SARS-CoV-2 Infection with Associated Rhabdomyolysis and Probable Myocarditis.

We describe a patient with SARS-CoV-2 and severe pneumonia who required mechanical ventilation and developed associated rhabdomyolysis with probable myocardial involvement as evidenced by cardiac enzyme abnormalities and echocardiographic findings. Repeat testing should be done in cases highly suspicious for SARS-CoV-2 as initial molecular tests may be negative, as in our case. LEARNING POINTS: SARS-CoV-2 infection may be associated with rhabdomyolysis and myocarditis.Negative results for SARS-CoV-2 despite a clinical presentation suggestive of COVID-19 disease should be treated with caution.Drugs known to cause rhabdomyolysis and myocarditis should be carefully reviewed when treating SARS-CoV-2 patients.

Successful medical treatment of infective endocarditis caused by Candida parapsilosis in an immunocompromised patient.

Candida spp is a common pathogen of nosocomial infections that has increased in recent decades, with mortality rates close to 40% in cases of systemic candidiasis. One type of presentation is infective endocarditis, which, by its prolonged need for treatment, represents a constant challenge for clinicians. We describe a 36-year-old woman, recently diagnosed with ovarian cancer, who developed aortic valve infective endocarditis caused by Candida parapsilosis and who was treated with oral antifungal medication, with no surgical intervention required.

Enfermedad oclusiva aorto-iliaca: del tratamiento quirúrgico al endovascular / Aorto-Iliac Occlusive disease: from surgical to endovascular treatment

Evaluar y comparar los resultados del tratamiento para la enfermedad oclusiva aorto-iliaca (EOAI) mediante la técnica quirúrgica, endovascular o híbrida. Material y métodos: Estudio retrospectivo, descriptivo se revisaron las historias clínicas de 50 pacientes tratados consecutivamente entre marzo 1993 y diciembre 2014. Se dividió a los pacientes en 3 grupos, según tratamiento recibido: Quirúrgico (Grupo Q), Endovascular (Grupo E) e Híbrido (Grupo H) y se evaluó el manejo y evolución en cada grupo de acuerdo al tipo de lesión (Clasificación TASC). Resultados: La revascularización de la EOAI fue exitosa en todos los casos, a excepción de una paciente con oclusión aguda aorto-iliaca post cateterismo de la aorta que falleció por embolismo masivo agudo. Este fue el único caso de mortalidad postoperatoria. En el seguimiento de 48,5 meses (rango: 1 - 204 meses), desaparecieron los síntomas en todos los pacientes. La permeabilidad primaria y secundaria fue 69% y 92% en el grupo Q y 100% en el grupo E. La mortalidad tardía fue de 2 casos en el grupo Q, ninguna en E y 1 en H. Conclusiones: Nuestra serie muestra resultado exitoso utilizando ambas técnicas: quirúrgica o endovascular para el tratamiento de la EOAI tanto a 30 días como a 4 años de seguimiento. Los resultados son similares a publicaciones internacionales. Las lesiones menos complejas fueron más frecuentemente tratadas con técnica endovascular con buenos resultados. Es crucial utilizar doppler pletismografía arterial de reposo y ejercicio para detectar los casos sintomáticos en estadíos tempranos (menos complicados)...

To assess early and late outcomes among different treatment techniques in patients with Aortoiliac Occlusive Disease (AIOD) and compare surgical, endovascular and hybrid technique. Methods: We have retrospectively analyzed records of 50 consecutive patients treated from March, 1993 to December, 2014. We divided them in 3 groups: Surgical (Q Group), Endovascular (E Group) and Hybrid treatment (H group). Successful revascularization was achieved with both surgical and endovascular techniques. Results: Clinical and technical success was achieved in all cases but one, who presented acute aortic occlusion. This was the only in-hospital postoperative mortality case due to acute massive athero-embolism post endovascular procedure. During 48.5 months follow up (1 - 204 months) there was no recurrence of symptoms. Primary and Secondary Patency was of 69% and 92% on Q group and 100% on E group. Late mortality was of2 cases in Q Group, none on E Group and 1 on H Group. Conclusions: Our series show successful outcomes using either endovascular or surgical techniques to treat ATOO at 30 days and 4 years follow up. Our results are similar to those published on international studies. Less complex lesions were treated mostly with endovascular techniques with good results. It is crucial to perform Arterial Doppler plethismography at rest and post exercise in order to detect these cases in early stages...

