Asunto(s)
Anestesia Obstétrica/métodos , Deficiencia del Factor VII/complicaciones , Deficiencia del Factor VII/tratamiento farmacológico , Factor VIIa/uso terapéutico , Complicaciones Hematológicas del Embarazo/tratamiento farmacológico , Femenino , Humanos , Hemorragia Posparto/prevención & control , Embarazo , Adulto JovenRESUMEN
We report a patient who presented a severe Panton-Valentine-secreting methicillin-susceptible Staphylococcus aureus pneumonia with threatening multi-organ failure including acute respiratory distress syndrome, cardiac failure, renal failure and disseminated intravascular coagulation. Clinical and biological disease course using empiric therapy with treatment directed against toxin production (linezolid, clindamycin and intravenous immunoglobulins) was found to be quickly effective.
Asunto(s)
Antiinfecciosos/uso terapéutico , Toxinas Bacterianas/biosíntesis , Exotoxinas/biosíntesis , Inmunoglobulinas Intravenosas/uso terapéutico , Leucocidinas/biosíntesis , Neumonía Bacteriana/tratamiento farmacológico , Infecciones Estafilocócicas/tratamiento farmacológico , Acetamidas/uso terapéutico , Adulto , Clindamicina/uso terapéutico , Humanos , Linezolid , Masculino , Insuficiencia Multiorgánica/tratamiento farmacológico , Insuficiencia Multiorgánica/etiología , Oxazolidinonas/uso terapéutico , Síndrome de Dificultad Respiratoria/tratamiento farmacológico , Síndrome de Dificultad Respiratoria/etiologíaRESUMEN
Staphylococcus aureus is responsible for two main clinical presentations in humans: suppurative infections and toxigenic diseases. A small percentage of S. aureus strains secrete Panton-Valentine leukocidin (PVL). This toxin is implicated in skin infections, furunculosis, osteoarticular infections, and particularly, in serious pulmonary infections known as necrotizing pneumonia, which affect immunocompetent patients with no comorbidity. A clear outline of the clinical presentation was described recently. Necrotizing pneumonia caused by PVL-secreting S. aureus strains is characterized by a combination of fever, hemoptysis, multilobar alveolar infiltrations, and leukopenia. The disease usually progresses to toxic shock or refractory hypoxemia. A number of interesting therapies targeting leukocidin have been proposed over the past few years based on in vitro data. This review focuses on the physiopathological basis and on the therapeutic relevance of various drugs.
Asunto(s)
Antitoxinas/uso terapéutico , Toxinas Bacterianas/toxicidad , Exotoxinas/metabolismo , Leucocidinas/metabolismo , Neumonía Estafilocócica/tratamiento farmacológico , Staphylococcus aureus/efectos de los fármacos , Adulto , Antitoxinas/toxicidad , Niño , Humanos , Neumonía Estafilocócica/complicacionesRESUMEN
A 54-years-old patient coming from Guinea, who presented fever, diarrhoea, consciousness disorders and severe haemolytic anaemia, was admitted to resuscitation unit in France. Despite many explorations carried out (evaluation of traumatic causes, infection, neoplasia, vascular, toxic causes, vitamin deficiency), it was not possible to explain neurological symptomatology. Besides, haemolytic anaemia was due to the ingestion of metamizole in a context of glucose-6-phosphate dehydrogenase deficit. This drug's marketing has been suspended in France since 2006. Despite appropriate treatment, after seven days of hospitalization, the patient died of multi-organ failure and hemophagocytic syndrome. This clinical case illustrates the difficulties encountered to set a diagnosis and manage patients coming from overseas. Uncommon aetiologies for French healthcare professionals should be evoked in the absence of comprehensive clinical information.
Asunto(s)
Anemia Hemolítica/etiología , Antitiroideos/efectos adversos , Deficiencia de Glucosafosfato Deshidrogenasa/diagnóstico , Metahemoglobinemia/inducido químicamente , Metimazol/efectos adversos , Agitación Psicomotora/etiología , Diagnóstico Diferencial , Diarrea/etiología , Resultado Fatal , Deficiencia de Glucosafosfato Deshidrogenasa/complicaciones , Guinea/etnología , Cefalea/etiología , Humanos , Linfohistiocitosis Hemofagocítica/etiología , Malaria Falciparum/diagnóstico , Masculino , Metahemoglobinemia/etiología , Persona de Mediana Edad , Insuficiencia Multiorgánica/etiología , Paris , Convulsiones/etiología , Vómitos/etiologíaRESUMEN
Ethylene glycol intoxication is one of the most serious acute poisonings due to the high toxicity that can result in death if not treated rapidly. We report the case of a patient who presented to the intensive care unit with a hypertensive crisis associated to a renal insufficiency. Laboratories investigations which revealed metabolic acidosis and elevated anion gap, highlighted an unexpected ethylene glycol intoxication. Clinical and psychiatric feature lead to suspect a chronic ingestion. Spontaneous recovery occured without specific treatment.
Asunto(s)
Glicol de Etileno/envenenamiento , Dolor Abdominal/inducido químicamente , Acidosis/inducido químicamente , Adulto , Femenino , Humanos , Remisión EspontáneaAsunto(s)
Cateterismo Venoso Central/efectos adversos , Síndrome de Horner/etiología , Venas Yugulares , Aneurisma Falso/etiología , Cateterismo Venoso Central/instrumentación , Femenino , Humanos , Persona de Mediana Edad , Nutrición Parenteral/efectos adversos , Nutrición Parenteral/instrumentaciónAsunto(s)
Enfermedades del Nervio Hipogloso/etiología , Intubación Intratraqueal/efectos adversos , Síndromes de Compresión Nerviosa/etiología , Adulto , Antiinflamatorios/uso terapéutico , Trastornos de la Articulación/etiología , Implantación de Mama , Trastornos de Deglución/etiología , Femenino , Humanos , Enfermedades del Nervio Hipogloso/tratamiento farmacológico , Metilprednisolona/uso terapéutico , Síndromes de Compresión Nerviosa/tratamiento farmacológicoRESUMEN
We report the case of an 18-year-old man with pulmonary leptospirosis presenting as an atypical pneumonia with alveolar haemorrhage, without icterus. Has he developed ARDS the patient was admitted in intensive care unit. This patient was contaminated when swimming in a lake. The purpose of this article is to remind doctors that in patient presenting atypical pneumopathy with haemoptysis, the pulmonary leptospirosis should be considered.