Rectal syphilis in a HIV patient from Peru / Sífilis rectal en un paciente con VIH de Perú

We present the case of a 53-year-old male patient, a man who had sex with men. He described the presence of inguinal adenopathy and non-painful ulcer with indurated edges on his penis that heal spontaneously after 3 months. In the same period of time the patient presented: tenesmus, bleeding and rectal pain. In the proctoscopy was observed at the level of the rectum: deep ulcer with regular and indurated edges, ulcerated bed with abundant mucus; The rectal mucosa around the ulcer had multiple circumferential erosions 2-4 mm in diameter. The biopsy showed infiltration of lymphomonocollar cells and granulomas. The HIV ELISA test was positive, CD 4: 275 cel./uL, HIV viral load: 10 300 copies / ml, VDRL: Non-reactive, FTA-Abs: 1/10 (positive). Warthin-Starry staining was used in the rectal ulcer biopsy sample identifying spirochetes. After the administration of benzatinic Penicillin G, the symptoms and lesions in the rectal region were resolved. Likewise, antiretroviral treatment was initiated. Ulcerative and erosive proctitis is common in people living with HIV infection, however, it is rare to identify spirochetes in the biopsy sample.

Presentamos el caso de un paciente varon de 53 años de edad, un hombre que tenía sexo con hombres. El describió la presencia de adenopatía inguinal y úlcera no dolorosa con bordes indurados en su pene que cicatrizó espontáneamente luego de 3 meses. En el mismo periodo de tiempo el paciente presentó: tenesmo, sangrado y dolor rectal. En la proctoscopía se observó a nivel del recto: úlcera profunda con bordes regulares e indurados, lecho ulceroso con abundante moco; la mucosa rectal alrededor de la ulcera tenía múltiples erosiones circunferenciales de 2-4 mm de diámetro. La biopsia mostró infiltrado de células linfomonocleares y granulomas. El examen de ELISA VIH resultó positivo, CD 4: 275 cel./uL, carga viral VIH: 10 300 copias / ml, VDRL: No reactivo, FTA-Abs: 1/10 (Positivo). Se utilizó la tinción de Warthin-Starry en la muestra de biopsia de ulcera rectal identificando espiroquetas. Luego de la administración de Penicilina G benzatinica, se resolvieron los síntomas y lesiones en la región rectal. Así mismo se inició el tratamiento antirretroviral. La proctitis ulcerosa y erosiva es frecuente en personas que viven con infección por VIH, sin embargo, es raro identificar espiroquetas en la muestra de biopsia.

Rectal syphilis in a HIV patient from Peru.

We present the case of a 53-year-old male patient, a man who had sex with men. He described the presence of inguinal adenopathy and non-painful ulcer with indurated edges on his penis that heal spontaneously after 3 months. In the same period of time the patient presented: tenesmus, bleeding and rectal pain. In the proctoscopy was observed at the level of the rectum: deep ulcer with regular and indurated edges, ulcerated bed with abundant mucus; The rectal mucosa around the ulcer had multiple circumferential erosions 2-4 mm in diameter. The biopsy showed infiltration of lymphomonocollar cells and granulomas. The HIV ELISA test was positive, CD 4: 275 cel./uL, HIV viral load: 10 300 copies / ml, VDRL: Non-reactive, FTA-Abs: 1/10 (positive). Warthin-Starry staining was used in the rectal ulcer biopsy sample identifying spirochetes. After the administration of benzatinic Penicillin G, the symptoms and lesions in the rectal region were resolved. Likewise, antiretroviral treatment was initiated. Ulcerative and erosive proctitis is common in people living with HIV infection, however, it is rare to identify spirochetes in the biopsy sample.

