evolução Fatal
2.
Clin Microbiol Infect ; 30(3): 395.e1-395.e4, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38042367

RESUMO

OBJECTIVE: Human monkeypox (mpox) is usually self-limited infection; however, rising data show a worse outcome in patients with impaired immune status, particularly those co-infected with HIV [Mitjà O, Alemany A, Marks M, Lezama Mora JI, Rodríguez-Aldama JC, Torres Silva MS et al. Mpox in people with advanced HIV infection: A global case series. Lancet. 2023; 401:939-49. DOI:https://doi.org/10.1016/S0140-6736(23)00273-8] [Govind A, Lazarte SM, Kitchell E, Chow JY, Estelle CD, Fixsen E et al. Severe mpox infections in people with uncontrolled human immunodeficiency virus (HIV). Clin Infect Dis. 2023; 76:1843-6. DOI:https://doi.org/10.1093/cid/ciad052]. METHODS: We report the clinical, pathological, and molecular study of a patient with mpox infection and a late HIV diagnosis, with fatal outcome. RESULTS: Necropsy revealed visceral spread of mpox. Mpox virus was sequenced twice during the admission, uncovering an emerging mutation near a genomic region where mutations associated with tecovirimat resistance have been documented. DISCUSSION: Monkeypox can manifest as an opportunistic infection in individuals with advanced HIV-associated immunosuppression.


Assuntos
Infecções por HIV , Humanos , Infecções por HIV/complicações , Autopsia , Benzamidas , Evolução Fatal
3.
Am J Dermatopathol ; 46(1): 54-59, 2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-37982499

RESUMO

ABSTRACT: Hydroa vacciniforme (HV) lymphoproliferative disorder is a rare NK/T-cell lymphoma mainly affecting children and with a clinical resemblance to HV, which is mostly reported in Latin American and some Asian countries. Overall, the mature T cell and NK-cell neoplasms are now grouped into 9 families based on diverse concepts: cell of origin/differentiation state, clinical scenario, disease localization, and cytomorphology. HV lymphoproliferative disorder is listed within the group of Ebstein Barr Virus-positive T-cell and NK-cell lymphoid proliferations and lymphomas of childhood according to the fifth edition of the World Health Organization Classification of mature lymphoid neoplasms. We report the extraordinary case of a 22-year-old white woman, native of Spain, first presented in 2016 when she started suffering from recurrent facial edema. Four years later, the disease progressed with lymph node spreading and a fatal outcome. Here, we describe the clinical and histological presentation of the lymphoma throughout its evolution. Cases like this can be difficult to classify posing a real challenge to clinicians and pathologists. So, it is vital to be aware of the rare presentation of this disease to be able to identify the clinical and histological picture to make a correct diagnosis and establish an early treatment.


Assuntos
Hidroa Vaciniforme , Linfoma de Células T Periférico , Transtornos Linfoproliferativos , Feminino , Humanos , Adulto Jovem , Evolução Fatal , Hidroa Vaciniforme/patologia , Transtornos Linfoproliferativos/patologia
4.
Anasthesiol Intensivmed Notfallmed Schmerzther ; 58(11-12): 660-664, 2023 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-38056445

RESUMO

We report the perioperative course of a 47-year-old patient who underwent a two-stage liver resection for bilobar metastatic colorectal carcinoma. The respiratory asymptomatic patient was tested positive for SARS-CoV-2 by PCR detection one day before the second surgical procedure. Postoperatively, the patient suffered cardiovascular arrest on postoperative day 8 and died despite immediately initiated resuscitative measures. With an initial clinical suspicion of vascular liver failure, postmortem pathologic examination revealed the underlying cause of death to be COVID-19-related myocarditis with acute right heart failure. Individual multidisciplinary risk assessment should be considered very critically when deviating from the "7-week rule" because the benefit is difficult to objectify, even in oncologic patients.


Assuntos
COVID-19 , Neoplasias Colorretais , Insuficiência Cardíaca , Hepatectomia , Neoplasias Hepáticas , Miocardite , Humanos , Pessoa de Meia-Idade , COVID-19/diagnóstico , COVID-19/mortalidade , Evolução Fatal , Fígado/cirurgia , SARS-CoV-2 , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Infecções Assintomáticas/mortalidade , Hepatectomia/métodos , Hepatectomia/mortalidade , Miocardite/etiologia , Miocardite/mortalidade , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/mortalidade
5.
Ugeskr Laeger ; 185(49)2023 Dec 04.
Artigo em Dinamarquês | MEDLINE | ID: mdl-38078474

RESUMO

ECT is generally regarded as a safe and efficient treatment. In this case report, a 76-year-old female patient did not wake up as expected after ECT. The patient was transferred to the emergency department, and a CT-scan showed an intracerebral haemorrhage. She died within two days of the event, and an autopsy confirmed the diagnosis and did not reveal any underlying cerebral pathology.


