RESUMEN
Panton-Valentine leucocidin is a major virulence factor produced by some strains of Staphylococcus aureus (SA-PVL). The best-described invasive infection is a necrotizing haemorrhagic pneumonia. Pleural effusion is not uncommon but is always associated with a parenchymal lesion. Here, we report a case of haemorrhagic pleurisy attributable to isolated SA-PVL.
Asunto(s)
Toxinas Bacterianas/metabolismo , Exotoxinas/metabolismo , Hemorragia/diagnóstico , Leucocidinas/metabolismo , Pleuresia/diagnóstico , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones Estafilocócicas/diagnóstico , Staphylococcus aureus/aislamiento & purificación , Adulto , Toxinas Bacterianas/toxicidad , Diagnóstico Diferencial , Exotoxinas/toxicidad , Femenino , Hemorragia/complicaciones , Hemorragia/microbiología , Humanos , Leucocidinas/toxicidad , Pleuresia/complicaciones , Pleuresia/microbiología , Neumonía Estafilocócica/diagnóstico , Radiografía Torácica , Infecciones del Sistema Respiratorio/complicaciones , Infecciones del Sistema Respiratorio/microbiología , Infecciones Estafilocócicas/complicaciones , Staphylococcus aureus/metabolismo , Adulto JovenRESUMEN
INTRODUCTION: In systemic lupus erythematosus, hemostasis disorders are mainly thrombotic, but more rarely hemorrhagic. CASE REPORT: A 25-year-old man presented with a macrophagic activation syndrome revealing a systemic lupus erythematosus, secondarily complicated by a hemorrhagic syndrome ; biological investigations revealed an increase thrombin time and an activated partial thromboplastin time, normalized by protamin neutralization in vitro, thus confirming the presence of a heparin-like anticoagulant. The hemostasis balance normalized after the specific treatment of lupus. CONCLUSION: This rare anomaly of hemostasis balance has been described in blood cancers and solid cancers. This is the first description of a case associated with an autoimmune connective tissue disorder such as lupus. After one year of follow-up, no diagnosis of blood or solid cancer was made.
Asunto(s)
Anticoagulantes/efectos adversos , Autoanticuerpos/efectos adversos , Trastornos Hemorrágicos/diagnóstico , Lupus Eritematoso Sistémico/diagnóstico , Síndrome de Activación Macrofágica/diagnóstico , Adulto , Anticoagulantes/sangre , Autoanticuerpos/sangre , Diagnóstico Diferencial , Factor VIII/inmunología , Trastornos Hemorrágicos/sangre , Trastornos Hemorrágicos/etiología , Heparina/análogos & derivados , Heparina/sangre , Humanos , Lupus Eritematoso Sistémico/sangre , Lupus Eritematoso Sistémico/complicaciones , Síndrome de Activación Macrofágica/sangre , Síndrome de Activación Macrofágica/complicaciones , MasculinoRESUMEN
INTRODUCTION: Nocardiosis are uncommon. The diagnosis may be difficult, with significant morbidity and mortality, often occurring on frail patients. Few data are available in France. METHODS: A retrospective single center study was conducted from 2002 to 2014 and included all patients with at least one positive microbiological sample for Nocardia with a follow-up in our hospital. RESULTS: Nineteen patients, including 15 men, were included with a mean age of 58 years (25-85). Seventeen had a risk factor (lung diseases [13], corticosteroids [12], solid neoplasia [2], HIV infection [2], diabetes mellitus [3], kidney transplant [2], lymphopenia [1]). Infections' locations were: pulmonary (12), brain (3), skin (2), lymph node (1) and corneal (1). The slow growth leads to a median of 35 days for a positive result (3-95). Nine species were identified. Fifteen patients (79%) received one or more lines of antibiotics including: cotrimoxazole (9), amoxicillin (7) cefotaxime/ceftriaxone (7) imipenem (3), or amikacin (3). The average duration of antibiotic therapy was 207 days. Four patients did not receive antibiotics due to a late result or a bacterial co-infection masking nocardiosis. Five patients died (26%) including 2 with cerebral nocardiosis. Six patients were cured, 4 suffered a relapse, 4 had an unknown evolution, and 1 was still treated. CONCLUSION: Our study shows that nocardiosis is a disease difficult to treat. A better understanding of this type of infection is necessary.
Asunto(s)
Nocardiosis , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Coinfección , Femenino , Francia/epidemiología , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Humanos , Huésped Inmunocomprometido , Enfermedades Pulmonares/complicaciones , Enfermedades Pulmonares/tratamiento farmacológico , Enfermedades Pulmonares/epidemiología , Masculino , Persona de Mediana Edad , Nocardia/aislamiento & purificación , Nocardiosis/diagnóstico , Nocardiosis/tratamiento farmacológico , Nocardiosis/epidemiología , Nocardiosis/microbiología , Estudios Retrospectivos , Factores de RiesgoRESUMEN
INTRODUCTION: The Doege-Potter syndrome is a rare paraneoplastic syndrome, first described by Doege and Potter in 1930, that usually involves solid fibrous pleural tumours. Hypoglycaemia is a rare complication of these tumours, due to secretion of insulin-like growth factors, and it can be the presenting symptom. The incidence of malignancy is low, about 12-15 %. CASE REPORT: An 81-year-old Caucasian man, operated on 20 years previously for a benign pleural fibroma, presented with several episodes of loss of consciousness due to profound hypoglycaemia and a history of increasing dyspnea. The chest X-ray revealed an intrathoracic mass. Following excision histological examination confirmed recurrence with malignant transformation to a high-grade sarcoma. CONCLUSION: The Doege-Potter syndrome is a rare condition but it should be suspected in episodes of hypoglycaemia associated with a history of dyspnea. These patients should be followed up postoperatively because of the risk of tumour recurrence.