Hyperbaric oxygen therapy as an adjunctive treatment for COVID-19-associated mucormycosis: a report of two cases. / Oxigenoterapia hiperbárica como tratamiento complementario en mucormicosis asociada con la COVID-19: a propósito de dos casos.

OBJECTIVE.: We present the first two cases reported in Peru of the use of adjuvant hyperbaric oxygen therapy (HBOT) in patients with COVID-19-associated mucormycosis (CAM). The first case is a 41-year-old woman, with pain in the left side of the face and palatine region with purulent rhinorrhea for a month. Only an oroantral fistula was found during physical examination. The second case is a 35-year-old male, with decreased left visual acuity and palatal pain with a fistula, draining purulent secretion for four months. Both patients have history of diabetes, had moderate COVID-19 four months prior to admission, and received corticosteroid therapy for this diagnosis. Tomographic evaluation of both patients showed involvement of the maxillary sinus and surrounding bone tissue; both received diagnostic and therapeutic nasal endoscopy for debridement. Histological analysis showed that the samples were compatible with mucormycosis. The patients underwent debridement and were treated with amphotericin B deoxycholate; however, they presented torpid evolution. Then, HBOT was added and the patients showed an evident improvement after four weeks of treatment with subsequent controls without the presence of mucormycosis. We highlight the favorable evolution of these patients while receiving HBOT as treatment for a disease with high morbimortality, which emerged during the pandemic.

Oxigenoterapia hiperbárica como tratamiento complementario en mucormicosis asociada a COVID-19: a propósito de dos casos / Hyperbaric oxygen therapy as an adjunctive treatment for COVID-19-associated mucormycosis: a report of two cases

Reportamos los dos primeros casos, en Perú, sobre el uso del tratamiento con oxigeno hiperbárico coadyuvante (TOHC) en pacientes con mucormicosis asociado a COVID-19 (MAC). El primer caso es una mujer de 41 años, con dolor en hemicara y región palatina izquierdas con rinorrea purulenta de un mes de evolución. Al examen físico, solo evidencia fístula oroantral. El segundo caso se trata de un varón de 35 años, con disminución de agudeza visual izquierda y dolor palatino con fístula que drena secreción purulenta de cuatro meses de evolución. Ambos pacientes tienen el antecedente de diabetes, tuvieron COVID-19 moderado cuatro meses antes del ingreso, y recibieron corticoterapia por este diagnóstico. Ambos pacientes tuvieron una evaluación tomográfica que mostró compromiso del seno maxilar y tejido óseo circundante, con endoscopia nasal diagnóstica y terapéutica para desbridamiento. Se obtuvieron muestras compatibles con mucormicosis en estudio histológico. Los pacientes fueron tratados con limpieza quirúrgica y anfotericina B desoxicolato, sin embargo, presentaron evoluciones tórpidas. Por lo tanto, se adicionó la TOHC y mostraron una mejoría evidente tras cuatro semanas de tratamiento con controles subsiguientes sin presencia de mucormicosis. Resaltamos la evolución de estos pacientes con TOHC, en una enfermedad con importante morbimortalidad, que ha sido emergente durante la pandemia.

We present the first two cases reported in Peru of the use of adjuvant hyperbaric oxygen therapy (HBOT) in patients with COVID-19-associated mucormycosis (CAM). The first case is a 41-year-old woman, with pain in the left side of the face and palatine region with purulent rhinorrhea for a month. Only an oroantral fistula was found during physical examination. The second case is a 35-year-old male, with decreased left visual acuity and palatal pain with a fistula, draining purulent secretion for four months. Both patients have history of diabetes, had moderate COVID-19 four months prior to admission, and received corticosteroid therapy for this diagnosis. Tomographic evaluation of both patients showed involvement of the maxillary sinus and surrounding bone tissue; both received diagnostic and therapeutic nasal endoscopy for debridement. Histological analysis showed that the samples were compatible with mucormycosis. The patients underwent debridement and were treated with amphotericin B deoxycholate; however, they presented torpid evolution. Then, HBOT was added and the patients showed an evident improvement after four weeks of treatment with subsequent controls without the presence of mucormycosis. We highlight the favorable evolution of these patients while receiving HBOT as treatment for a disease with high morbimortality, which emerged during the pandemic.

