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1.
Handchir Mikrochir Plast Chir ; 54(2): 155-159, 2022 Apr.
Artículo en Alemán | MEDLINE | ID: mdl-35419785

RESUMEN

We present the case of a 57-year-old male patient with a fatal outcome after resection of a soft tissue sarcoma of the lateral thigh. A polymicrobial surgical site infection with Staphylococcus lugdunensis and Clostridium perfringens caused fulminant necrotising fasciitis with an additional gas gangrene. The patient suffered a severe sepsis with consecutive haemolysis and multiorgan failure. The authors recapitulate the deadly progress of a rarely reported complication after oncological resection. The therapeutic approach and surgical interventions are discussed based on the current literature.


Asunto(s)
Infecciones por Clostridium , Fascitis Necrotizante , Gangrena Gaseosa , Sarcoma , Neoplasias de los Tejidos Blandos , Infecciones por Clostridium/complicaciones , Infecciones por Clostridium/diagnóstico , Infecciones por Clostridium/cirugía , Fascitis Necrotizante/diagnóstico , Fascitis Necrotizante/etiología , Fascitis Necrotizante/cirugía , Resultado Fatal , Gangrena Gaseosa/diagnóstico por imagen , Gangrena Gaseosa/etiología , Humanos , Masculino , Persona de Mediana Edad , Sarcoma/cirugía , Muslo/cirugía
2.
N Engl J Med ; 386(9): 861-868, 2022 03 03.
Artículo en Inglés | MEDLINE | ID: mdl-35235727

RESUMEN

Melioidosis, caused by the bacterium Burkholderia pseudomallei, is an uncommon infection that is typically associated with exposure to soil and water in tropical and subtropical environments. It is rarely diagnosed in the continental United States. Patients with melioidosis in the United States commonly report travel to regions where melioidosis is endemic. We report a cluster of four non-travel-associated cases of melioidosis in Georgia, Kansas, Minnesota, and Texas. These cases were caused by the same strain of B. pseudomallei that was linked to an aromatherapy spray product imported from a melioidosis-endemic area.


Asunto(s)
Aromaterapia/efectos adversos , Burkholderia pseudomallei/aislamiento & purificación , Brotes de Enfermedades , Melioidosis/epidemiología , Aerosoles , Encéfalo/microbiología , Encéfalo/patología , Burkholderia pseudomallei/genética , COVID-19/complicaciones , Preescolar , Resultado Fatal , Femenino , Genoma Bacteriano , Humanos , Pulmón/microbiología , Pulmón/patología , Masculino , Melioidosis/complicaciones , Persona de Mediana Edad , Filogenia , Choque Séptico/microbiología , Estados Unidos/epidemiología
3.
ScientificWorldJournal ; 2022: 8300247, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35281747

RESUMEN

The agouti (Dasyprocta leporina) is a neotropical rodent which has the potential to be domesticated. As such, some research studies have been done on the biology of this animal. Recently, these animals are being kept in captivity as a source of animal protein. Animals which are kept in captivity may present diseases that would not have been reported in the wild due to lack of observation or the lack of occurrence. The aim of this short communication is to report a case of systemic bacterial infection that affected the lungs and liver of a captive agouti. Bacterial analysis revealed that the infection was caused by Escherichia coli. Bacterial infections have been reported in the mammary tissue as well as the skin of the agouti, but to the authors' knowledge, this is the first report of systemic infection in the agouti affecting several organs. This case was seen in a nine-month-old male agouti that was being housed at the University of the West Indies Field Station (UWI, UFS). The animal showed no apparent sign of disease except for lethargy and subsequently died before any treatment was administered. These findings showed that the agouti may have been under some stress (nutritional or environmental) which predisposed this animal to this infection. Future work has to address the nutritional requirements for the growing agouti as well as some treatment options for managements of similar cases in the future.