Assuntos
Hemorragia Cerebral , Tomografia Computadorizada por Raios X , Feminino , Humanos , Idoso , Evolução Fatal , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/etiologia
6.
Acta Vet Scand ; 65(1): 56, 2023 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-38102633

RESUMO

BACKGROUND: Halicephalobus gingivalis is a nematode with zoonotic potential which can cause fatal opportunistic infections in various mammals. The parasite has never been diagnosed in Sweden, in any species, prior to the presented case. CASE PRESENTATION: An imported 21-year-old Icelandic mare developed severe neurological signs. The horse was eventually euthanized and submitted for post-mortem examination where severe lesions in the kidneys were noted. Histopathology revealed the presence of H. gingivalis in both kidneys and the brain. Phylogenetic analysis of the parasite determined it to belong to Lineage 1. CONCLUSIONS: With the occurrence of H. gingivalis in Sweden, the disease should be added to the list of differential diagnoses in cases with acute onset of neurological disease in both horses and other mammals including humans.


Assuntos
Doenças Transmissíveis , Encefalite , Doenças dos Cavalos , Parasitos , Rabditídios , Animais , Feminino , Doenças Transmissíveis/veterinária , Encefalite/diagnóstico , Encefalite/veterinária , Evolução Fatal , Doenças dos Cavalos/epidemiologia , Doenças dos Cavalos/parasitologia , Cavalos , Mamíferos , Filogenia , Suécia , Islândia
9.
J Investig Med High Impact Case Rep ; 11: 23247096231208996, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37919962

RESUMO

Acquired immunodeficiency syndrome (AIDS)-associated Kaposi sarcoma (KS) is an angioproliferative neoplasia caused by infection with human herpesvirus 8 (HHV-8). It typically presents with mucocutaneous involvement, but it can be disseminated. Initial presentation with primarily pulmonary KS is rare. We present a case of a 32-year-old male with untreated human immunodeficiency virus (HIV) diagnosed 1 year before presentation who developed progressively worsening cough and shortness of breath for 6 months. He was hospitalized twice and treated for unresolved pneumonia in an outside hospital. The patient concomitantly developed purplish nodules on his face, then the upper trunk, back, chest, and thighs bilaterally that gradually increased in size and number. Histopathology findings from skin lesions were consistent for KS. Bronchoscopy found multiple erythematous plaques throughout the tracheobronchial tree with telangiectasias and inflammation suggestive of pulmonary KS. His imaging findings and positive serum HHV-8 polymerase chain reaction (PCR) were consistent with disseminated KS. He started antiretroviral therapy (ART) to treat his HIV infection, followed by liposomal doxorubicin chemotherapy. But both ART and chemotherapy were interrupted due to adherence and insurance issues. The patient was readmitted with acute respiratory failure requiring mechanical ventilation with multiple vasopressors that led to the patient's demise. The late recognition of KS diagnosis and delayed treatment can lead to worse outcomes.


Assuntos
Síndrome de Imunodeficiência Adquirida , Infecções por HIV , Herpesvirus Humano 8 , Neoplasias Pulmonares , Pneumonia , Sarcoma de Kaposi , Masculino , Humanos , Adulto , Sarcoma de Kaposi/complicações , Sarcoma de Kaposi/diagnóstico , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Evolução Fatal , Neoplasias Pulmonares/patologia , Pneumonia/complicações
11.
Sud Med Ekspert ; 66(5): 59-61, 2023.
Artigo em Russo | MEDLINE | ID: mdl-37796464

RESUMO

THE AIM OF THE STUDY: Was to conduct the analysis of patient's clinical observation with acute dinitrophenol poisoning, admitted to a toxicological department of CCH №6 of Izhevsk, Udmurt Republic in 2021 yr. In this clinical case report, a 19 years old girl, who took 20 tablets of dinitrophenol, illegally obtained in online-shop, died. The fatal outcome was realized by the uncoupling of oxidative phosphorylation mechanism and cellular respiration, which in its turn led to serious dystrophic changes in all organs and tissues. Disorders of hemodynamics and blood rheological properties dominated in poisoning pathogenesis, led to congestion, stasis in microcirculatory vessels, hyperpermeability with multiple perivascular hemorrhages in organs, occurrence of piecemeal necrosis in kidneys and liver, nephrosis and nonspecific reactive hepatitis. Production ATP from ADP becomes impossible in these conditions, and respiratory energy chain completely disappears as heat, that explains the heat-increasing and fat-burning effects of dinitrophenol.