Diagnostic and therapeutic cholangioscopy in biliary diseases: a prospective study in Peru / Uso diagnóstico y terapéutico de la colangioscopía en enfermedades de la vía biliar: un estudio prospectivo en Perú

Introduction: Cholangioscopy is a test that allows the evaluation of the biliary epithelium. It is used for diagnosis and management of biliary diseases. Objectives: Determine the success rate of complete removal of difficult stones with the use of laser lithotripsy through cholangioscopy as well as its complications. Determine the visual impression accuracy of bile duct injuries. Materials and methods: This is a prospective and descriptive study. We included 39 patients between July 2016 and July 2017 with diagnosis of difficult stones in the biliary tract and indeterminate stenosis of the biliary tract that were submitted to cholangioscopy. Results: Success rate of complete removal of difficult stones was 65.3%, there was one complication. Two laser sessions were required in 4 of the 17 patients who obtained complete removal of the stones. The visual impression accuracy of lesions in the bile duct to determine malignancy coincided in all cases with the final diagnosis of the patient. Conclusions: Laser lithotripsy allows a safe and effective treatment of the difficult stones of the bile duct. Precession of visual impression of lesions in the bile duct is very high.

Introducción: La colangioscopía es un examen que permite evaluar la luz biliar, el epitelio biliar y sirve para diagnóstico y manejo de enfermedades de la vía biliar. Objetivos: Determinar la tasa de éxito de remoción completa de cálculos difíciles con el uso de litotripcia con láser a través de la colangioscopía asi como las complicaciones de ésta. Determinar la precisión de impresión visual de lesiones de la vía bilar. Materiales y métodos: Estudio prospectivo, descriptivo. Se incluyeron a 39 pacientes entre Julio 2016 a Julio 2017 con diagnóstico de cálculo difícil en la vía biliar y estenosis indeterminada de la vía biliar que fueron sometidos a colangioscopía. Resultados: La tasa de éxito de remoción completa de cálculos difíciles fue de 65,3% con una complicación. Se requirió de dos sesiones con láser en 4 de los 17 pacientes que obtuvieron remoción completa de cálculos. La precisión de impresión visual de lesiones en la vía biliar para determinar malignidad coincidió en todos los casos con el diagnóstico final del paciente. Conclusiones: La colangioscopía con uso de litotripcia con láser permite un tratamiento seguro y eficaz en los cálculos difíciles de la vía biliar. La precesión de la impresión visual de lesiones en la vía biliar es muy alta.

[Colon Paracoccidioidomycosis in a hospital from Lima - Peru: report of 4 cases]. / Paracoccidioidomicosis colónica en un hospital de Lima - Perú: reporte de 4 casos.

Paracoccidioidomycosis is the most prevalent mycosis in South America. Mucocutaneous and lymph node involvement is the most frequent affectation of this disease in our country, with the intestinal commitment rarely reported. We report 4 cases of colonic manifestation with abdominal pain, chronic diarrhea, and weight loss. The diagnosis was made with biopsy and Gomori stain. The average age was 29 years old. The colonoscopy showed many ulcers in the ileum distal and colon. We found VIH as comorbidity in one patient.

Paracoccidioidomicosis colónica en un hospital de Lima - Perú: reporte de 4 casos / Colon Paracoccidioidomycosis in a hospital from Lima - Peru: report of 4 cases

La paracoccidioidomicosis es la micosis más prevalente de Sudamérica. En nuestro medio la afectación mucocutánea y linfática suele ser la de mayor prevalencia, siendo el compromiso intestinal pocas veces reportado. Se reportan 4 casos de afectación colónica con manifestación de dolor abdominal, diarrea crónica y disminución de peso en los cuales el diagnóstico se realizó a través de la anatomía patológica con la tinción de Gomori. La edad promedio fue de 29 años. La colonoscopía reveló presencia de múltiples úlceras en colon y en íleon distal. Como comorbilidad se encontró VIH en un paciente

Paracoccidioidomycosis is the most prevalent mycosis in South America. Mucocutaneous and lymph node involvement is the most frequent affectation of this disease in our country, with the intestinal commitment rarely reported. We report 4 cases of colonic manifestation with abdominal pain, chronic diarrhea, and weight loss. The diagnosis was made with biopsy and Gomori stain. The average age was 29 years old. The colonoscopy showed many ulcers in the ileum distal and colon. We found VIH as comorbidity in one patient

Diagnostic and therapeutic cholangioscopy in biliary diseases: a prospective study in Peru.

