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1.
Am J Case Rep ; 22: e934503, 2021 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-34759259

RESUMO

BACKGROUND Splenic epidermoid cysts rarely occur and the majority of cases are discovered incidentally. However, large cysts can present with symptoms due to mass effect. Splenectomy is the treatment indicated for most splenic cysts and definitive diagnosis can only be made after histopathological examination. CASE REPORT A 16-year-old boy was referred to the general surgery clinic from a local hospital with a history of abdominal asymmetry, distention, decreased oral intake, and early satiety. Abdominal computed tomography (CT) was performed and revealed a large splenic mass measuring 18.4×14×17.4 cm with multiple mural calcifications at the rim. The mass was displacing the stomach, jejunal loops, pancreas, left kidney, and transverse colon. Preoperative biopsy was not possible because a parasitic cyst was suspected; therefore, splenectomy was performed through midline laparotomy. The patient recovered well, with no complications except for transient reactive thrombocytosis. Histopathology was reported as benign epithelial cysts, with the most likely diagnosis being a splenic epidermoid cyst. Subsequently, the patient was followed up at the surgery clinic. During the last outpatient visit, the patient exhibited good recovery with no problems. CONCLUSIONS Large splenic epidermoid cysts are rare, particularly in the pediatric population. Nonspecific clinical and radiological findings are hurdles to an accurate diagnosis. Preoperative diagnosis is crucial to determine the type of intervention. However, a final diagnosis can only be made after histopathological examination.


Assuntos
Cisto Epidérmico , Esplenopatias , Adolescente , Criança , Cisto Epidérmico/diagnóstico por imagem , Cisto Epidérmico/cirurgia , Humanos , Masculino , Arábia Saudita , Esplenectomia , Esplenopatias/diagnóstico por imagem , Esplenopatias/cirurgia , Tomografia Computadorizada por Raios X
2.
Cir Cir ; 89(S1): 1-5, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34762621

RESUMO

INTRODUCTION: Spontaneous splenic rupture from tuberculosis (TB) is a very unusual presentation within the wide range of presentations of this infectious disease. CLINICAL CASE: A 40-year-old male with a diagnosis of human immunodeficiency virus, begins with fever and pain in the left hypochondrium. A computed tomography scan was performed, showing probable splenic abscesses; suddenly, it begins with hemodynamic deterioration, exacerbation of pain, a surgical exploration was performed, showing spontaneous splenic rupture. Microscopic study of the spleen shows the presence of Mycobacterium tuberculosis. CONCLUSIONS: This is yet another presentation of TB, which can become a surgical emergency.


Assuntos
Esplenopatias , Ruptura Esplênica , Tuberculose , Adulto , Humanos , Masculino , Ruptura Espontânea , Ruptura Esplênica/diagnóstico por imagem , Ruptura Esplênica/etiologia , Ruptura Esplênica/cirurgia , Tuberculose/complicações , Tuberculose/diagnóstico
3.
Am J Case Rep ; 22: e933598, 2021 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-34772906

RESUMO

BACKGROUND Sclerosing angiomatoid nodular transformation (SANT) of the spleen is a rare benign disease of the splenic red pulp of unknown etiology. Definite diagnosis is made on histopathology alone as it has no diagnostic radiologic characteristics. CASE REPORT We present a case of a large incidental splenic mass in a middle-aged man, whose refractory anemia resolved with splenectomy. Our initial imaging studies failed to differentiate this lesion from other splenic lesions like hamartoma and haemangioma. To the best of our knowledge, no SANT cases in the literature have been investigated with red cell scan, as performed in our patient, nor has any case had resolved anemia after treatment. Splenectomy was offered as malignancy could not be safely excluded. Histopathology confirmed the diagnosis of SANT. The patient made good recovery and had no signs of recurrence 2 years later. CONCLUSIONS SANT of the spleen is a rare condition that can mimic many other splenic tumors and poses diagnostic challenge when histopathology is unavailable. Our case adds to the number of SANT reported in literature in the hope of elucidating the pathophysiology of this rare condition.


