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2.
Ann Parasitol ; 65(2): 183-186, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31578842

RESUMO

A 10-year-old intact female Chihuahua, 2.5 kg of weight and BCS 2 (range 1­5) was taken in for medical consultation due to the presence of four skin lesion, two in the ventral thoracic region and two in the dorsal region. The dog was receiving medication due to congestive heart failure. A cutaneous form of canine leishmaniosis was diagnosed using molecular tools from a 10-years-old Chihuahua dog living in the Caribbean region. The critical health condition of the geriatric patient may have evolved to a fatal renal failure. This report is the first of a fatal case of leishmaniosis in a dog from the endemic region in Mexico.


Assuntos
Doenças do Cão , Leishmania infantum , Leishmaniose Cutânea , Animais , Doenças do Cão/diagnóstico , Doenças do Cão/parasitologia , Cães , Evolução Fatal , Feminino , Leishmaniose Cutânea/diagnóstico , Leishmaniose Cutânea/patologia , Leishmaniose Cutânea/veterinária , México , Pele/parasitologia
4.
Rev Med Suisse ; 15(666): 1807-1811, 2019 Oct 09.
Artigo em Francês | MEDLINE | ID: mdl-31599522

RESUMO

Measles is a disease that was considered as relegated to medical history, since an extremely efficient vaccine had been developed. However, in Switzerland and elsewhere there has been an increasing number of epidemics in the past years, and the highest number of new cases this year. Based on two clinical cases showing very different outcomes, we discuss the disease, its clinic, complications, management, and the challenges remaining in obtaining a sufficient vaccination coverage worldwide as well as in our country.


Assuntos
Exantema/etiologia , Sarampo/epidemiologia , Sarampo/prevenção & controle , Evolução Fatal , Humanos , Sarampo/complicações , Sarampo/terapia , Vacina contra Sarampo , Suíça/epidemiologia , Vacinação/estatística & dados numéricos
5.
Medicine (Baltimore) ; 98(41): e17574, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593144

RESUMO

RATIONALE: Approximately 5000 species of wild mushroom are reported worldwide, of which 100 are documented as poisonous and <10 are fatal. The clinical picture of patients with wild mushroom intoxication depends mostly on the type of ingested mushroom, ranging from mild gastrointestinal symptoms to organ failure and death. PATIENT CONCERNS: We report 2 children, sister and brother admitted in our clinic for gastrointestinal symptoms: abdominal pain, nausea, vomiting, and diarrhea after wild mushroom ingestion. DIAGNOSIS: The laboratory tests revealed hepatic cytolysis syndrome, hyperbilirubinemia, impaired coagulation status, hypoalbuminemia, hypoglycemia, and electrolytic unbalances in both cases. Abdominal ultrasound showed hepatomegaly and ascites. INTERVENTION: After admission, both cases received penicillin by vein, activated charcoal, liver protectors, glucose, and electrolytes perfusions. Nevertheless, their status worsened and required the transfer to the pediatric intensive care unit for appropriate supportive measure. Therefore, therapeutic plasma exchange was initiated along with N-acetyl cysteine and hemostatic drugs. OUTCOMES: Despite all these therapeutic interventions, both cases developed hepatorenal syndrome and died after a couple of days from ingestion. LESSONS: Mushroom poisoning remains a public health problem in developing countries. Preventable strategies and education regarding the consumption of wild type mushrooms are essential for decreasing the morbidity and mortality rates in these areas.


Assuntos
Síndrome Hepatorrenal/etiologia , Intoxicação Alimentar por Cogumelos/complicações , Intoxicação Alimentar por Cogumelos/diagnóstico , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Agaricales/classificação , Ascite/diagnóstico por imagem , Criança , Pré-Escolar , Diarreia/diagnóstico , Diarreia/etiologia , Ingestão de Alimentos , Evolução Fatal , Feminino , Hepatomegalia/diagnóstico por imagem , Humanos , Masculino , Intoxicação Alimentar por Cogumelos/patologia , Intoxicação Alimentar por Cogumelos/terapia , Troca Plasmática/métodos , Romênia/epidemiologia , Ultrassonografia , Vômito/diagnóstico , Vômito/etiologia
7.
Medicine (Baltimore) ; 98(38): e17034, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567940

RESUMO

BACKGROUND: Pericardial infection caused by Acinetobacter baumannii is rare, particularly that of carbapenem-resistant A baumannii (CRAB). CASE PRESENTATION: We describe a rare case of purulent pericarditis due to CRAB in a 76-year-old man with acute myocardial infarction and acute kidney injury. The man was admitted to the intensive care unit for a catheter-related bloodstream infection. Pericardial effusion was detected via the bedside X-ray and ultrasound, and pericardiocentesis was performed. Cultures of the pericardial fluid, catheter tip, and blood independently revealed the presence of CRAB. These findings confirmed a diagnosis of purulent pericarditis. CONCLUSIONS: Clinicians should be reminded that CRAB infection can lead to purulent pericarditis, particularly in patients with congestive heart failure or renal insufficiency.