Diarrea del viajero / Traveler's diarrhea

La diarrea del viajero es una de las condiciones que con mayor frecuencia afecta a los viajeros de países industrializados que visitan las zonas tropicales y subtropicales del planeta. El 20 a 50% de viajeros se van afectar por esta condición, siendo en ocasiones tan severa como para afectar los planes del viajero en la quinta parte de pacientes. El cuadro se manifiesta por la aparición de diarrea asociada a síntomas entéricos como dolor abdominal, nauseas, vómitos y en caso de diarrea inflamatoria fiebre y deposiciones con sangre. Entre los agentes etiológicos bacterianos más frecuentes están Escherichia coli enterotoxigénica, Salmonella, Shigella, entre otros agentes, aunque en cerca de la mitad de los casos no se aísla un agente etiológico. En caso de diarrea persistente debe descartarse parásitos y en zonas endémicas debe realizarse las pruebas especiales para descartar infección por Cyclospora cayetanensis. En pacientes con diarrea del viajero está indicado el manejo empírico con antibióticos, lo cual disminuye la duración de la enfermedad. En ausencia de fiebre o diarrea con sangre puede usarse loperamida. La prevención es importante en especialmente en pacientes de alto riesgo o en quienes sea importante que no se afecte el viaje.

TravelersÆ diarrhea is one of the most common conditions that affect travelers from industrialized countries who visit tropical and subtropical areas of the world. Twenty to fifty percent of travelers will suffer from this condition, and one fifth of these subjects will have diarrhea severe enough to affect their travel plans. Illness is characterized by the occurrence of diarrhea, associated with other gastrointestinal symptoms such as abdominal pain, nausea, vomiting and sometimes, in association of inflammatory diarrhea, fever and bloody stools. Among the most common etiologic agents Enterotoxigenic Escherichia coli, Salmonella, and Shigella are among the most common bacterial pathogens, although in close to one half of cases culture results are negative. In cases of persistent diarrhea parasites must be ruled out, and in endemic areas special stains must be ordered to rule agents like Cyclospora cayetanensis. In patients with TravelersÆ diarrhea empiric treatment with antibiotics is indicated, reducing the duration of illness. In the absence of fever or bloody diarrhea loperamide can be used. Prevention is important, especially in high risk patients or those in whom the trip must not be affected by the illness.

[Relapsing viral hepatitis type A complicated with renal failure]. / Hepatitis viral tipo A recurrente complicada con insuficiencia renal.

We report the case of a 42-year old male with an episode of relapsing hepatitis A of cholestatic pattern, which clinic course was complicated by fever, anemia and renal failure, requiring hemodialysis. The occurrence of cryglobulins and diminished complement levels was detected. A kidney biopsy was performed showing evidence of thrombotic microangiopathy. The patient had a good therapeutic response to corticosteroids, although he developed recurrence of fever and a palpable purpuric rush over his lower extremities when dose was reduced. A skin biopsy found leukocytoclastic vasculitis. Symptoms and physical findings improved when therapy with cycloposphamide was started and the dose of corticosteroids was increased. Hepatitis A virus infection usually has a benign course, although complications may occasionally develop. The relapsing form can be seen in 3-20% of the case; it can appear with a cholestatic pattern and most of the time it has a mild clinic development. Unlike hepatitis B, extra-hepatic manifestations are unusual in hepatitis A, and renal manifestations are even more infrequent. Acute renal failure (ARF) in non-fulminating hepatitis A has been reported only occasionally and its etiology remains unclear. Several hypotheses have been proposed, including renal toxicity due to hyperuricemia or increased bilirrubin, cryoglobulinemia, alterations in the renal blood flow due to endotoxemia or peripheral immune complex-mediated damage when hypocomplementemia is found. Kidney biopsy showed evidence of thrombotic microangiopathy, which raised the hypothesis of a Hemolytic Uremic Syndrome (HUS). An association with HUS has been described in a patient with surface antigen for hepatitis B (HBsAg) and anomalies in the hepatic biochemical tests, but as far as we know this is the first case of relapsing hepatitis A associated with a confirmed microangiopathic renal involvement.