Portal Hypertension as a Complication of Cystic Echinococcosis: A 20-Year Cohort Analysis.

Cystic echinococcosis (CE) is a parasitic disease caused by the larval forms of species of the tapeworm Echinococcus. The most common location is the liver. To assess the frequency and clinical characteristics of portal hypertension (PH) and the risk factors for PH development, we performed a retrospective observational study of inpatients diagnosed with hepatic CE and PH from January 1998 to December 2018, at Complejo Asistencial Universitario de Salamanca, Spain. Of 362 patients analyzed with hepatic CE, 15 inpatients (4.1%) had a portal vein diameter ≥ 14 mm, and the mean diameter of the portal vein was 16.9 (standard deviation [SD] ±2.1) mm. Twelve patients were men. The mean age was 59.5 years (SD ± 17.8 years). Four patients had ascites (26.6%), four had collateral circulation (26.6%), 14 had hepatosplenomegaly (93.3%), five had esophageal varices (33.3%), four had hematemesis, and three had jaundice. Other causes of PH included hepatitis B virus (1 patient) and hepatitis C virus (1 patient) infections and alcohol abuse (1 patient). The host variables associated with PH development were male sex (odds ratio, 4.6; 95% confidence interval, 1.1-20.9; P = 0.030) and larger cyst size (10.8 ± 6.3 versus 7.6 ± 4.1; P = 0.004). Hepatic CE is an infrequent cause of PH that usually occurs without indications of liver failure. Larger cyst size and male sex were the main risk factors associated with this complication. Mortality was higher for patients with hepatic CE with PH than for patients with hepatic CE without PH.

Preventive Effect of Cardiotrophin-1 Administration before DSS-Induced Ulcerative Colitis in Mice.

Ulcerative colitis is a relatively frequent, chronic disease that impacts significantly the patient's quality of life. Although many therapeutic options are available, additional approaches are needed because many patients either do not respond to current therapies or show significant side effects. Cardiotrophin-1 (CT-1) is a cytokine with potent cytoprotective, anti-inflammatory, and antiapoptotic properties. The purpose of this study was to assess if the administration of CT-1 could reduce colon damage in mice with experimental colitis was induced with 5% dextran sulfate sodium (DSS) in the drinking water. Half of the mice received an i.v. dose of CT-1 (200 µg/kg) 2 h before and 2 and 4 days after DSS administration. Animals were followed during 7 days after DSS administration. The severity of colitis was measured by standard scores. Colon damage was assessed by histology and immunohistochemistry. Inflammatory mediators were measured by Western blot and PCR. CT-1 administration to DSS-treated mice ameliorated both the clinical course (disease activity index), histological damage, inflammation (colon expression of TNF-α, IL-17, IL-10, INF IFN-γ, and iNOS), and apoptosis. Our results suggest that CT-1 administration before induction of colitis improves the clinical course, tissue damage, and inflammation in DSS-induced colitis in mice.

Cardiotrophin-1 attenuates experimental colitis in mice.

Cardiotrophin-1 (CT-1) holds potent anti-inflammatory, cytoprotective, and anti-apoptotic effects in the liver, kidneys, and heart. In the present study, the role of endogenous CT-1 and the effect of exogenous CT-1 were evaluated in experimental ulcerative colitis. Colitis was induced in CT-1 knockout and wild-type (WT) mice by administration of dextran sulphate sodium (DSS) in the drinking water during 7 days. CT-1 knockout mice showed higher colon damage and disease severity than WT mice. In addition, CT-1 (200 µg/kg/day, iv) or vehicle (as control) was administered during 3 days to WT, colitic mice, starting on day 4 after initiation of DSS. Disease activity index (DAI), inflammatory markers (tumor necrosis factor α (TNF-α), INFγ, IL-17, IL-10, inducible nitric oxide synthase (iNOS)), colon damage, apoptosis (cleaved caspase 3), nuclear factor κB (NFκB) and STAT-3 activation, and bacterial translocation were measured. Compared with mice treated with DSS, mice also treated with exogenous CT-1 showed lower colon damage, DAI, plasma levels of TNFα, colon expression of TNF-α, INFγ, IL-17, iNOS and cleaved caspase 3, higher NFκB and signal transducer and activator of transcription 3 (STAT3) pathways activation, and absence of bacterial translocation. We conclude that endogenous CT-1 plays a role in the defense and repair response of the colon against ulcerative lesions through an anti-inflammatory and anti-apoptotic effect. Supplementation with exogenous CT-1 ameliorates disease symptoms, which opens a potentially new therapeutic strategy for ulcerative colitis.