Assuntos
Anemia , Histiocitoma Fibroso Benigno , Esplenopatias , Neoplasias Esplênicas , Anemia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Esplenopatias/diagnóstico , Esplenopatias/cirurgia , Neoplasias Esplênicas/complicações , Neoplasias Esplênicas/diagnóstico , Neoplasias Esplênicas/cirurgia
4.
Cir Cir ; 89(S1): 33-36, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34762619

RESUMO

Splenic tuberculosis is a little-known and difficult to diagnose entity due to its low presentation of symptoms. It corresponds to one of the forms of extrapulmonary presentation of the disease, which in turn have a greater association with immunocompromised states such as diabetes mellitus. We present the case of a patient with diabetes mellitus who was admitted in the context of septic shock secondary to a probable splenic abscess, requiring surgical intervention. A total splenectomy was performed, managing to isolate Mycobacterium tuberculosis from the surgical specimen.


Assuntos
Abscesso Abdominal , Choque Séptico , Esplenopatias , Tuberculose , Abscesso/etiologia , Abscesso/cirurgia , Humanos , Choque Séptico/etiologia , Esplenopatias/complicações , Esplenopatias/cirurgia , Tuberculose/complicações
5.
BMJ Case Rep ; 14(10)2021 Oct 13.
Artigo em Inglês | MEDLINE | ID: mdl-34645640

RESUMO

A 30-year-old man was admitted to Intensive Therapy Unit (ITU) with status epilepticus secondary to severe hypoglycaemia on a background of type 1 diabetes. CT of the brain showed generalised cerebral oedema. He was successfully stepped down to a medical ward after 2 weeks. He was noted to have persistently high calcium, which required multiple doses of pamidronate. Parathyroid hormone level was appropriately low. CT of the thorax, abdomen and pelvis showed mild hepatosplenomegaly with small pathological lymph nodes throughout the abdomen. Bone marrow biopsy was unremarkable. Lymph node biopsy was difficult to achieve, and therefore a positron emission tomography scan was arranged. This showed an enlarged and hypermetabolic spleen. Differential diagnoses at this point included lymphoma and sarcoidosis. He underwent diagnostic splenectomy, and the diagnosis of sarcoidosis was confirmed histologically. Calcium level remained normal 17 months after splenectomy.


Assuntos
Diabetes Mellitus Tipo 1 , Hipercalcemia , Sarcoidose , Esplenopatias , Adulto , Diabetes Mellitus Tipo 1/complicações , Humanos , Hipercalcemia/etiologia , Masculino , Pamidronato , Sarcoidose/complicações , Sarcoidose/diagnóstico , Esplenopatias/complicações , Esplenopatias/diagnóstico por imagem
6.
BMC Gastroenterol ; 21(1): 407, 2021 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-34706678

RESUMO

BACKGROUND: To investigate the safety and efficacy of 8Spheres in partial splenic embolization. To explore the possibility of accurate control of splenic embolic volume by quantifying the number of microspheres used during PSE. METHOD: The data of 179 patients who underwent PSE were collected. The patients were divided into two groups: 300-500 um microsphere group (N = 83) and 500-700 um microsphere group (N = 96). The spleen volume before PSE, infarct volume and infarct rate of the spleen after PSE, changes in peripheral blood cells after PSE, postoperative adverse events and incidence of infection were compared between the two groups. RESULTS: 300-500 um group vs 500-700 um group: postoperative spleen volume (cm3): 753.82 ± 325.41 vs 568.65 ± 298.16 (P = 0.008); spleen embolization volume (cm3): 525.93 ± 118.29 vs 630.26 ± 109.71 (P = 0.014); spleen embolization rate: 41.1 ± 12.3% vs 52.4 ± 10.1% (P = 0.021). Leukocytes and platelets were significantly increased after PSE in both groups; leukocyte, 1 month: 4.13 ± 0.91 vs 5.08 ± 1.16 (P = 0.026); 3 months: 4.08 ± 1.25 vs 4.83 ± 0.98 (P = 0.022); platelet, 1 month: 125.6 ± 20.3 vs 138.7 ± 18.4 (P = 0.019); 3 months: 121.8 ± 16.9 vs 134.3 ± 20.1 (P = 0.017). Incidence of abdominal pain after PSE, 72 (86.7%) vs 69 (71.9%), P = 0.027. The incidence of other adverse events and infections after PSE was not statistically different. CONCLUSION: PSE with 8Spheres is safe and effective. The use of 500-700 um microsphere for PSE can make the increase of peripheral blood cells more stable. Each vial of 8Spheres corresponds to a certain volume of splenic embolization, so it is possible to achieve quantitative embolization in PSE.