Assuntos
Infecções por Acinetobacter/diagnóstico , Acinetobacter baumannii/isolamento & purificação , Lesão Renal Aguda/diagnóstico , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico , Pericardite/diagnóstico , Infecções por Acinetobacter/complicações , Acinetobacter baumannii/efeitos dos fármacos , Lesão Renal Aguda/complicações , Idoso , Carbapenêmicos/farmacologia , Diagnóstico Diferencial , Farmacorresistência Bacteriana , Evolução Fatal , Humanos , Masculino , Infarto do Miocárdio sem Supradesnível do Segmento ST/complicações , Pericardiocentese , Pericardite/complicações , Pericardite/diagnóstico por imagem , Tomografia Computadorizada por Raios X
8.
Medicine (Baltimore) ; 98(39): e17148, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574818

RESUMO

RATIONALE: Thrombotic microangiopathy (TMA) is a group of clinical syndromes characterized by excessive platelet activation and endothelial injury that leads to acute or chronic microvascular obliteration by intimal mucoid and fibrous thickening, with or without associated thrombi. It frequently involves the kidney but may involve any organ or system at variable frequencies depending on the underlying etiology. Among its numerous causes, drug toxicities and complement regulation abnormalities stand out as some of the most common. A more recently described association is with monoclonal gammopathy. Lung involvement by TMA is infrequent, but has been described in Cobalamin C deficiency and post stem-cell transplantation TMA. PATIENT CONCERNS: This is the case of a patient with smoldering myeloma who received proteasome-inhibitor therapy due to retinopathy and developed acute renal failure within one week of therapy initiation. DIAGNOSES: A renal biopsy showed thrombotic microangiopathy. At the time, mild pulmonary hypertension was also noted and presumed to be idiopathic. INTERVENTIONS: Given the known association of proteasome-inhibitor therapy with thrombotic microangiopathy, Bortezomib was discontinued and dialysis was initiated. OUTCOMES: Drug withdrawal failed to prevent disease progression and development of end-stage renal disease, as well as severe pulmonary hypertension that eventually lead to the patient's death. LESSONS: To our knowledge, this is the first reported case of pulmonary involvement by TMA associated with monoclonal gammopathy which appears to have been triggered by proteasome-inhibitor therapy. Clinicians should be aware of this possibility to allow for more prompt recognition of pulmonary hypertension as a potential manifestation of monoclonal gammopathy-associated TMA, especially in patients also receiving proteasome-inhibitors, so that treatment aiming to slow disease progression can be instituted.


Assuntos
Lesão Renal Aguda/induzido quimicamente , Hipertensão Pulmonar/induzido quimicamente , Inibidores de Proteassoma/efeitos adversos , Mieloma Múltiplo Latente/tratamento farmacológico , Microangiopatias Trombóticas/induzido quimicamente , Autopsia , Biópsia , Evolução Fatal , Feminino , Humanos , Rim/efeitos dos fármacos , Rim/patologia , Pulmão/efeitos dos fármacos , Pessoa de Meia-Idade , Paraproteinemias/complicações , Mieloma Múltiplo Latente/etiologia
9.
Medicine (Baltimore) ; 98(39): e17245, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574838

RESUMO

RATIONALE: Over the past decade, although several new entities of renal tumors have emerged, a form of renal cell carcinoma (RCC) that morphologically resembles epithelial-myoepithelial carcinoma has not been reported thus far. Herein, we describe a case of an unusual renal tumor that remained unclassified under a current RCC subtype, and briefly present its morphologic, immunophenotypic, and genetic features. PATIENT CONCERNS: The patient was an 85-year-old man who presented with hematuria and flank pain. Imaging studies revealed a left renal mass without enlarged lymph nodes. There were no abnormal masses or nodules in other organs. DIAGNOSES: The patient underwent no other treatment except the left radical nephrectomy under a clinical diagnosis of invasive urothelial carcinoma and was discharged on the thirteenth day. Histologically, the renal tumor showed biphasic proliferation of epithelial (strongly cytokeratin-positive; P63, P40, and vimentin-negative) and myoepithelial (strongly vimentin-positive; focal P63 and P40-positive; and weakly cytokeratin-positive) cells arranged in a perivascular pseudorosette-like pattern. No mutations were detected in multiple gene tests. According to the pathological structure, the patient was diagnosed as primary epithelial myoepithelial carcinoma-like renal tumor. INTERVENTIONS: To the best of our knowledge, the present tumor has not been previously described, and thus, this variant has not been integrated into a known form of PCC. Therefore, we cannot diagnose this type of tumor with other types of kidney tumors. OUTCOMES: Three years after primary diagnosis, the patient died of multiple organ failure result from multiple distant metastases. LESSONS: We present the first case of carcinoma of the kidney with EMC-like features and a perivascular pseudorosette-like growth pattern. Clinicians should be aware of the features of this uncommon variant of RCC to avoid diagnostic delays or misdiagnosis and prevent unnecessary or inappropriate treatment.


