Breast abscess due to Nannizziopsis obscura in an immunocompromised renal transplant patient after travel to Nigeria: case report and review.

BACKGROUND: Nannizziopsis is a genus of fungi with several known cases in reptiles of pyogranulomatous infections at cutaneous and musculoskeletal level, of rapid and fatal evolution. There are few cases of this genus described in humans, mainly skin affection but also with visceral abcesses, typically in immunosuppressed patients, with a recent visit to Africa. CASE PRESENTATION: A 45-year-old woman immunosuppressed after renal transplantation and with a recent visit to Nigeria presented with a painless breast abcess, ulceration to the skin and bleeding, and non hematic telorrhea. The mammogram, also completed with an ultrasound scan, showed a polylobulated nodule, BI-RADS 4C. Due to the suspicion of breast cancer, a core needle biopsy was performed and the pathology study showed abundant presence of fungal spores and hyphae. It was identified by genomic amplification of the internal transcription spacer region-2 and a percentage of similarity with sequences of Nannizziopsis obscura from GenBank of 98% was obtained. An empiric treatment with anidulafungin was initiated, and after the surgical resection, it was replaced by isavuconazole, with a total time of treatment of one month. CONCLUSIONS: This is the first case report of a successful treatment of Nannizziopsis obscura with isavuconazole, with the shortest time of treatment published for this fungi. We highlighted the importance of referring difficult to diagnose species to reference centers, as well as achieving the most complete resection in order to shorten the antibiotic therapy.

Vitamina D e hipertensión arterial / Vitamin D and hypertension

La deficiencia de vitamina D, definida como valores de 25-hidroxivitamina D < 20-30 ng/ml, es un problema prevalente en la población general. Además de relacionarse clásicamente con la enfermedad musculoesquelética, el déficit de vitamina D se ha relacionado con enfermedades autoinmunes, cáncer, enfermedades metabólicas y enfermedades cardiovasculares. La hipertensión arterial, como principal factor de riesgo cardiovascular, también se ha relacionado con el déficit de vitamina D, llevando a converger dos grandes problemas de salud prevalentes en la población mundial. Por tanto, este artículo revisa aquellos estudios más importantes que vinculan ambas patologías, los mecanismos descritos que las relacionan y la evidencia actual acerca del efecto que la suplementación de vitamina D podría tener sobre la hipertensión arterial (AU)

Low levels of vitamin D, defined as levels of 25-hydroxyvitamin D < 20-30 ng/ml, is a prevalent problem in the general population. Besides the classic relation with musculoskeletal disease, vitamin D has been also related to autoimmune diseases, cancer, metabolic diseases or cardiovascular diseases. High blood pressure, as the main cardiovascular risk factor, also has been related to vitamin D deficiency, constituting two prevalent worldwide health problems. Therefore, this article reviews the most important studies that combine both pathologies, the biological mechanism that relate them and the current evidence about the effect of vitamin D supplementation on hypertension (AU)

[Vitamin D and hypertension]. / Vitamina D e hipertensión arterial.

Low levels of vitamin D, defined as levels of 25-hydroxyvitamin D < 20-30 ng/ml, is a prevalent problem in the general population. Besides the classic relation with musculoskeletal disease, vitamin D has been also related to autoimmune diseases, cancer, metabolic diseases or cardiovascular diseases. High blood pressure, as the main cardiovascular risk factor, also has been related to vitamin D deficiency, constituting two prevalent worldwide health problems. Therefore, this article reviews the most important studies that combine both pathologies, the biological mechanism that relate them and the current evidence about the effect of vitamin D supplementation on hypertension.