Assuntos
Intoxicação , Feminino , Humanos , Adulto Jovem , Dinitrofenóis , Evolução Fatal , Microcirculação
12.
BMJ Case Rep ; 16(9)2023 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-37673462

RESUMO

Gastrointestinal mucormycosis (GIM) is an uncommonly encountered fungal infection following solid-organ transplantation. GIM is known to be associated with immunocompromised states, remains difficult to diagnose and often results in fatal outcomes. It is plausibly the delay in initiation of appropriate treatment strategies that leads to failure of response and patient demise. We report two cases of GIM following live donor liver transplantation, presenting with bleeding and perforation, respectively, highlighting the challenges in making a timely diagnosis of mucormycosis, particularly in immunocompromised patients.


Assuntos
Transplante de Fígado , Mucormicose , Humanos , Transplante de Fígado/efeitos adversos , Mucormicose/diagnóstico , Mucormicose/tratamento farmacológico , Mucormicose/etiologia , Doadores Vivos , Cognição , Evolução Fatal
13.
J Med Case Rep ; 17(1): 396, 2023 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-37723518

RESUMO

BACKGROUND: Posttransplant lymphoproliferative disorder is one of the most severe complications after transplantation, caused by uncontrolled proliferation of Epstein-Barr virus-positive B-cells in the setting of chronic immunosuppression. As one of the biggest transplant centers worldwide, we observed a potential increase in the number of patients with posttransplant lymphoproliferative disorder presenting with gastrointestinal symptoms in 1 year, during the coronavirus disease 2019 pandemic. There is limited information about dysregulation of the immune system following coronavirus disease 2019 infection, which may lead to Epstein-Barr virus reactivation in Epstein-Barr virus-positive B-cells and development of posttransplant lymphoproliferative disorder. Furthermore, there is no consensus in literature on a modality that can help in early diagnosis of posttransplant lymphoproliferative disorder with nonspecific gastrointestinal presentations before late and fatal complications occur. CASE PRESENTATION: Our case series includes five Iranian (Persian) patients, three female (2, 2.5, and 5 years old) and two male (2 and 2.5 years old), who developed gastrointestinal posttransplant lymphoproliferative disorder after liver transplantation. All of our patients were on a similar immunosuppressant regimen and had similar Epstein-Barr virus serologic status (seronegative at time of transplantation but seropositive at time of posttransplant lymphoproliferative disorder diagnosis). Four patients had either a positive coronavirus disease 2019 polymerase chain reaction test or exposure within the family. Although all of our patients presented with nonspecific gastrointestinal symptoms, four patients developed late posttransplant lymphoproliferative disorder complications such as bowel perforation and obstruction. All five patients with gastrointestinal posttransplant lymphoproliferative disorder received chemotherapy, but only two survived and currently are continuing the therapy. In one of the surviving patients, prompt endoscopic investigation resulted in early diagnosis of posttransplant lymphoproliferative disorder and a better outcome. CONCLUSION: Since 80% of our patients had exposure to coronavirus, a potential relationship might be suggested between the two. Furthermore, as we witnessed in one case, urgent endoscopic investigation in immunocompromised patients presenting with gastrointestinal symptoms can improve the clinical outcomes and therefore should be considered for early diagnosis of posttransplant lymphoproliferative disorder.


Assuntos
COVID-19 , Infecções por Vírus Epstein-Barr , Gastroenteropatias , Pré-Escolar , Feminino , Humanos , Masculino , Endoscopia Gastrointestinal , Infecções por Vírus Epstein-Barr/complicações , Evolução Fatal , Gastroenteropatias/etiologia , Herpesvirus Humano 4 , Incidência , Irã (Geográfico)/epidemiologia
14.
N Engl J Med ; 389(13): 1203-1210, 2023 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-37754285

RESUMO

We treated a 27-year-old patient with Duchenne's muscular dystrophy (DMD) with recombinant adeno-associated virus (rAAV) serotype 9 containing dSaCas9 (i.e., "dead" Staphylococcus aureus Cas9, in which the Cas9 nuclease activity has been inactivated) fused to VP64; this transgene was designed to up-regulate cortical dystrophin as a custom CRISPR-transactivator therapy. The dose of rAAV used was 1×1014 vector genomes per kilogram of body weight. Mild cardiac dysfunction and pericardial effusion developed, followed by acute respiratory distress syndrome (ARDS) and cardiac arrest 6 days after transgene treatment; the patient died 2 days later. A postmortem examination showed severe diffuse alveolar damage. Expression of transgene in the liver was minimal, and there was no evidence of AAV serotype 9 antibodies or effector T-cell reactivity in the organs. These findings indicate that an innate immune reaction caused ARDS in a patient with advanced DMD treated with high-dose rAAV gene therapy. (Funded by Cure Rare Disease.).


