ABSTRACT
Objetivo: diagnosticar y tratar la presencia de una fístula cutánea. Caso clínico: un paciente de sexo masculino, de 9 años de edad, consultó por una lesión cutánea en la zona mandibular del lado izquierdo. Concusiones: una fístula cutánea requiere un diagnóstico diferencial preciso, a fin de determinar su etiología y planificar el procedimiento endodóntico correcto. Como consecuencia de una mortificación pulpar, la presencia de bacterias dentro del conducto radicular puede generar una periodontitis perirradicular crónica de origen endodóntico.
Subject(s)
Humans , Male , Child , Periapical Diseases/complications , Cutaneous Fistula/diagnosis , Cutaneous Fistula/therapy , Diagnosis, Differential , Drainage , Cutaneous Fistula/microbiology , Calcium Hydroxide/therapeutic use , Root Canal TherapyABSTRACT
Actinomycosis is a chronic granulomatous disease caused by Gram-positive anaerobic bacteria of the genus Actinomyces. Pulmonary actinomycosis is a rare infection in children, and its extension into the chest wall is infrequently reported. We report a case of pulmonary actinomycosis in a 14-year-old girl of Mapuche descent who presented with chronic respiratory symptoms and multiple discharging skin sinuses on her right lower chest wall. The diagnosis was made by skin biopsy, which showed sulfur granules with actinomyces colonies. She was successfully treated with intravenous ceftriaxone and penicillin G for 6 weeks, followed by oral amoxicillin for 6 months.
Subject(s)
Actinomyces/isolation & purification , Actinomycosis/complications , Cutaneous Fistula/microbiology , Lung Diseases/microbiology , Adolescent , Female , Humans , Indians, South AmericanABSTRACT
Actinomyces meyeri cutaneous actinomycosis is a very rare disease. It often results from contiguous dissemination of an underlying focus. We report a case of pulmonary actinomicosis with secondary cutaneous involvement which led to the diagnosis. A 51-year-old man presented with an indurated, erythematous plaque on his right chest wall. He had been diagnosed with pneumoniae one month prior ago and received antibiotic treatment but symptoms persisted. Fibrobroncoscopy was normal and bronchoalveolar lavage samples were negative. The cutaneous plaque evolved with fistulization and drainage of serohematic material with white grains. Actinomyces meyeri was cultured from bacteriologic samples. Ceftriaxone and doxiciclin were administered for a total of 12 months with complete resolution of the clinical condition.
Subject(s)
Actinomyces/isolation & purification , Actinomycosis/diagnosis , Cutaneous Fistula/microbiology , Actinomycosis/complications , Actinomycosis/drug therapy , Anti-Bacterial Agents/therapeutic use , Chronic Disease , Combined Modality Therapy , Cutaneous Fistula/therapy , Drainage , Humans , Male , Middle Aged , Thoracic Wall/microbiologyABSTRACT
OBJECTIVE: The aim of this paper is to review the subject and to report on and discuss a case of bronchopleural cutaneous fistula due to Eikenella corrodens. DESCRIPTION: A 16-year-old girl was brought to our hospital with fever and blood-tinged sputum 2 weeks prior to her admission. She suffered from neurologic sequelae of herpetic encephalitis and had been bed-ridden since 5 years of age. A longitudinal paraspinal soft mass had been noted in the previous week by her mother. She had been given oral feeding despite frequent choking for the past few years. On palpation, the mass can be squeezed to follow the least resistance of subcutaneous space longitudinally extending to the lower thoracic region. Chest computed tomography scan revealed right lower lobe necrotizing pneumonitis and a pleuro-cutaneous fistula leading to the subcutaneous air locules. A protracted course of antibiotics was prescribed and subcutaneous air trapping decreased in size over 8 weeks. COMMENTS: Eikenella corrodens has increasingly been implicated as a potential causative pathogen in pleuropulmonary infections. Pleuro-cutaneous fistula and abscess formation complicating empyema and necrotizing pneumonitis due to E. corrodens infection have not been reported. A bulging thoracic subcutaneous lesion waxes and wanes with respiration suggest the possibility of a pleruo-cutaneous fistula. Treatment of Eikenella empyema using antibiotics without surgical decortication requires a prolonged course of antibiotic therapy.
Subject(s)
Bronchial Fistula/microbiology , Cutaneous Fistula/microbiology , Eikenella corrodens , Fistula/microbiology , Gram-Negative Bacterial Infections/complications , Pleural Diseases/microbiology , Adolescent , Female , Gram-Negative Bacterial Infections/microbiology , HumansABSTRACT
OBJETIVO: Fazer uma revisão sobre fistula cutânea broncopleural causada por Eikenella corrodens e relatar e discutir o caso de uma paciente. DESCRIÇAO: Paciente do sexo feminino, 16 anos de idade, foi encaminhada ao nosso hospital em estado febril com histórico de escarro com estrias de sangue há 2 meses; apresentava seqüelas neurológicas de encefalite herpética e estava confinada ao leito desde os cinco anos de idade. A mãe relatou ter detectado, dias antes, uma massa mole paraespinhal longitudinal. A paciente recebia alimentação via oral apesar da ocorrência de freqüentes engasgamentos nos últimos anos. A apalpação, a massa podia ser pressionada até encontrar menor resistência do espaço subcutâneo, estendendo-se longitudinalmente até a região torácica inferior. A tomografia torácica revelou pneumonia necrotizante do lobo direito inferior e uma fistula bronco pleural formando áreas de cavitação subcutânea. A paciente foi submetida a tratamento prolongado com antibióticos com decrescentes coletas de ar por 8 semanas. COMENTARIOS: A Eikenella corrodens tem sido indicada como potencial patógeno causador de infecções pleuropulmonares. Não há relatos de fístula pleurocutânea e formação de abscessos como complicadores de empiema e pneumonia necrotizante causados por infecção de E. corrodens. A presença de lesão torácica proeminente que aumenta e diminui com a respiração pode ser uma indicação de fistula pleurocutânea. O tratamento do empiema de Eikenella com antibióticos sem decorticação cirúrgica exige um tratamento prolongado com antibioticoterapia.