INTRODUCTION: Cholangioscopy is a test that allows the evaluation of the biliary epithelium. It is used for diagnosis and management of biliary diseases. OBJECTIVES: Determine the success rate of complete removal of difficult stones with the use of laser lithotripsy through cholangioscopy as well as its complications. Determine the visual impression accuracy of bile duct injuries. MATERIALS AND METHODS: This is a prospective and descriptive study. We included 39 patients between July 2016 and July 2017 with diagnosis of difficult stones in the biliary tract and indeterminate stenosis of the biliary tract that were submitted to cholangioscopy. RESULTS: Success rate of complete removal of difficult stones was 65.3%, there was one complication. Two laser sessions were required in 4 of the 17 patients who obtained complete removal of the stones. The visual impression accuracy of lesions in the bile duct to determine malignancy coincided in all cases with the final diagnosis of the patient. CONCLUSIONS: Laser lithotripsy allows a safe and effective treatment of the difficult stones of the bile duct. Precession of visual impression of lesions in the bile duct is very high.

Histoplasmosis del colon y recto en un paciente de Perú / Colon and rectum histoplasmosis in a patient from Peru

Se reportó un caso de varón de 52 años con historia de 3 meses caracterizada por pujo, tenesmo, hematoquezia, dolor al defecar, disminución de 18 kg de peso, fiebre, secreción fecaloidea y purulenta a través de orificio perianal. A la colonoscopía se evidencian múltiples úlceras en colon ascendente, transverso y descendente. También en recto se aprecia lesión elevada de aproximadamente 5 cm. Las biopsias de dichas lesiones fueron coloreadas con hematoxilina-eosina y tinción de Gomori-Grocott demostrando múltiples macrógafos conteniendo microorganismos compatibles con histoplasmosis. Las pruebas para ELISA VIH, HTLV I-II fueron negativas. La histoplasmosis del colon y recto en paciente inmunocompetente es extremadamente rara, habiéndose reportado pocos casos.

We report a case of a male patient of 52 years old with a 3 months history of pushing, tenesmus, hematochezia, pain while defecating, lost of 18 kg of weight, fever, fecaloid and purulent discharge through an perianal hole. During the colonoscopy procedure, we found many ulcers in the ascending, transverse and descending colon.We also found an elevated lesion of about 5 cm in the rectum. We used hematoxylin - eosin and Gomori-Grocott stain in the biopsies and identified many microorganisms inside macrophages which were compatible with histoplasmosis. ELISA tests for HIV, HTLV I- II were negative. Colon and rectal histoplasmosis in an immunocompetent patient is extremely rare. There are few cases of colonic histoplasmosis reported.

[Colon and rectum histoplasmosis in a patient from Peru]. / Histoplasmosis del colon y recto en un paciente de Perú.

We report a case of a male patient of 52 years old with a 3 months history of pushing, tenesmus, hematochezia, pain while defecating, lost of 18 kg of weight, fever, fecaloid and purulent discharge through an perianal hole. During the colonoscopy procedure, we found many ulcers in the ascending, transverse and descending colon.We also found an elevated lesion of about 5 cm in the rectum. We used hematoxylin - eosin and Gomori-Grocott stain in the biopsies and identified many microorganisms inside macrophages which were compatible with histoplasmosis. ELISA tests for HIV, HTLV I- II were negative. Colon and rectal histoplasmosis in an immunocompetent patient is extremely rare. There are few cases of colonic histoplasmosis reported.