Assuntos
Distrofina , Terapia Genética , Distrofia Muscular de Duchenne , Síndrome do Desconforto Respiratório , Transgenes , Adulto , Humanos , Anticorpos , Distrofina/genética , Terapia Genética/efeitos adversos , Terapia Genética/métodos , Distrofia Muscular de Duchenne/genética , Distrofia Muscular de Duchenne/terapia , Síndrome do Desconforto Respiratório/etiologia , Síndrome do Desconforto Respiratório/imunologia , Transgenes/genética , Transgenes/imunologia , Evolução Fatal , Imunidade Inata/genética , Imunidade Inata/imunologia
15.
BMC Geriatr ; 23(1): 533, 2023 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-37658318

RESUMO

We present a case of an elderly woman suffering from Pasteurella multocida (P. multocida) bacteremia, without obvious bite marks, but owning a pet dog. Although the patient was not immunocompromised, and prompt treatment with intravenous antibiotics was initiated, she developed severe septic shock with multiple organ failure and died. In healthy individuals, an infection caused by these bacteria is easy to treat and often harmless, whereas in elderly serious complications can occur. We believe this report of a fatal outcome of a P. multocida bacteremia in a non-immunocompromised, but elderly patient is important, given the growing cohort of elderly pet-owners seeking medical care. A greater awareness of this zoonosis and its potentially fatal outcome is warranted.


Assuntos
Bacteriemia , Pasteurella multocida , Idoso , Animais , Cães , Feminino , Humanos , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Evolução Fatal , Animais de Estimação , Prazer
17.
Virology ; 586: 115-121, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37542818

RESUMO

BACKGROUND: Monoclonal antibody (palivizumab), intravenous immune globulin (IGIV), or respiratory syncytial virus (RSV)-polyclonal-hyperimmune-globulin (RSV-IG as Respigam®, RI-001, RI-002) are used with ribavirin in RSV-infected immunocompromised patients, with debated efficacy. Palivizumab-resistance (PR) can arise during treatment of persistent infections in this population. RSV-IG may confer benefit in PR-RSV infection. METHODS: RSV-IG [RI-001] was provided for an immunocompromised infant with RSV-pneumonitis refractory to ribavirin and palivizumab. RSV-neutralizing antibody, respiratory RSV load (qPCR), and F-gene-sequence-detection of PR was determined. Prophylactic RSV-IG [RI-002] or palivizumab was administered in a cotton-rat model infected with wild-type and PR-RSV. Lung RSV load and neutralizing antibody were measured. RESULTS: As protective RI-001-neutralizing antibody titers waned in the infant, a subpopulation of PR-escape mutants were detected with a fatal RSV-burden in the lungs. In PR-RSV-infected cotton rats, prophylactic RI-002 reduced RSV-load in the lungs (2.45 vs 0.28 log10 PFU/g lung-tissue reduction, respectively, p < 0.05) and provided protective RSV-neutralizing antibody. CONCLUSIONS: RSV-IG and ribavirin use in immunocompromised patients requires further study.


Assuntos
Farmacorresistência Viral , Palivizumab , Infecções por Vírus Respiratório Sincicial , Vírus Sincicial Respiratório Humano , Humanos , Palivizumab/uso terapêutico , Vírus Sincicial Respiratório Humano/efeitos dos fármacos , Infecções por Vírus Respiratório Sincicial/tratamento farmacológico , Hospedeiro Imunocomprometido , Animais , Sigmodontinae , Pulmão/patologia , Pulmão/virologia , Imunoglobulinas/administração & dosagem , Anticorpos Neutralizantes/administração & dosagem , Feminino , Lactente , Evolução Fatal , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações
18.
Parasitol Res ; 122(10): 2451-2452, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37555856

RESUMO

This case report describes a 62-year-old male fisherman who presented with persistent vomiting, headache, and behavior changes. Despite initial antibiotic and corticosteroid treatment, his condition worsened, leading to coma and subsequent death. Macro-genome sequencing of cerebrospinal fluid (CSF) revealed the presence of Naegleria fowleri infection, which had been missed during initial laboratory tests. The patient's exposure history included sea-swimming near Zhoushan Island.


Assuntos
Amebíase , Infecções Protozoárias do Sistema Nervoso Central , Meningoencefalite , Naegleria fowleri , Masculino , Humanos , Pessoa de Meia-Idade , Infecções Protozoárias do Sistema Nervoso Central/diagnóstico , Amebíase/diagnóstico , Natação , Naegleria fowleri/genética , Evolução Fatal , Água do Mar , Meningoencefalite/diagnóstico
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