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Introducción. La tuberculosis osteoarticular en niños es una condición infrecuente que representa un pequeño porcentaje de las infecciones extrapulmonares por Mycobacterium tuberculosis.Presentación del caso. Niño de 30 meses con antecedente de que COVID-19 que fue llevado al servicio de urgencias por dolor en la marcha, imposibilidad para la bipedestación y dolor severo en posición decúbito. El paciente tenía niveles de reactantes de fase aguda elevados y mediante tomografía computarizada y resonancia magnética nuclear se evidenció destrucción de L3 con pérdida de la médula ósea, colapso vertebral y colección de fluido, así como compromiso de L4. Posteriormente, en una biopsia abierta se encontró colección de fluido con secreción, con resultado negativo en cultivos de bacterias y resultado positivo en prueba molecular de detección de Mycobacterium tuberculosis. Una semana después del ingreso, se inició manejo farmacológico antituberculoso y se inmovilizó con ortesis toracolumbosacra. En un nuevo ingreso al servicio de urgencias, se realizó drenaje quirúrgico por dehiscencia de la herida, secreción y febrícula. Sin embargo, en un control posterior se encontró espondilodiscitis en L3 y L4, y abscesos epidurales. Finalmente, una vez terminado el manejo con ortesis, en un último control se observó que el paciente presentaba cifosis toracolumbar residual, pero no tenía signos de compromisos radicular o medular, ni de déficit osteoarticular.Conclusión. La tuberculosis vertebral es una condición infrecuente en población pediátrica, por lo que es importante tener una sospecha clínica en todos los niños con síntomas típicos de la enfermedad.
Introduction: Osteoarticular tuberculosis in children is a rare condition that accounts for a small percentage of extrapulmonary Mycobacterium tuberculosis infections. Case presentation: A 30-month-old boy with a history of COVID-19 was taken to the emergency department due to antalgic pain, inability to stand up straight, and severe pain in decubitus position. The patient had elevated acute phase reactants levels, and computed tomography and magnetic resonance imaging showed destruction of L3 with bone marrow loss, vertebral collapse, and fluid collection, as well as involvement of L4. An open biopsy showed fluid collection with secretion, negative bacterial cultures, and positive molecular test for Mycobacterium tuberculosis. One week after admission, antitubercular pharmacological treatment was started and the patient was immobilized with a thoracolumbosacral orthosis. In a new admission to the emergency department, surgical drainage was performed due to wound dehiscence, secretion, and low-grade fever. However, in a subsequent follow-up, spondylodiscitis was found at L3 and L4, as well as epidural abscesses. Finally, once the orthosis management was completed, during a last follow-up, it was observed that the patient had residual thoracolumbar kyphosis, but no signs of radicular or spinal cord involvement, or osteoarticular deficit.Conclusion: Spinal tuberculosis is a rare condition in the pediatric population, so clinical suspicion in all children with typical symptoms of the disease is always important
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Only 5% of pleural neoplasms are fibrous tumors of the pleura, which typically develop from sub-mesothelial mesenchymal tissue of the visceral pleura. These tumors often behave clinically benignly, and when they are larger than 15 cm or occupy more than 40% of the hemithorax, they are referred to as "giant" tumors. Surgical excision is the gold standard treatment, although intra-operative bleeding is one of the major complications. In this case report, we discuss a 39-year-old female patient with a large homogeneous enhancing mass of soft tissue density in the right lower hemithorax with systemic arterial supply from the right inferior phrenic artery. Angiography and embolization were valuable adjuncts in preoperative management. Via thoracotomy, the mass was successfully removed completely with minimal blood loss. Giant SFTP is a rare neoplasm of the pleura. Intraoperative bleeding is one of the main complications during surgical resection, which is the gold standard of its treatment. Angiography and embolization are valuable complements in the preoperative treatment of this type of tumors to reduce intraoperative blood loss and operative times.