Assessment of Kidney Graft Function Evolution Measured by Creatinine and Cystatin C.

INTRODUCTION: The 2013 Kidney Disease Outcomes Quality Initiative Clinical Practice Guideline suggests measuring cystatin C (sCys) in adults with glomerular filtration rate (GFR) based on creatinine (sCr) between 45 and 59 mL/min/1.73 m2 if confirmation of chronic kidney disease (CKD) is required. There is not enough evidence to recommend the use of sCys or sCr to estimate GFR in kidney transplant recipients. OBJECTIVES: Our aims were to describe the evolution of sCr, sCys, and GFR in a group of kidney transplant patients and to determine their association with some markers of morbidity at 1 year. METHODS: A total of 54 patients were included. Analytical and clinical data were recorded. Renal function was analyzed using the CKD Epidemiology Collaboration (EPI) sCr equation and CKD-EPI sCys equation. RESULTS: sCys-estimated GFR was higher than estimated from sCr by CKD-EPI. The values of sCys have more variability than those of sCr. The agreement between the stages of CKD by sCr or sCys-estimated GFR measured by Cohen's kappa coefficient was only fair. One-year CKD-associated variables correlated differently with sCr and sCys-estimated GFR. Hemoglobin, uric acid, calcium, and phosphorus related to sCr-estimated GFR, whereas serum albumin was associated with sCys-estimated GFR. CONCLUSIONS: sCys values have a higher variability than sCr in kidney transplant recipients. sCys- or sCr-based GFRs have a nonsimilar behavior in these patients with weak agreement to stratify CKD stages and a different relationship to CKD-related comorbid conditions.

Situación epidemiológica de la hidatidosis en los centros hospitalarios del sistema público de salud de Extremadura (2003-2012) / Epidemiological update of hydatid disease in hospitals in the public health system of Extremadura (2003-2012)

INTRODUCCIÓN: La hidatidosis humana es una zoonosis con distribución cosmopolita. Todavía constituye un importante problema de salud pública en muchas regiones del mundo, incluida la cuenca mediterránea. La situación epidemiológica actual no es conocida en ciertas regiones de España. El objetivo de este trabajo es renovar los datos epidemiológicos de la hidatidosis en pacientes hospitalizados en el sistema público de salud de Extremadura. MÉTODOS: Estudio descriptivo longitudinal y retrospectivo de pacientes hospitalizados con diagnóstico de hidatidosis (códigos CIE 122.0-122.9) en centros sanitarios del sistema público de salud de Extremadura durante el periodo 2003-2012. RESULTADOS: Se incluyeron 876 pacientes con diagnóstico de hidatidosis; 536 (61%) fueron varones, con una edad media de 65,5 ± 17,8; 19 casos (2,2%) fueron menores de 19 años: 17 (89,47%) casos entre los años 2003-2007 versus 2 casos entre 2008-2012 (OR = 7,83; IC 95%: 1,79-34,11; p = 0,001). Un total de 141 (16,0%) eran menores de 45 años. El diagnóstico primario fue más frecuente en menores de 45 años y el diagnóstico secundario más frecuente en mayores de 70 años (p < 0,05). La tasa de incidencia fue mayor a través del registro de pacientes hospitalizados (8,02 casos por 105 personas-año) respecto al sistema de declaración obligatoria de enfermedades (1,88 casos por 105 personas-año), p < 0,05. CONCLUSIÓN: En Extremadura la hidatidosis es todavía frecuente, con una clara disminución en el número de casos pediátricos. El número de casos obtenidos mediante los registros de pacientes hospitalizados respecto al sistema de notificación de enfermedades de Extremadura sugieren la necesidad de modificaciones que mejoren la vigilancia y el control de la hidatidosis