Asunto(s)
Dasyproctidae/microbiología , Infecciones por Escherichia coli/veterinaria , Animales , Infecciones por Escherichia coli/diagnóstico , Infecciones por Escherichia coli/patología , Resultado Fatal , Hepatopatías/microbiología , Hepatopatías/patología , Hepatopatías/veterinaria , Enfermedades Pulmonares/microbiología , Enfermedades Pulmonares/patología , Enfermedades Pulmonares/veterinaria , Masculino , Enfermedades Cutáneas Bacterianas/microbiología , Enfermedades Cutáneas Bacterianas/patología , Enfermedades Cutáneas Bacterianas/veterinaria
6.
J Forensic Leg Med ; 87: 102335, 2022 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-35313146

RESUMEN

Acetamiprid is a member of neonicotinoid insecticides with a low risk of toxicity in humans. However, ingestion of large amounts may cause severe poisoning. This is the first case reported in the literature in which severe toxicity and death occurred after acetamiprid ingestion. A 57-year-old male patient consumed 50g/250mL of an insecticide formulation containing acetamiprid for suicidal purposes. The ambulance team performed cardiopulmonary resuscitation on the patient who had a cardiac arrest. His heart beat returned after a 15-min cardiopulmonary resuscitation, and afterward, he had tachycardia, hypotension, respiratory failure, high gap metabolic acidosis with a high lactate, hypokalemia, hypocalcemia, mydriasis, and coma. The patient underwent supportive treatment for a variety of symptoms. However, he died despite all supportive treatment. This case demonstrates that ingestion of large amounts of the acetamiprid and late presentation can be fatal despite all supportive care.


Asunto(s)
Paro Cardíaco , Insecticidas , Envenenamiento , Insuficiencia Respiratoria , Resultado Fatal , Humanos , Masculino , Persona de Mediana Edad , Neonicotinoides , Envenenamiento/diagnóstico
7.
Medicine (Baltimore) ; 101(6): e28771, 2022 Feb 11.
Artículo en Inglés | MEDLINE | ID: mdl-35147103

RESUMEN

RATIONALE: Amyotrophic lateral sclerosis (ALS) is a progressive and fatal neurodegenerative disease. However, the misdiagnosis of ALS always occurs because of atypical clinical manifestations. Since mutations in Cu/Zn superoxide dismutase 1 (SOD1) have been implicated as causative and account for 20% of fALS cases, early genetic sequencing of suspected individuals in ALS pedigrees could be helpful. PATIENT CONCERNS: Here we report a Chinese family spanning three generations with fALS. A heterozygous c.125G>A (p.Gly42Asp) missense mutation in exon 2 of SOD1 gene was detected in our proband as well as her 2 siblings and next generation. Phenotypic diversity was also reported among symptomatic individuals. DIAGNOSES: Peripheral blood samples from the proband were collected and sent for polymerase chain reaction (PCR) and Sanger sequencing of the SOD1 gene at Sanvalley Diagnostics. The other 11 members in the studied family then underwent locus verification. INTERVENTIONS: Butylphthalide, Vitamin B12, Coenzyme Q10 and mouse nerve growth factor is given to the symptomatic members. OUTCOMES: The symptoms of our proband was not improved by treatments at a late stage. She passed away the fourth year of the disease due to respiratory failure. Two siblings of the proband were given active treatments once verified as carrier. Their symptoms are still limited to limb weakness. LESSONS: This study suggests genetic sequencing is a powerful tool for the diagnosis of familial ALS. Phenotypic heterogeneity exists among G41D-mutated individuals, which further highlights the importance of genomic strategies for early diagnosis.