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Although the association of coronavirus disease 2019 (COVID-19) and thromboembolic disease is well known, cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and mechanical valve thrombosis have not been described enough. Mechanical valve thrombosis is a medical emergency that is associated with a great impact on patients' morbidity and mortality. Here, we report a case of a patient with mechanical valve thrombosis secondary to SARS-CoV-2 infections that required valve replacement with satisfactory postoperative recovery. A 52-year old female patient was presented with a previously implanted mechanical prosthesis (type - St. Jude Medical 29 mm; St. Paul, MN: St. Jude Medical, Inc.) eight years ago due to rheumatic fever, under anticoagulation with warfarin and valvular atrial fibrillation (permanent), congenital single kidney (glomerular filtration rate {GFR}: 89.9 mL/min), and hypothyroidism. She was admitted to the hospital with a high level of complexity due to respiratory difficulty and generalized edematous syndrome, and a reverse transcription-polymerase chain reaction (RT-PCR) confirmed COVID-19 infection (20 days before admission); the patient was anticoagulated with warfarin (international normalized ratio {INR} at admission was 2.63 seconds). As per protocol, a CT-chest scan tomography was performed and showed organized pneumonia in the right apical lobe. We performed a transesophageal echocardiogram, which showed a thrombus (20 x 15 x 20 mm) in the lateral disc of the mechanical prosthesis, restricting its mobility. The patient presented signs of hypoperfusion (lactate levels: 4 mmol/L; urine per hour: 1 cc/kg) with associated low cardiac output syndrome, requiring double vasopressor support at the maximum dose (achieving a mean arterial pressure of 72 mmHg) due to the clinical condition and the large size of the thrombus, the cardiovascular surgeon, in agreement with the family, decides to carry out emergency valve replacement surgery with replacement of a mechanical prosthesis replacement (St. Jude No. 29; St. Paul, MN: St. Jude Medical, Inc.). The patient presented a satisfactory postoperative recovery, achieving INR goals, with subsequent discharge and follow-up at two months with transthoracic ultrasound, where normofunctional mitral prosthesis was demonstrated, without evidence of thrombi or intracavitary masses. Mechanical mitral valve thrombosis, secondary to SARS-CoV-2 infection is a serious complication with poor prognosis that requires a high rate of suspicion, and timely diagnostic aids are essential to confirm the diagnosis. Managing this issue should be interdisciplinary and individualized considering the clinical condition of the patient and the associated comorbidities.
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La histoplasmosis es una micosis producida por el Histoplasma capsulatum. Esta condición es endémica en Estados Unidos, Suramérica, América central y África. Suele presentarse en todas las edades, pero en niños; en especial en aquellos inmunodeprimidos, se han descrito presentaciones graves o atípicas. Se presenta el caso de un paciente de 16 años con antecedentes de trasplante renal, que inicia con síntomas respiratorios inespecíficos, tos y alzas térmicas intermitentes. La radiografía de tórax mostró una imagen de condensación cavitada en el lóbulo superior izquierdo, por lo que se realiza una fibrobroncoscopia, lavado broncoalveolar y cultivos para patógenos habituales, micobacterias y hongos, lográndose aislar al Histoplasma capsulatum. EL objetivo de este trabajo es el de resaltar la consideración de histoplasmosis como diagnóstico diferencial de lesiones cavitadas en parénquima pulmonar en pacientes inmunodeprimidos con la presentación de un caso clínico.
Histoplasmosis is a mycosis caused by Histoplasma capsulatum. This condition is endemic in the United States, South America, Central America, and Africa. It usually occurs in all ages, but in children, especially those immunosuppressed, serious or atypical presentations have been described. We present the case of a 16-year-old patient with a history of kidney transplantation that began with nonspecific respiratory symptoms, cough, and intermittent fever peaks. Imaging findings suggestive of cavitation were found, which by means of a fiberoptic bronchoscopy and bronchoalveolar lavage study isolated Histoplasma capsulatum by means of a deep mycosis culture. The main interest of the case presented is the consideration of histoplasmosis in the presence of cavitated lesions in the lung parenchyma in immunosuppressed patients.