INTRODUCTION: Echinococcosis is a zoonotic infection with a worldwide distribution, and is still an important health problem in many areas of the world, including the Mediterranean basin. At present the epidemiological situation is unclear in certain regions of Spain. The aim of this study was to update the epidemiological situation in Extremadura through an analysis of hospitalised patients in the public health system diagnosed with hydatid disease. METHODS: A longitudinal retrospective study was conducted between 2003 and 2012 on hospitalised patients with a diagnosis of hydatidosis (ICD 122.0-122.9) in hospitals of the public health service of Extremadura. RESULTS: During the period of study, 876 patients were diagnosed with hydatid disease. Of these 536 (61%) of cases were male, with a mean age of 65.53 ± 17.8 years. More importantly, 19 (2.2%) of patients were 19 years old, with 17 cases between 2003-2007 versus 2 cases between 2008-2012 (OR = 7.83; 95% CI: 1.79-34.11; P = .001). A total of 141 (16.0%) were younger than 45 years. The primary diagnosis was most frequently reported in the younger population < 45 years, whereas the secondary diagnosis was usually found in the elderly population > 70 years (P < .05). The incidence rate of hydatid disease obtained from Hospital Discharge Records (HDRs) was significantly higher compared to the incidence that was declared in the Notifiable Disease System of Extremadura (8.02 cases per 105 person-years vs. 1.88 cases per 105 person-years [P < .05]). CONCLUSION: In Extremadura hydatid disease is still frequent. With a clear decrease in the number of paediatric cases. The number of cases obtained from HDRs regarding Notification System Diseases Extremadura suggests the need for modifications to improve surveillance and control of hydatid disease

[Epidemiological update of hydatid disease in hospitals in the public health system of Extremadura (2003-2012)]. / Situación epidemiológica de la hidatidosis en los centros hospitalarios del sistema público de salud de Extremadura (2003-2012).

INTRODUCTION: Echinococcosis is a zoonotic infection with a worldwide distribution, and is still an important health problem in many areas of the world, including the Mediterranean basin. At present the epidemiological situation is unclear in certain regions of Spain. The aim of this study was to update the epidemiological situation in Extremadura through an analysis of hospitalised patients in the public health system diagnosed with hydatid disease. METHODS: A longitudinal retrospective study was conducted between 2003 and 2012 on hospitalised patients with a diagnosis of hydatidosis (ICD 122.0-122.9) in hospitals of the public health service of Extremadura. RESULTS: During the period of study, 876 patients were diagnosed with hydatid disease. Of these 536 (61%) of cases were male, with a mean age of 65.53±17.8 years. More importantly, 19 (2.2%) of patients were 19 years old, with 17 cases between 2003-2007 versus 2 cases between 2008-2012 (OR=7.83; 95%CI: 1.79-34.11; P=.001). A total of 141 (16.0%) were younger than 45 years. The primary diagnosis was most frequently reported in the younger population <45 years, whereas the secondary diagnosis was usually found in the elderly population >70 years (P<.05). The incidence rate of hydatid disease obtained from Hospital Discharge Records (HDRs) was significantly higher compared to the incidence that was declared in the Notifiable Disease System of Extremadura (8.02 cases per 10(5) person-years vs. 1.88 cases per 10(5) person-years [P<.05]). CONCLUSION: In Extremadura hydatid disease is still frequent. With a clear decrease in the number of paediatric cases. The number of cases obtained from HDRs regarding Notification System Diseases Extremadura suggests the need for modifications to improve surveillance and control of hydatid disease.

Tratamiento con acido hialurónico intraarticular intraoperatorio mediante artroscopia de rodilla / Intra-articular hyaluronic acid treatment by intraoperative knee arthroscopy

La viscosuplementación con un condroprotector (ácido hialurónico) tras una artroscopia en la que se llevan a cabo acciones potencialmente lesivas para el cartílago (meniscectomía, condroabrasión), puede ser una alternativa de tratamiento eficaz y eficiente. Se presenta un caso clínico de un paciente con gonartrosis leve de rodilla izquierda sin indicación de sustitución articular y donde el tratamiento conservador no es satisfactorio, en el cual se realiza artroscopia de lavado y desbridamiento articular e infiltración intraoperatoria de ácido hialurónico en el compartimento articular con mayor degeneración (AU)

Viscosupplementation with chondroprotective (hyaluronic acid) after arthroscopy with potentially harmful gestures to the cartilage (meniscectomy or con-droabrasión) can be an efficient and effective alternative treatment. We report a case of mild knee osteoarthritis left knee joint without prosthetic replacement indication and where conservative treatment is not successful, in which we perform arthroscopic joint lavage and debridement with subsequent infiltration of hyaluronic acid (AU)

Oxicodona en altas dosis por vía subcutánea: a propósito de un caso / High-dose subcutaneous oxycodone: case report