Miopatía autoinmune necrotizante / Necrotizing autoimmune myositis

Mujer de 21 años, procedente de Camisea, Cusco, con dos semanas de debilidad muscular progresiva que llego inclusive a la falla ventilatoria, elevación extrema de crantina sérica total, patrón miopático en la electromiografía y con presencia de necrosis masiva sin infiltrado inflamatorio en la biopsia muscular. La pciente mejoró clínica y por los estudios de laboratorio con el tratamiento inmunosupresor.

A 21 year-old woman, from Camisea, Cusco, with two weeks of progressive muscle weakness that came even to ventilatory failure, extreme elevation of total serum creatine phosphokinase (CPK) a myopathic pattern in electromyography and presence of massive necrosis without inflammatory infiltrate in the muscle biopsy. The patient improved the clinical and laboratory parameters with immunosuppressive treatment.

Síndrome de superposición en esclerodermia: a propósito de un caso / Overlap syndrome and systemic sclerosis: a case report

Introdución: Distintos rasgos de enfermedades pueden coexistir en la enfermedad mixta del tejido conectivo, a diferencia del síndrome de superposición u overlap, que es la presentación de varias enfermedades autoinmunes que cumplen con sus criterios diagnósticos en un paciente. Caso clínico: Nosotros presentamos el caso de una mujer de 32 años tratada por esclerodermia durante cuatro años, que en una nueva evaluación se le diagnosticó lupus y polimiositis, conocido como síndrome de superposición. Discutimos las características particulares de la esclerosis y su evolución a otras enfermedades inmunitarias.

Introducction: Different characteristics from diseases can coexist in the mixed disease of the connective weave, unlike the syndrome of superposition or overlap, that is the presentation of several autoimmune diseases that fulfill their criteria diagnoses in a patient. Clinical case: We presented/displayed the case of a woman of 32 years tried by esclerodermia during four years, that in a new evaluation diagnosed lupus and polimiositis, well-known like superposition syndrome. We discuss to the particular characteristics of the sclerosis and their evolution to other immune diseases.

Neumonía eosinofílica: presentación de dos casos, agudo y crónico / Eosinophilic pneumonia: Chronic and acute forms

Se presenta dos casos de neumonía eosinofílica idiopática, uno crónico y otro agudo. En el caso clínico 1 se realizó una confirmación anatomopatológica de neumonía eosinofílica idiopática y en el caso clínico 2 se tuvo una neumonia eosinofílica aguda probable. Ambos presentaron tos, fiebre y disnea. El estudio radiográfico reveló lesiones alveolares bilaterales con tendencia a la consolidación. La marcada eosinofilia en sangre periférica fue un dato resaltante que facilitó el diagnóstico. Ambos casos tuvieron muy buena respuesta a la corticoterapia.(Rev Med Hered 2007;18:39-44).

Hemocromatosis hereditaria / Hereditary hemochromatosis

Se presenta el caso de un varón de 43 años, con diagnóstico de diabetes mellitus, insuficiencia cardiaca, pigmentación de piel, cirrosis hepática, y de hemocromatosis hereditaria confirmada por biopsia hepática. El objetivo de esta publicación es tener presente como diagnóstico diferencial a la hematocromatosis ante un paciente en la edad media de la vida con varias patologías y órganos involucrados.

[Hereditary hemochromatosis]. / Hemocromatosis hereditaria.

The case of a 43-year-old male is presented, with diagnosed diabetes mellitus,heart failure, skin pigmentation, hepatic cirhosis, and hereditary hemochromatosis confirmed by liver biopsy. The objective of this publication is to have hemochromatosis in mind as a differential diagnosis in a middle-aged patient with several pathologies and organs involved.