RESUMEN
BACKGROUND: Clinical guidelines list active fungal infection and sepsis as contraindications to liver transplantation due to the risk of worsening infection with immunosuppression postoperatively. Mortality from systemic opportunistic infections in transplant recipients is high, approaching 100% for disseminated aspergillosis. However, the optimal duration of treatment required before transplant is unclear. Additionally, delaying surgery while the infection is treated risks death from hepatic decompensation and physical deconditioning, preventing progression to transplantation. CASE REPORT: Here, we present a patient who underwent successful repeat liver transplantation for recurrent autoimmune hepatitis and graft rejection while undergoing treatment for disseminated aspergillosis and nocardiosis. He had pulmonary, hepatic, and central nervous system involvement. He had received 2 months of antimicrobials but had ongoing radiologic evidence of infection when listed for retransplantation. He remains well and infection-free 1 year postoperatively. CONCLUSION: Few cases of successful liver transplantation in the setting of disseminated aspergillosis have been reported previously. To our knowledge, this is the first successful liver transplant in a patient with disseminated nocardial infection.
Asunto(s)
Aspergilosis , Trasplante de Hígado , Nocardiosis , Masculino , Humanos , Reoperación , Aspergilosis/tratamiento farmacológico , Hígado , Nocardiosis/diagnóstico , Nocardiosis/cirugía , Trasplante de Hígado/efectos adversosRESUMEN
PURPOSE: The right atrium is preferred over the superior vena cava (SVC) for tunnelled dialysis catheter (TDC) tip placement as it offers the best compromise between optimal catheter performance and complications. However, clinical practice guidelines are not all unanimous on this as a universal recommendation. Right atrial tip placement may also fail due to variations in body surface area, venous anatomy or TDC designs and lengths. Moreover, the presence of recurrent long intra-cardiac fibrin sheath or cardiac rhythm management device leads serves as contraindications. Extra-cardiac tip placement in the azygous, hepatic veins and lower segment of the inferior vena cava (IVC) is an alternative but is invariably associated with poor blood flow and shortened patency. METHODS: We report the concept of extra-cardiac tip placement into the larger calibre hepatic segment IVC via a transjugular approach in two diabetic haemodialysis patients with overestimated TDC length out of 380 insertions. RESULTS: Blood flow was maintained above 250 ml/min for 5-6 months and no tip migration ensued. CONCLUSIONS: The IVC upper segment is a reliable site for extra-cardiac tip placement in select cases but its safety and efficacy need to be further studied in larger clinical trials.
Asunto(s)
Cateterismo Venoso Central/métodos , Catéteres de Permanencia , Catéteres Venosos Centrales , Venas Yugulares , Fallo Renal Crónico/terapia , Diálisis Renal , Vena Cava Inferior , Cateterismo Venoso Central/efectos adversos , Cateterismo Venoso Central/instrumentación , Diseño de Equipo , Humanos , Venas Yugulares/diagnóstico por imagen , Fallo Renal Crónico/diagnóstico , Masculino , Persona de Mediana Edad , Flebografía/métodos , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Vena Cava Inferior/diagnóstico por imagenRESUMEN
Rapidly growing mycobacterial skin and soft tissue infections are known to complicate cosmetic surgical procedures. Treatment consists of more surgery and prolonged antibiotic therapy guided by drug susceptibility testing. Paradoxical reactions occurring during antibiotic therapy can further complicate treatment of non-tuberculous mycobacterial infections. We report a case of post liposuction Mycobacterium abscessus surgical site infection in a returned medical tourist and occurrence of paradox during treatment.