Presentamos el caso de una paciente de 57 años de edad, que presentaba un cáncer epidermoide de canal anal metastásico. En su evolución presentó un intenso dolor glúteo somático con crisis de dolor irruptivo sacras 8/10 controladas con oxicodona oral. A pesar de la impresión inicial, la etiología de las crisis resultó ser secundaria, en parte, a secuelas de tratamiento radioterápico previo. Posteriormente, la aparición de metástasis cerebelosas condicionó la presencia de vómitos de difícil manejo, finalmente controlados con antihistamínicos y olanzapina parenterales. Por este mismo motivo, se procedió a la rotación de la vía de administración a oxicodona en perfusión subcutánea continua. La oxicodona parenteral se mantuvo durante 43 días, a dosis de 300 mg/día, y en la perfusión se combinaron diversos fármacos (haloperidol, metoclopramida, escopolamina, midazolam, butilbromuro de escopolamina). Esta perfusión resultó claramente eficaz para el control de la sintomatología, sin que se evidenciaran problemas de incompatibilidad en la combinación de fármacos. Se observó una discreta reacción cutánea a partir de la semana de infusión, fácilmente controlable rotando el punto de inserción de la palomilla (AU)

We report the case of a 57 year-old patient with a metastatic anal epidermoid cancer. She progressively developed severe somatic pain in her buttocks, with breakthrough pain crises 8/10 located in the sacrum, which were well managed with oral oxycodone. Despite initial impressions, the pain crises were found to be partially related to radiotherapy side effects. She subsequently had intractable vomiting related to metastases in the cerebellum which was controlled with parenteral antihistamines and olanzapine. For this same reason, a switch in the route of administration to continuous subcutaneous infusion of oxycodone was performed. Parenteral oxycodone was maintained for 43 days at a dose of 300 mg/day, and was combined with several drugs (haloperidol, metoclopramide, hyoscine hydrobromide, midazolam, hyoscine butylbromide). The infusion was found to be quite effective in dealing with the symptoms, and no problems of incompatibility were detected with the co-administration of the various drugs. A skin reaction was detected one week after starting the infusion, which was easily managed by rotation of the injection site (AU)

Sarcoma de Kaposi clásico en el pie: presentación de 2 casos no relacionados con VIH / The classic Kaposi´s sarcoma in feet: two cases not related to HIV

La infección por el virus de la inmunodeficiencia humana (VIH) ha aumentado la incidencia de pacientes con sarcoma dc Kaposi, de forma que la presencia del Kaposi junto con la demostración de la infección se considera criterio de SIDA. Previamente a la aparición del SIDA existía el sarcoma de Kaposi, afectando otras localizaciones diferentes y en un grupo poblacional diferente. Se presentan dos casos de pacientes no VIII con lesiones cutáneas de Sarcoma de Kaposi en su Variante clásica, con lesiones que afectan a los pies (AU)

Human immunodcficiencyvirus (HIV) infection has increased the incidence of patients with Kaposi’s sarcoma so patients with this disease associated to infection is considered AIDS. Previous to the discovery of this syndrome, Kaposi’s appears in patients on different locations and different population group. We present two cases of Kaposi’s syndrome in not HIV patients with lesions located in both feet (AU)

[Autoimmune enteropathy in an adult patient]. / Enteropatía autoinmune en un paciente adulto.

Autoimmune enteropathy (AIE) is an infrequent cause of malabsorption that is usually associated with the presence of circulating autoantibodies and a predisposition to autoimmune disorders. This disease is more frequent in children. The diagnosis of this disorder is based on five criteria: chronic diarrhea (>6 weeks), malabsorption, specific histological findings, exclusion of similar disorders, and the presence of specific antibodies such as anti-enterocyte and anti-goblet cell antibodies. We present the case of a 63-year-old patient with chronic diarrhea, weight loss and significant deterioration of nutritional status.

Secuestros pulmonares: presentación de 8 casos / Pulmonary sequestrations: Presentation of eight cases

Introducción El secuestro pulmonar es un parénquima pulmonar patológico aislado y con vascularización arterial propia y es infrecuente. Objetivos Estudio descriptivo-retrospectivo de pacientes del Hospital Universitario La Princesa. Material y métodos Se analizan las características de pacientes del Servicio de Cirugía Torácica del Hospital Universitario La Princesa entre 1996-2008.ResultadosSe intervino a 8 pacientes con confirmación anatomopatológica, 5 eran mujeres. La infección respiratoria apareció en 7 pacientes, con afectación del lóbulo inferior derecho en 4 de ellos. La variante intralobular se diagnosticó en 7 enfermos. La vascularización provenía de la aorta torácica en 5 casos. La vía de abordaje fue la toracotomía posterolateral y se practicaron lobectomías en 5 pacientes. No hubo morbimortalidad.Conclusión1. Es una anomalía congénita infrecuente. 2. En nuestra serie, la frecuencia es mayor en mujeres en los lóbulos inferiores y es similar en ambos hemitórax. 3. La clínica más frecuente fue la infección respiratoria de repetición. 4. El diagnóstico se realizó mediante pruebas de imagen (AU)