Asunto(s)
Esclerosis Amiotrófica Lateral/diagnóstico , Superóxido Dismutasa-1/genética , Superóxido Dismutasa/genética , Esclerosis Amiotrófica Lateral/genética , Esclerosis Amiotrófica Lateral/mortalidad , Análisis Mutacional de ADN , Resultado Fatal , Femenino , Predisposición Genética a la Enfermedad , Humanos , Persona de Mediana Edad , Mutación , Mutación Missense , Linaje , Superóxido Dismutasa/metabolismo
8.
Chest ; 161(2): e103-e110, 2022 02.
Artículo en Inglés | MEDLINE | ID: mdl-35131062

RESUMEN

CASE PRESENTATION: An 85-year-old Japanese man, who was taking aspirin and edoxaban for previous myocardial infarction and atrial fibrillation, came to our hospital with a chief complaint of dyspnea for 3 weeks. Chest radiography showed a massive left pleural effusion (Fig 1A). Analysis of pleural fluid showed an elevated hematocrit level at 32.8% (blood hematocrit level, 32.0%), and he was diagnosed with hemothorax. However, he had neither coagulation disorder nor thrombocytopenia, and the pleural effusion was negative for atypical cells. These findings suggested that the antithrombotic and anticoagulant medications might have induced the hemothorax.


Asunto(s)
Hemangiosarcoma/complicaciones , Hemotórax/etiología , Neoplasias de la Vejiga Urinaria/complicaciones , Anciano de 80 o más Años , Autopsia , Biopsia , Diagnóstico Diferencial , Resultado Fatal , Hemangiosarcoma/diagnóstico por imagen , Hemotórax/diagnóstico por imagen , Hemotórax/cirugía , Humanos , Imagen por Resonancia Magnética , Masculino , Radiografía Torácica , Recurrencia , Toracoscopía , Tomografía Computarizada por Rayos X , Neoplasias de la Vejiga Urinaria/diagnóstico por imagen
9.
J Infect Dev Ctries ; 16(1): 222-225, 2022 01 31.
Artículo en Inglés | MEDLINE | ID: mdl-35192541

RESUMEN

Clostridium perfringens causes pyogenic liver abscesses, which are rare but rapidly fatal infections. These abscesses often occur in patients with immunodeficiency due to malignancy, liver cirrhosis, diabetes mellitus, or organ transplantation. The identification of gram-positive bacilli in septicemia, the presence of gas-forming liver damage and intravascular hemolysis are manifestations of Clostridium perfringens infection. Clostridioides toxin A hydrolyzes phospholipids in erythrocyte membranes, causing spherocytosis and subsequent intravascular hemolysis, resulting in rapid deterioration and a high mortality rate. A 62-year-old man with recurrent hepatocellular carcinoma complained of a high fever and abdominal pain one day after microwave ablation. Abdominal computed tomography revealed gas-containing lesions in the liver. His condition was complicated with massive hemolysis. Laboratory examinations revealed low hemoglobin, high serum lactate dehydrogenase, and elevated indirect bilirubin levels, suggesting massive intravascular hemolysis. Although aggressive treatment was applied, he died within 16 hours after onset of the infection. After the patient died, a blood culture indicated Clostridium perfringens positivity. Clostridium perfringens-induced septicemia with massive hemolysis is rare but rapidly leads to a severe prognosis. It is important to identify Clostridium perfringens infection early and initiate effective treatment, especially abscess aspiration, which should be performed as soon as possible.


Asunto(s)
Carcinoma Hepatocelular , Infecciones por Clostridium , Absceso Hepático , Neoplasias Hepáticas , Carcinoma Hepatocelular/complicaciones , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/cirugía , Infecciones por Clostridium/diagnóstico , Clostridium perfringens , Resultado Fatal , Humanos , Absceso Hepático/diagnóstico , Absceso Hepático/etiología , Neoplasias Hepáticas/complicaciones , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/cirugía , Masculino , Microondas , Persona de Mediana Edad
10.
BMC Cardiovasc Disord ; 22(1): 41, 2022 02 12.
Artículo en Inglés | MEDLINE | ID: mdl-35151254

