RESUMEN
El dengue es la infección trasmitida por vectores con mayor impacto en carga de enfermedad, económica y social a nivel mundial, con más de 3,6 billones de personas en riesgo de infección. Sus manifestaciones son variables, caracterizadas en su mayoría por síndrome febril con riesgo de sangrado, choque y muerte. El compromiso pulmonar es infrecuente, siendo el síndrome de dificultad respiratoria aguda una complicación inesperada, aunque informada, asociada a un mal pronóstico. Se presenta un paciente sin antecedentes relevantes de importancia, con focalización pulmonar severa asociado a infección por el virus dengue. En el caso presentado se descartaron procesos infecciosos bacterianos u otros agentes causales de síndrome de dificultad respiratoria aguda, lo que sumado a las características clínicas de ingreso, zona de ocurrencia del caso considerada como endémica, curso clínico, paraclínico y la franca positividad de las pruebas para dengue así como la seroconversión de estas, a pesar de no haber sido realizadas pruebas moleculares, se consideró como el agente causal más probable el virus dengue. Todo esto lleva a recomendar siempre considerarlo como potencial agente causal, lo que permite así un diagnóstico y manejo óptimos(AU)
Dengue is the vector-borne infection with the greatest impact on disease, economic and social burden worldwide, with more than 3.6 billion people under risk of contagion. Its manifestations are varied, most of them characterized by febrile syndrome with a risk of bleeding, shock and death. Pulmonary involvement is infrequent, and acute respiratory distress syndrome is an unexpected complication, though it has been reported in association to a bad prognosis. A case is presented of a male patient without relevant antecedents of interest, with severe pulmonary focalization associated to dengue virus infection. Bacterial infectious processes and other causative agents of acute respiratory distress syndrome were ruled out. In view of the patient's clinical status at admission, the endemicity of the patient's area of residence, the clinical and paraclinical course, and the obvious positivity of the dengue tests performed and their seroconversion, despite not having conducted molecular tests, it was concluded that the most probable causative agent was dengue virus. Therefore, it is recommended that dengue infection always be considered as a potential causative agent of acute respiratory distress syndrome, thus contributing to optimal diagnosis and management(AU)
Asunto(s)
Humanos , Masculino , Adulto , Síndrome de Dificultad Respiratoria del Recién Nacido , Enfermedades Endémicas , Técnicas de Diagnóstico Molecular , Virus del Dengue , Pronóstico , Costo de Enfermedad , SeroconversiónRESUMEN
Venous thromboembolic disease is an important cause of mortality worldwide. A widely recognized risk factor is active neoplasia, mainly hematological tumors, in which associated thrombocytopenia can be a frequent complication. We present the case of a patient with submassive pulmonary thromboembolism associated with severe thrombocytopenia with signs of right heart failure and a requirement for systemic thrombolysis and anticoagulation, however with absolute contraindication for them. The case establishes a therapeutic challenge for the treating group, leading us to carry out an extensive search of the literature and propose a management algorithm in this complex situation.