Introduction Lung sequestration is a pathologically isolated pulmonary parenchyma, with its own arterial vascularisation. Aims A descriptive-retrospective study of patients of the La Princesa University Hospital, Madrid. Material and Methods The characteristics of patients admitted to the La Princesa University Hospital Thoracic Surgery Unit during 1996–2008, were analysed. Results Of the 500 patients, 8 had histopathology confirmation, of which 5 were women. There was respiratory infection in 7 patients, with 4 in the lower right lobe. The intralobar variant was diagnosed in 7 patients. The systemic vascularisation came from the thoracic aorta in five cases. A standard posterolateral thoracotomy with lobectomy was performed in 5 patients. There was no morbidity or mortality. It was more common in women, in lower lobes and similar in both hemithorax; 3. The most common clinical symptom was the respiratory infection; 4. The diagnosis was made with imaging tests (AU)

[Pulmonary sequestrations: presentation of eight cases]. / Secuestros pulmonares: presentación de 8 casos.

INTRODUCTION: Lung sequestration is a pathologically isolated pulmonary parenchyma, with its own arterial vascularisation. AIMS: A descriptive-retrospective study of patients of the La Princesa University Hospital, Madrid. MATERIAL AND METHODS: The characteristics of patients admitted to the La Princesa University Hospital Thoracic Surgery Unit during 1996-2008, were analysed. RESULTS: Of the 500 patients, 8 had histopathology confirmation, of which 5 were women. There was respiratory infection in 7 patients, with 4 in the lower right lobe. The intralobar variant was diagnosed in 7 patients. The systemic vascularisation came from the thoracic aorta in five cases. A standard posterolateral thoracotomy with lobectomy was performed in 5 patients. There was no morbidity or mortality. It was more common in women, in lower lobes and similar in both hemithorax; 3. The most common clinical symptom was the respiratory infection; 4. The diagnosis was made with imaging tests.

Enteropatía autoinmune en un paciente adulto / Autoimmune enteropathy in an adult patient

El diagnóstico de esta entidad se basa en cuatro criterios, la presencia de diarrea crónica (más de 6 semanas), un cuadro clínico compatible con malabsorción, una histología específica, la exclusión de otras enfermedades que pueden cursar de forma similar y la presencia de autoanticuerpos específicos como pueden ser los anticuerpos entienterocito y anticélula caliciforme. Presentamos a continuación el caso de un paciente de 63 años de edad con un cuadro clínico que consiste en diarrea crónica, pérdida de peso e importante repercusión en su estado nutricional (AU)

Autoimmune enteropathy (AIE) is an infrequent cause of malabsorption that is usually associated with the presence of circulating autoantibodies and a predisposition to autoimmune disorders. This disease is more frequent in children.The diagnosis of this disorder is based on five criteria: chronic diarrhea (>6 weeks), malabsorption, specific histological findings, exclusion of similar disorders, and the presence of specific antibodies such as anti-enterocyte and anti-goblet cell antibodies. We present the case of a 63-year-old patient with chronic diarrhea, weight loss and significant deterioration of nutritional status (AU)

[Emphysematous pancreatitis: Conservative or surgical treatment?]. / Pancreatitis enfisematosa. ¿Tratamiento conservador o quirúrgico?

Emphysematous pancreatitis is a severe and rare complication of acute pancreatitis. This entity is diagnosed on clinical grounds and on the basis of the radiologic finding of gas in the retroperitoneum. Infected pancreatic necrosis is potentially lethal, with mortality rates of more than 35%. Surgery is associated with significant morbidity and mortality in these critically ill patients. Endoscopic ultrasonography techniques, laparoscopic surgery and percutaneous drainage have the potential to offer a safe and effective alternative treatment modality. However, the precise role of these procedures requires further investigation. The treatment of these patients should be individualized, dynamic and multidisciplinary. We present two cases of emphysematous pancreatitis with distinct therapeutic management.

Papel de la cirugía mínimamente invasiva en el manejo del carcinoma broncogénico / Sleep apnea-hypopnea syndrome (SAHS), chronic obstructive pulmonary disease (COPD) and non-invasive

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Pancreatitis enfisematosa. ¿Tratamiento conservador o quirúrgico? / Emphysematous pancreatitis: Conservative or surgical treatment?