Assuntos
Carcinoma de Células Renais/patologia , Neoplasias Renais/patologia , Mioepitelioma/patologia , Idoso de 80 Anos ou mais , Carcinoma de Células Renais/genética , Evolução Fatal , Humanos , Imunofenotipagem , Rim/patologia , Neoplasias Renais/genética , Masculino , Mioepitelioma/genética , Formação de Roseta
12.
Vasc Health Risk Manag ; 15: 253-258, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31496715

RESUMO

Antiphospholipid syndrome (APS) is an autoantibody-mediated acquired thrombophilia characterized by venous and/or arterial thromboses, pregnancy morbidity (predominantly repeated fetal losses), and the presence of phospholipid antibodies. The estimated annual incidence of APS is 5 new cases per 100,000 people. The most common thrombotic events in patients with APS in order of frequency are stroke, transient ischemic attack, deep vein thrombosis, and pulmonary embolism. Patients with APS may develop an intracardiac thrombus, which is a life-threatening complication with a high risk of increased morbidity and mortality; however, it is treatable by surgical removal, extensive anticoagulant administration, and prevention of other complications. Catastrophic APS, which is a rare and severe condition diagnosed based on rapidly progressive thromboembolic events involving three or more organs, systems, or tissues, occurs in less than 1% of all patients with APS. We herein report an autopsy case of catastrophic APS in a 12-year-old Thai boy with multiple thromboembolic events including intracardiac thrombus formation with a positive lupus anticoagulant test result. To the best of our knowledge, this is the youngest reported patient with APS to date.


Assuntos
Síndrome Antifosfolipídica/complicações , Cardiopatias/etiologia , Tromboembolia/etiologia , Síndrome Antifosfolipídica/sangue , Síndrome Antifosfolipídica/diagnóstico , Síndrome Antifosfolipídica/terapia , Autopsia , Biomarcadores/sangue , Doença Catastrófica , Criança , Evolução Fatal , Cardiopatias/sangue , Cardiopatias/diagnóstico , Cardiopatias/terapia , Humanos , Inibidor de Coagulação do Lúpus/sangue , Masculino , Tromboembolia/sangue , Tromboembolia/diagnóstico , Tromboembolia/terapia
15.
Medicina (B Aires) ; 79(4): 295-298, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31487252

RESUMO

The infiltration of the bone marrow y non-hematopoietic cells is called myelophthisis. In patients with gastric cancer, this invasion is extremely infrequent and the survival is usually less than three months. We present the case of a 35-year-old man with bone marrow involvement secondary to diffuse gastric carcinoma of signet ring cells.


Assuntos
Anemia Mielopática/diagnóstico , Carcinoma de Células em Anel de Sinete/diagnóstico , Neoplasias Gástricas/diagnóstico , Adulto , Anemia Mielopática/etiologia , Carcinoma de Células em Anel de Sinete/complicações , Carcinoma de Células em Anel de Sinete/tratamento farmacológico , Evolução Fatal , Humanos , Masculino , Neoplasias Gástricas/complicações , Neoplasias Gástricas/tratamento farmacológico
16.
Rev Inst Med Trop Sao Paulo ; 61: e49, 2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31531627

RESUMO

This manuscript reports a case of intestinal toxemia botulism in an adult with recently diagnosed metastatic colon cancer in whom botulism symptoms began 23 days after hospital admission. Representing the rarest form of botulism presentation in clinical practice, this infectious disease may have developed due to a cluster of predisposing factors that favored Clostridium botulinum colonization and the endogenous production of neurotoxins, among which are previous use of broad-spectrum antibiotics and colon changes related to the development of the neoplasia. This case highlights the importance of considering intestinal toxemia botulism in the differential diagnosis of a patient presenting with symmetrical descending flaccid paralysis, since immediate treatment with botulinum antitoxin may improve clinical outcomes.