RESUMEN

BACKGROUND: Arrhythmogenic cardiomyopathy (AC) is a rare, heritable myocardial disorder that is a leading cause of ventricular arrhythmia and sudden cardiac death (SCD) in young people. Desmoplakin (DSP) mutations account for 3-20% of AC cases. However, the number of patients with DSP mutations is extremely small in all published reports and genotype-phenotype correlations are scant and mostly non-gene-specific. CASE PRESENTATION: A 45-year-old man was admitted after an out-of-hospital cardiac arrest, with documented ventricular fibrillation. He had no previous history of heart disease or family history of SCD or cardiomyopathy. The cardiac magnetic resonance showed a mildly dilated left ventricle with an ejection fraction of 30% and a non-dilated right ventricle with mildly depressed systolic function, and extensive subepicardial late gadolinium enhancement. Genetic screening identified a heterozygote nonsense mutation in DSP (NM_004415.2: c.478 C > T; p.Arg160Ter). Cascade genetic screening of the relatives revealed a high prevalence of the genotype and cutaneous phenotype, but a very low penetrance of the cardiac phenotype. CONCLUSIONS: We report a case of SCD and an autosomal dominant mutation in DSP that causes arrhythmogenic dilated cardiomyopathy/AC. Like the recessive mutation in DSP known to cause Carvajal syndrome, Arg160Ter may be associated with cutaneous abnormalities.


Asunto(s)
Arritmias Cardíacas/genética , Cardiomiopatía Dilatada/genética , Codón sin Sentido , Muerte Súbita Cardíaca/etiología , Desmoplaquinas/genética , Enfermedades del Cabello/genética , Queratodermia Palmoplantar/genética , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/fisiopatología , Cardiomiopatía Dilatada/complicaciones , Cardiomiopatía Dilatada/diagnóstico , Cardiomiopatía Dilatada/fisiopatología , Resultado Fatal , Predisposición Genética a la Enfermedad , Enfermedades del Cabello/complicaciones , Enfermedades del Cabello/diagnóstico , Enfermedades del Cabello/fisiopatología , Heterocigoto , Humanos , Queratodermia Palmoplantar/complicaciones , Queratodermia Palmoplantar/diagnóstico , Queratodermia Palmoplantar/fisiopatología , Masculino , Persona de Mediana Edad , Fenotipo
12.
Front Immunol ; 13: 810284, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35185899

RESUMEN

Acute myeloid leukemia (AML) patients who develop hematological relapse (HR) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) generally have dismal clinical outcomes. Measurable residual disease (MRD)-directed preemptive interventions are effective approaches to prevent disease progression and improve prognosis for molecular relapsed patients with warning signs of impending HR. In this situation, boosting the graft-vs-leukemia (GVL) effect with immune checkpoint inhibitors (ICIs) might be a promising prevention strategy, despite the potential for causing severe graft-vs-host disease (GVHD). In the present study, we reported for the first time an AML patient with RUNX1-RUNX1T1 who underwent preemptive treatment with the combined application of tislelizumab (an anti-PD-1 antibody) and azacitidine to avoid HR following allo-HSCT. On day +81, molecular relapse with MRD depicted by RUNX1-RUN1T1-positivity as well as mixed donor chimerism occurred in the patient. On day +95, with no signs of GVHD and an excellent eastern cooperative oncology group performance status (ECOG PS), the patient thus was administered with 100 mg of tislelizumab on day 1 and 100 mg of azacitidine on days 1-7. After the combination therapy, complete remission was successfully achieved with significant improvement in hematologic response, and the MRD marker RUNX1-RUNX1T1 turned negative, along with a complete donor chimerism in bone marrow. Meanwhile, the patient experienced moderate GVHD and immune-related adverse events (irAEs), successively involving the lung, liver, lower digestive tract and urinary system, which were well controlled by immunosuppressive therapies. As far as we know, this case is the first one to report the use of tislelizumab in combination with azacitidine to prevent post-transplant relapse in AML. In summary, the application of ICIs in MRD positive patients might be an attractive strategy for immune modulation in the future to reduce the incidence of HR in the post-transplant setting, but safer clinical application schedules need to be explored.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Enfermedad Injerto contra Huésped/etiología , Leucemia Mieloide Aguda/terapia , Adulto , Anticuerpos Monoclonales Humanizados/efectos adversos , Azacitidina/efectos adversos , Subunidad alfa 2 del Factor de Unión al Sitio Principal/genética , Resultado Fatal , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Humanos , Inhibidores de Puntos de Control Inmunológico/efectos adversos , Leucemia Mieloide Aguda/genética , Masculino , Proteína 1 Compañera de Translocación de RUNX1/genética , Recurrencia , Trasplante Homólogo
14.
Pathol Res Pract ; 231: 153796, 2022 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-35144085