La pancreatitis enfisematosa (PE) es una complicación grave y rara de la pancreatitis aguda. El diagnóstico se basa en los datos clínicos y en el hallazgo radiológico de gas en el retroperitoneo. La necrosis pancreática infectada es potencialmente letal, con una tasa de mortalidad superior al 35%. La cirugía en estos pacientes asocia una alta morbimortalidad. La ultrasonografía endoscópica, el tratamiento quirúrgico laparoscópico y el drenaje percutáneo ofrecen una modalidad de tratamiento alternativo a la cirugía, seguro y eficaz. Sin embargo, se requieren más estudios para definir el lugar que ocupan estas técnicas en el tratamiento de estos pacientes, que debe ser individualizado, dinámico y multidisciplinario. Presentamos 2 casos de PE con distinto tratamiento terapéutico(AU)

Emphysematous pancreatitis is a severe and rare complication of acute pancreatitis. This entity is diagnosed on clinical grounds and on the basis of the radiologic finding of gas in the retroperitoneum. Infected pancreatic necrosis is potentially lethal, with mortality rates of more than 35%. Surgery is associated with significant morbidity and mortality in these critically ill patients. Endoscopic ultrasonography techniques, laparoscopic surgery and percutaneous drainage have the potential to offer a safe and effective alternative treatment modality. However, the precise role of these procedures requires further investigation. The treatment of these patients should be individualized, dynamic and multidisciplinary. We present two cases of emphysematous pancreatitis with distinct therapeutic management(AU)

[Contributions of the ambulatory blood pressure monitoring to the values measured at the medical office]. / Aportaciones de la monitorización ambulatoria a la presión arterial casual.

OBJECTIVE: To communicate our experience with this technique centred in the definition of the patterns and the peculiar characteristics of the rising pattern. METHODS: During a four year period, the ambulatory blood pressure monitoring was obtained in 500 hypertensive patients with difficult to control blood pressure or of recent detection, following the guide of the Cardiorisk project. RESULTS: The most frequent pattern observed was non-dipper (46.6%). The pulse pressures obtained by ambulatory and office blood pressure monitoring kept a correlation that serve as guide to the office blood pressure measurements. The level of control by ambulatory monitoring blood pressure is only discretely superior to the office blood pressure if the cases of white coat and masked hypertension are considered. The rising pattern is associated to a major vascular risk. CONCLUSIONS: An increased vascular risk is noticed in the rising pattern with respect to other patterns. The morphology of different atypical patterns was also presented. The help of the ambulatory blood pressure monitoring along with one taken in the office determined a great aid to interpret the huge variability of the arterial pressure.

Tuberculosis intestinal: un reto diagnóstico / No disponible

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Espondilodiscitis por Enterococcus faecalis: análisis de un caso / Spondylodiscitis due to Enterococcus faecalis: a case report

Un varón de 85 años ingresó en nuestro hospital para valoración de lumbalgia invalidante de 2 meses de evolución. Tenía antecedentes de lumbalgia recidivante, hepatopatía crónica por el virus C de la hepatitis y diabetes mellitus tipo 2. Se observó por técnicas de imagen afección vertebral y discal, y en el cultivo del material aspirado a nivel discal creció Enterococcus faecalis, que también fue demostrado en hemocultivos, con idénticas características fenotípicas. Tras 6 semanas de tratamiento parenteral, corsé y fisioterapia experimentó progresiva mejoría, y se lo siguió ambulatoriamente. Se comenta la rareza de E. faecalis como agente etiológico de la espondilodiscitis, lo que condiciona actitudes terapéuticas basadas en las orientaciones microbiológicas aplicadas a otras formas más frecuentes de etiología piógena y según antibiograma

An 85-year-old man was admitted to our hospital for evaluation of disabling low back pain with onset 2 months previously. The patient had a history of recurrent lower back pain, hepatitis C virus infection and type 2 diabetes. Imaging techniques showed vertebral and discal involvement. Culture of the aspirated discal specimen revealed Enterococcus faecalis, which was also found in blood cultures, with the same phenotypic characters. After 6 weeks of parenteral antibiotics, bracing and physical therapy, the patient progressively improved and was followed-up on an outpatient basis. E. faecalis is a rare cause of spondylodiscitis, which may lead to this etiological agent being overlooked in favor of other more frequent etiologic agents