RESUMEN
Case report: We present a case of a 66-year-old female diagnosed with R. gnavus bacteremia associated with fecal peritonits secondary to small-bowel herniation and perforation. Identification as R. gnavus was delayed because of absence of this species in the MALDI-TOF MS database (Vitek MS, bioMérieux). Identification was provided by 16S rRNA gene sequencing. Review: R. gnavus, a Gram-positive, strictly anaerobic bacterium, is a member of the human gut microbiota. Dysbiosis in the gut microbiota, with increased amounts of R. gnavus, has been described in inflammatory bowel disease. R. gnavus has only been reported occasionally as the cause of infections. Hence the potential pathogenicity is not yet fully recognized, and data regarding the antimicrobial susceptibility profile are rare. Identification of anaerobic bacteria such as R. gnavus is greatly accelerated as a result of the introduction of MALDI-TOF MS. However, as illustrated in this case report, an extensive and up-to-date MALDI-TOF MS database is necessary for providing an accurate identification.
Asunto(s)
Antibacterianos/administración & dosificación , Bacteriemia , Infecciones por Bacterias Grampositivas , Perforación Intestinal , Intestino Delgado/microbiología , Técnicas Microbiológicas , Peritonitis , Ruminococcus , Anciano , Antibacterianos/clasificación , Bacteriemia/etiología , Bacteriemia/microbiología , Bacteriemia/terapia , Diagnóstico Tardío , Femenino , Microbioma Gastrointestinal , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/etiología , Infecciones por Bacterias Grampositivas/fisiopatología , Infecciones por Bacterias Grampositivas/terapia , Hernia Abdominal/complicaciones , Hernia Abdominal/diagnóstico por imagen , Humanos , Perforación Intestinal/diagnóstico , Perforación Intestinal/etiología , Perforación Intestinal/cirugía , Laparoscopía/métodos , Técnicas Microbiológicas/métodos , Técnicas Microbiológicas/normas , Peritonitis/diagnóstico , Peritonitis/etiología , Peritonitis/fisiopatología , Peritonitis/terapia , Ruminococcus/aislamiento & purificación , Ruminococcus/patogenicidad , Resultado del TratamientoAsunto(s)
Neoplasias de los Conductos Biliares/diagnóstico por imagen , Neoplasias de los Conductos Biliares/patología , Imagen Multimodal/métodos , Papiloma/diagnóstico por imagen , Papiloma/patología , Anciano , Bélgica , Neoplasias de los Conductos Biliares/cirugía , Biopsia con Aguja , Colangiopancreatografia Retrógrada Endoscópica/métodos , Pancreatocolangiografía por Resonancia Magnética , Estudios de Seguimiento , Hospitales Universitarios , Humanos , Inmunohistoquímica , Masculino , Papiloma/cirugía , Medición de Riesgo , Tomografía Computarizada por Rayos X/métodos , Resultado del TratamientoAsunto(s)
Colon/patología , Mucosa Intestinal/patología , Enfermedad de Tangier/patología , Transportador 1 de Casete de Unión a ATP/genética , Pólipos Adenomatosos/complicaciones , Pólipos Adenomatosos/patología , Pólipos del Colon/complicaciones , Pólipos del Colon/patología , Colonoscopía , Neoplasias Colorrectales/complicaciones , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/patología , Células Espumosas/patología , Humanos , Masculino , Persona de Mediana Edad , Mutación , Enfermedad de Tangier/complicaciones , Enfermedad de Tangier/diagnóstico , Enfermedad de Tangier/genéticaRESUMEN
Ectopic varices are dilated portosystemic venous collaterals located outside of the gastro-esophageal region. Whereas they are common endoscopic findings in patients with portal hypertension, ectopic variceal bleeding is rather rare and accounts for only 1 to 5 % of all variceal bleedings. The rectum and the duodenum are the most common sites for ectopic varices, but they can be present along the whole intestinal tract and neighborhood. At present, there is no consensus well established on diagnostic workup for ectopic variceal bleeding and their therapeutic strategies. Further investigation of large series or randomized-controlled trials is needed because nowadays most of the data available are based on case reports. We report here an unusual case of an ectopic variceal bleeding, presented as an acute small intestine bleeding, due to a portosystemic shunt via dilated mesenteric veins and a varicous left ovarian vein in a patient with alcoholic cirrhosis. The involvement of an ovarian vein in ectopic variceal bleeding is rarely described.