RESUMEN

This case report describes a fatal case of a young woman with superior sagittal, transverse and sigmoid sinus thrombosis after administration of the ChAdOx1 nCov-19 vaccination. Eleven days post-vaccination she was found unconscious and transferred to the Emergency Department. Blood parameters showed low platelets, and a CT scan showed an extensive left intracranial hemorrhage and the presence of an occlusive thrombus of the superior sagittal sinus. She under-went a craniectomy, but after the intervention, she remained in a comatose state. After a few days, her clinical conditions worsened, and she died. A complete autopsy was performed which showed a thrombosis of the cerebral venous district, of the upper and lower limbs. A blood sample was also performed to carry out a gene study about the predisposition to thrombosis. The organ samples were studied through light microscope both in hematoxylin-eosin and immunohistochemical examination, and showed a strong inflammatory response in all samples and at the site of thrombosis. Our study aims to provide a proper autopsy technique to study the entire cerebral venous system through a multidisciplinary approach (anatomical dissection and neurosurgery) in post-vaccine venous thrombosis.


Asunto(s)
/efectos adversos , Trombosis de los Senos Intracraneales/etiología , Trombocitopenia/etiología , Adulto , COVID-19/prevención & control , Resultado Fatal , Femenino , Humanos
15.
Front Immunol ; 13: 849140, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35222440

RESUMEN

We report a case of inflammatory colitis after SARS-CoV-2 infection in a patient with no additional co-morbidity who died within three weeks of hospitalization. As it is becoming increasingly clear that SARS-CoV-2 infection can cause immunological alterations, we investigated the expression of the inhibitory checkpoint PD-1 and its ligand PD-L1 to explore the potential role of this axis in the break of self-tolerance. The presence of the SARS-CoV-2 virus in colon tissue was demonstrated by qRT-PCR and immunohistochemical localization of the nucleocapsid protein. Expression of lymphocyte markers, PD-1, and PD-L1 in colon tissue was investigated by IHC. SARS-CoV-2-immunoreactive cells were detected both in the ulcerated and non-ulcerated mucosal areas. Compared to healthy tissue, where PD-1 is weakly expressed and PD-L1 is absent, PD-1 and PD-L1 expression appears in the inflamed mucosal tissue, as expected, but was mainly confined to non-ulcerative areas. At the same time, these markers were virtually undetectable in areas of mucosal ulceration. Our data show an alteration of the PD-1/PD-L1 axis and suggest a link between SARS-CoV-2 infection and an aberrant autoinflammatory response due to concomitant breakdown of the PD-1/PD-L1 interaction leading to early death of the patient.