Assuntos
Botulismo/diagnóstico , Neoplasias do Colo/complicações , Infecção Hospitalar/microbiologia , Enteropatias/microbiologia , Toxemia/diagnóstico , Botulismo/complicações , Evolução Fatal , Fezes/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Toxemia/complicações
17.
Rev Inst Med Trop Sao Paulo ; 61: e50, 2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31531628

RESUMO

This study involves a 49-year-old male, who for three years suffered with a myelodysplastic syndrome and who needed frequent blood transfusions. One day following a transfusion, he presented fever and abdominal pain. The fever became persistent and only improved temporarily with two cycles of intravenous ciprofloxacin. Nearly 120 days after beginning the second cycle of treatment, he had experienced a weight loss of 16 kg and recurring fever. Screening for fever of unknown origin was conducted, including Bartonella infection. No etiology could be found. The patient improved with an antimicrobial regimen composed of oral doxycycline and intravenous ciprofloxacin. After 15 days afebrile, the patient was discharged with a four-month oral prescription of doxycycline and ciprofloxacin. Eight months following the antibiotic treatment, the patient received an allogeneic bone marrow transplant. Five days following the transplant, the patient initiated a febrile neutropenia and died. From a blood sample collected and stored at the time of hospitalization, a microbiological and molecular study was performed again. Blood- and liquid culture-PCRs from the same blood sample were all negative, but an isolate from solid subculture was found. The molecular reactions from this isolate were all positive and the sequence was 100% homologous to Bartonella henselae . The present report points to the limitations of laboratory techniques currently available for investigation of possible cases of bartonellosis in clinical practice, and the potential risk of Bartonella spp. transmission through blood transfusions.


Assuntos
Bacteriemia/microbiologia , Infecções por Bartonella/diagnóstico , Bartonella henselae , Síndromes Mielodisplásicas/microbiologia , Evolução Fatal , Feminino , Humanos , Pessoa de Meia-Idade
18.
Pan Afr Med J ; 33: 122, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31558922

RESUMO

Dermatomyositis is a systemic idiopathic disease characterized by a combination of both muscle and skin symptoms. It is a paraneoplastic dermatosis. Its association with rectal cancer has been rarely described in the literature. We here report the case of a female patient with paraneoplastic dermatomyositis associated with metastatic rectal adenocarcinoma presenting with clinical symptoms commonly found in subjects with paraneoplastic dermatomyositis. Other complementary examinations (CPK test + EMG + skin biopsy) were performed which confirmed this diagnosis. The patient underwent chemotherapy, but after the second cycle, she experienced a rapid worsening of her general condition and died after some days in a state of multisystem organ failure. This study aims to highlight paraneoplastic dermatomyositis' aggressive nature and to update current knowledge on the importance of chemotherapy in the management of neoplastic dermatomyositis.


Assuntos
Adenocarcinoma/diagnóstico , Dermatomiosite/diagnóstico , Neoplasias Retais/diagnóstico , Adenocarcinoma/patologia , Idoso , Biópsia , Dermatomiosite/etiologia , Evolução Fatal , Feminino , Humanos , Insuficiência de Múltiplos Órgãos/etiologia , Síndromes Paraneoplásicas/diagnóstico , Síndromes Paraneoplásicas/etiologia , Neoplasias Retais/patologia
19.
Chirurgia (Bucur) ; 114(4): 512-517, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31511137

RESUMO

Introduction: Phyllodes tumors are rare breast tumors. The best treatment is wide local excision with 1 cm safety margin unless metastatic. The three pathological types (benign, borderline and malignant were reported in men. Case presentation: A 73year-old male with huge left breast swelling extending from the clavicle to the left hypochondriac region. Core needle biopsy suggested malignant phyllodes tumor. Postcontrast CT revealed a huge mass seen at the left anterolateral chest wall measuring about (22 x 25 x 26 cm). Simple mastectomy was performed en bloc with the tumor. The microscopic examination led to the diagnosis of high grade malignant phyllodes. IHC showed diffuse positive vimentin, CD10 and negative CK in the neoplastic cells. The patient lost follow up for three months.Then he was presented with fungating local recurrence with bilateral metastatic pulmonary. The patient underwent palliative excision. After the second surgery, he was prepared for palliative chemoradiotherapy but the patient died one month later at home. Discussion and conclusions: Very few cases of phyllodes tumor were reported in men. Pathologically, phyllodes tumors are subdivided into three types: benign, borderline and malignant according to mitotic frequency, nature of margins, stromal growth, cellularity and atypia. Malignant phyllodes tumors tend to spread via hematological route mainly to the lung, then to the bone. Phyllodes tumors even benign type tend to recur even after complete excision with higher tendency for malignant cases. Wide local excision is the standard of care for phyllodes tumors with or without adjuvant radiotherapy in malignant lesions- with no proved value for chemotherapy or hormonal therapy.


Assuntos
Neoplasias da Mama Masculina/diagnóstico por imagem , Tumor Filoide/diagnóstico por imagem , Idoso , Neoplasias da Mama Masculina/patologia , Neoplasias da Mama Masculina/cirurgia , Evolução Fatal , Humanos , Neoplasias Pulmonares/secundário , Masculino , Mastectomia , Tumor Filoide/patologia , Tumor Filoide/cirurgia , Resultado do Tratamento
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