RESUMO
Despite remarkable advances in detection and therapy, coccidioidomycosis remains a persistent threat to military troops deployed in endemic areas. Pregnant women, immunocompromised hosts, and dark-skinned persons, particularly those of Filipino, African, Hispanic or Asian ancestry, are at greatest risk for disseminated coccidioidomycosis. The ethnically diverse military forces have susceptible active duty and reserve members stationed at or temporarily trained on bases located in endemic areas for Coccidioides immitis. Although the vast majority of infections with this organism are subclinical, unusual patterns of dissemination pose a diagnostic challenge. The military physician may be tasked with recognizing acute non-specific symptoms as well as bizarre, occult manifestations of coccidioidomycosis. We present a case of disseminated coccidioidomycosis in an active duty Caucasian male who presented with a right shoulder mass. Our patient is atypical in that he had disseminated disease although immunocompetent and Caucasian. Another unusual feature is that the mass was not preceded or accompanied by any other symptoms. We could find only two other reported cases of coccidioidomycosis presenting as a soft tissue mass, both in African-American patients. The epidemiology and history of coccidioidomycosis will be reviewed, with an emphasis on military populations. The insidious nature of coccidioidomycosis, the importance of early detection and treatment in decreasing morbidity and mortality, and the presence of large numbers of military members in the endemic areas make the lessons of this case particularly relevant for all flight surgeons.
Assuntos
Medicina Aeroespacial , Coccidioidomicose/diagnóstico , Coccidioidomicose/epidemiologia , Militares , Adulto , América/epidemiologia , Biópsia , Coccidioidomicose/terapia , Desbridamento , Diagnóstico Diferencial , Doenças Endêmicas/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Hospitalização/tendências , Humanos , Imageamento por Ressonância Magnética , Masculino , Gravidez , Fatores de Risco , Ombro , ViagemRESUMO
Tuberculous spondylitis (Pott's disease) is an uncommon complication of Mycobacterium tuberculosis infection that may have serious consequences if the diagnosis is missed or delayed. A case of tuberculous spondylitis in a military dependent is presented. Clinical presentation, radiologic findings, laboratory findings, and treatment are discussed.
Assuntos
Militares , Tuberculose da Coluna Vertebral/diagnóstico , Adulto , Antituberculosos/administração & dosagem , Biópsia , Transplante Ósseo , Terapia Combinada , Feminino , Seguimentos , Humanos , Compressão da Medula Espinal/patologia , Compressão da Medula Espinal/cirurgia , Vértebras Torácicas/patologia , Vértebras Torácicas/cirurgia , Tuberculose da Coluna Vertebral/patologia , Tuberculose da Coluna Vertebral/cirurgiaAssuntos
Bacteriemia/etiologia , Cateterismo Venoso Central/efeitos adversos , Meduloblastoma/complicações , Infecção por Mycobacterium avium-intracellulare/etiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Adolescente , Antibacterianos/uso terapêutico , Criança , Humanos , Masculino , Meduloblastoma/terapia , Infecção por Mycobacterium avium-intracellulare/tratamento farmacológicoRESUMO
The world-wide deployability of aircrew members exposes them to a peculiar array of medical problems. Non-immune populations, upon deployment to endemic areas, may present to the deployed flight surgeon with acute, poorly recognizable syndromes, such as acute coccidioidomycosis. Alternatively, the acquisition of the chronic progressive form of coccidioidomycosis in endemic areas may be a problem for the flight surgeon, who may be faced with a poorly recognizable syndrome which first manifests itself weeks to months after the crewmember's return from deployment. We describe three cases of coccidioidomycosis in service members that highlight the difficulty in the diagnosis of this disease. These cases prompted an epidemiologic survey of recent cases of coccidioidomycosis among Air Force beneficiaries, presented here, to better define the impact of this disease on personnel assigned to endemic areas. A brief discussion of the epidemiologic and clinical features of the disease and of the aeromedical disposition of the aviator is presented.
Assuntos
Militares , Adulto , Medicina Aeroespacial , Coccidioidomicose/epidemiologia , Humanos , Masculino , Sudoeste dos Estados Unidos/epidemiologiaRESUMO
The differential diagnosis of an abdominal mass in an infant or young child includes hepatoblastoma. This rare embryonal neoplasm of the liver is linked to several congenital abnormalities and may be associated with maternal occupational exposure to metal fumes, petroleum products, or paints. Alpha-fetoprotein is a useful tumor marker that may also be elevated with hepatocellular carcinoma. The relatively better prognosis of hepatoblastoma, if completely resected, mandates its differentiation from hepatoma. The fetal subtype of hepatoblastoma seems to represent a "favorable" histology pattern.
Assuntos
Carcinoma Hepatocelular/diagnóstico , Neoplasias Hepáticas/diagnóstico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/terapia , Pré-Escolar , Terapia Combinada , Diagnóstico Diferencial , Hepatectomia , Humanos , Lactente , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/terapia , Masculino , México , Prognóstico , alfa-Fetoproteínas/análiseAssuntos
Hospedeiro Imunocomprometido , Infecção por Mycobacterium avium-intracellulare/fisiopatologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Criança , Humanos , Masculino , Meduloblastoma/complicações , Meduloblastoma/tratamento farmacológico , Infecção por Mycobacterium avium-intracellulare/complicações , Infecção por Mycobacterium avium-intracellulare/terapia , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológicoRESUMO
Colonic lipomas are a rare source of massive lower gastrointestinal bleeding requiring operative intervention. A case of massive hemorrhage from cecal lipomatosis is presented. The methods of preoperative diagnosis and treatment are discussed.
Assuntos
Neoplasias do Ceco/complicações , Neoplasias do Colo/complicações , Hemorragia Gastrointestinal/etiologia , Lipoma/complicações , Neoplasias do Ceco/patologia , Neoplasias do Ceco/cirurgia , Neoplasias do Colo/patologia , Neoplasias do Colo/cirurgia , Feminino , Humanos , Lipoma/patologia , Lipoma/cirurgia , Pessoa de Meia-IdadeRESUMO
This case study discusses the presentation, evaluation, and aeromedical disposition of an aviator with renal cell carcinoma, a disease seldom seen in the military flying population. It emphasizes the necessity of flight surgeon awareness of preventive medicine aspects of waivered medical disorders.