Asunto(s)
COVID-19/inmunología , Colitis/inmunología , Colon/metabolismo , Síndrome de Liberación de Citoquinas/inmunología , Inflamación/inmunología , SARS-CoV-2/fisiología , Anciano , Antígeno B7-H1/metabolismo , Colon/patología , Resultado Fatal , Femenino , Humanos , Receptor de Muerte Celular Programada 1/metabolismo , Autotolerancia , Transducción de Señal
16.
Front Immunol ; 13: 807050, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35154124

RESUMEN

Cytokine release syndrome (CRS) is a phenomenon of immune hyperactivation described in the setting of immunotherapy. Unlike other immune-related adverse events, CRS triggered by immune checkpoint inhibitors (ICIs) is not well described. The clinical characteristics and course of 25 patients with ICI-induced CRS from 2 tertiary hospitals were abstracted retrospectively from the medical records and analyzed. CRS events were confirmed by 2 independent reviewers and graded using the Lee et al. scale. The median duration of CRS was 15.0 days (Q1; Q3 6.3; 29.8) and 10 (40.0%) had multiple episodes of CRS flares. Comparing the clinical factors and biomarkers in Grades 1-2 and 3-5 CRS, we found that patients with Grades 3-5 CRS had following: (i) had longer time to fever onset [25.0 days (Q1; Q3 13.0; 136.5) vs. 3.0 days (Q1; Q3 0.0; 18.0), p=0.027]; (ii) more cardiovascular (p=0.002), neurologic (p=0.001), pulmonary (p=0.044) and rheumatic (p=0.037) involvement; (iii) lower platelet count (p=0.041) and higher urea (p=0.041) at presentation compared to patients with Grades 1-2 CRS. 7 patients (28.0%) with Grades 1-2 CRS were rechallenged using ICIs without event. 9 patients (36.0%) were treated with pulse methylprednisolone and 6 patients (24.0%) were treated with tocilizumab. Despite this, 3 patients (50%) who received tocilizumab had fatal (Grade 5) outcomes from ICI-induced CRS. Longer time to fever onset, lower platelet count and higher urea at presentation were associated with Grade 3-5 CRS. These parameters may be used to predict which patients are likely to develop severe CRS.


Asunto(s)
Anticuerpos Monoclonales Humanizados/administración & dosificación , Síndrome de Liberación de Citoquinas/inducido químicamente , Síndrome de Liberación de Citoquinas/tratamiento farmacológico , Inhibidores de Puntos de Control Inmunológico/efectos adversos , Inmunoterapia/efectos adversos , Metilprednisolona/administración & dosificación , Neoplasias/terapia , Índice de Severidad de la Enfermedad , Anciano , Biomarcadores/sangre , Síndrome de Liberación de Citoquinas/sangre , Resultado Fatal , Femenino , Humanos , Masculino , Persona de Mediana Edad , Quimioterapia por Pulso/métodos , Estudios Retrospectivos , Centros de Atención Terciaria , Resultado del Tratamiento
18.
Ann Neurol ; 91(4): 568-574, 2022 04.
Artículo en Inglés | MEDLINE | ID: mdl-35148013

RESUMEN

Coronavirus disease 2019 (COVID-19) severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2 infection) can lead to intensive care unit (ICU) admission and critical illness myopathy (CIM). We examined 3 ICU patients with COVID-19 who required mechanical ventilation for pneumonia and developed CIM. Pathological examination of the skeletal muscle biopsies revealed myopathic changes consistent with CIM, variable inflammation with autophagic vacuoles, SARS-CoV immunostaining + fibers/granules, and electron microscopy findings of mitochondrial abnormalities and coronavirus-like particles. Although mitochondrial dysfunction with compromised energy production is a critical pathogenic mechanism of non-COVID-19-associated CIM, in our series of COVID-19-associated CIM, myopathic changes including prominent mitochondrial damage suggest a similar mechanism and association with direct SARS-CoV-2 muscle infection. ANN NEUROL 2022;91:568-574.


Asunto(s)
COVID-19/complicaciones , COVID-19/virología , Enfermedad Crítica , Enfermedades Musculares/etiología , Enfermedades Musculares/virología , SARS-CoV-2 , Adulto , Anciano , Autofagia , Resultado Fatal , Femenino , Humanos , Inflamación/patología , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Mitocondrias/patología , Músculo Esquelético/patología , Vacuolas/patología
19.
Medicine (Baltimore) ; 101(5): e28721, 2022 Feb 04.
Artículo en Inglés | MEDLINE | ID: mdl-35119018

RESUMEN

RATIONALE: Cytomegalovirus (CMV) disease is relatively uncommon in nontransplant hematological patients. Moreover, cutaneous manifestations of CMV diseases have scarcely been reported and are probably under-recognized. PATIENT CONCERNS: We describe a patient with large B-cell lymphoma who developed a band-form, erythematous lesion over his left abdomen soon after the second course of rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone chemotherapy. DIAGNOSES: The lesion was initially mistaken for bacterial cellulitis or herpes zoster and was histologically confirmed as cutaneous CMV infection. Subsequent work-up also detected CMV viremia and the presence of CMV meningoencephalitis. INTERVENTIONS: The patient was treated with ganciclovir plus CMV immune globulin followed by foscarnet. OUTCOMES: Although the patient's cutaneous lesion resolved, his cognitive impairment did not recover, and he developed a fatal multi-organ failure 1 month later. LESSONS: Cutaneous CMV disease can herald multisystem involvement and an unfavorable prognosis in immunocompromised hosts. It should be ruled out with biopsy in patients with hematological malignancy who have cutaneous lesions refractory to antibacterial therapy.


Asunto(s)
Infecciones por Citomegalovirus , Neoplasias Hematológicas , Enfermedades de la Piel/virología , Antivirales/uso terapéutico , Infecciones por Citomegalovirus/diagnóstico , Infecciones por Citomegalovirus/tratamiento farmacológico , Resultado Fatal , Foscarnet/uso terapéutico , Ganciclovir/uso terapéutico , Neoplasias Hematológicas/tratamiento farmacológico , Humanos , Huésped Inmunocomprometido , Masculino , Enfermedades de la Piel/tratamiento farmacológico
20.
Medicine (Baltimore) ; 101(2): e28544, 2022 Jan 14.
Artículo en Inglés | MEDLINE | ID: mdl-35029212

RESUMEN

RATIONALE: Postmortem imaging (PMI), including computed tomography (PMCT), postmortem computed tomography angiography (PMCTA), and postmortem magnetic resonance imaging (PMMRI), is rapidly becoming effective and a practical method in forensic medicine. This study aimed to present a specific forensic case in which the PMI approach and its applications were used. PATIENT CONCERNS: A 40-year-old male patient had moderate unilateral nose bleeding constantly 10 times after suffering from a head injury induced by a car accident. After a bilateral massive nose bleeding for the last time, he died from hemorrhagic shock. Traumatic internal carotid artery pseudoaneurysm (TICAP) was suspected in this patient. DIAGNOSIS, INTERVENTIONS, AND OUTCOMES: A whole-body scanning was performed using PMCT and PMMRI. Then, PMCTA using left ventricular cardiac puncture was also implemented. A water-soluble contrast agent was injected into the left ventricle and pumped toward the intracranial, followed by a repeated whole-body PMCT scan. The PMCT/PMMRI detected a high-density/signal mass inside the left sphenoid sinus. The PMCTA detected a distinct leakage of the contrast agent into the left sphenoid sinus from an adjacent aneurysm of the C3 section of the left internal carotid artery. Autopsy and histology confirmed a TICAP inside the sphenoid sinus. LESSONS: This case showed that the PMI was of great value for identifying the cause of death in special cases. When vascular lesions are suspected in the body, PMI and especially the PMCTA approach may be an effective detection method.


Asunto(s)
Aneurisma Falso/diagnóstico por imagen , Autopsia/métodos , Arteria Carótida Interna/diagnóstico por imagen , Medios de Contraste , Adulto , Aneurisma Falso/etiología , Angiografía por Tomografía Computarizada , Resultado Fatal , Hemorragia , Humanos , Masculino
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