Assuntos
Embolização Terapêutica , Hiperesplenismo , Esplenopatias , Embolização Terapêutica/efeitos adversos , Humanos , Hiperesplenismo/terapia , Microesferas
8.
Ann Saudi Med ; 41(5): 307-311, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34618603

RESUMO

Splenic abscess is an aggressive disease with a non-specific etiology and symptoms that are systemically detrimental. During the current COVID-19 pandemic, there has been a noted rise in the incidence of splenic abscesses. The aim of this article was to explore whether infection with the SARS-CoV-2 virus increases the risk of developing splenic abscesses. We reviewed three cases with SARS-CoV-2 infection who developed splenic abscess. The clinical characteristics, treatment course, management and outcome are reported. We perceived that hypercoagulability status, superimposing infections and immunosuppression were related to SARS-CoV-2 infection. These were common factors in these three observed cases of splenic abscess as a complication related to the new viral pandemic. SARS-CoV-2 infection might be a risk factor in development of splenic abscess. SIMILAR CASES PUBLISHED: To the best of our knowledge only one case similar to our case series was published.


Assuntos
COVID-19 , Esplenopatias , Abscesso/etiologia , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , SARS-CoV-2 , Esplenopatias/etiologia
9.
Niger J Clin Pract ; 24(10): 1569-1571, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34657028

RESUMO

Hydatid cyst is an endemic disease especially in underdeveloped and developing countries, affecting mostly the liver and lungs. However, a wide range of unusual anatomical sites in the abdomen have been reported, including the spleen, pancreas, kidney, and ovaries as well as dissemination within the abdominal and pelvic cavities. The location of hydatid disease in the colon is very infrequent, and very few cases have been presented so far. The hydatid cysts located in other sites are mostly due to rupture or extrusion of primary liver or splenic cysts. In this article, we present a case of primary left-sided colon hydatid cyst, resected laparoscopically with the affected intestinal segment. The diagnosis of hydatid cyst was made by macroscopic and microscopic examinations.


Assuntos
Equinococose , Esplenopatias , Colo , Equinococose/diagnóstico , Equinococose/diagnóstico por imagem , Hemorragia Gastrointestinal/etiologia , Humanos , Esplenopatias/diagnóstico , Esplenopatias/cirurgia
10.
BMJ Case Rep ; 14(9)2021 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-34511417

RESUMO

Non-parasitic splenic cysts are rare and are seldom diagnosed outside the paediatric surgical practice. Giant true primary epithelial cysts greater than 14 cm in diameter are even rarer. Laparoscopic surgery is preferable; however, bleeding, splenectomy and recurrence are recognised risks. Here, we report a young female patient with a 21 cm symptomatic primary splenic cyst. The patient underwent a spleen-preserving laparoscopy and was followed up for 2 years when she had an MRI of the abdomen. Surgical, technical and perioperative treatment aspects are discussed here, in the context of the current literature.


Assuntos
Cisto Epidérmico , Laparoscopia , Esplenopatias , Adolescente , Cisto Epidérmico/cirurgia , Feminino , Humanos , Recidiva Local de Neoplasia , Esplenectomia , Esplenopatias/diagnóstico por imagem , Esplenopatias/cirurgia
11.
Korean J Gastroenterol ; 78(3): 183-187, 2021 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-34565788

RESUMO

Accessory spleens are common congenital anatomic variations that are usually asymptomatic. On the other hand, they can be clinically significant if complicated by hemorrhage, torsion, or infarction. This paper describes a case of an infarcted accessory spleen in a 30-year-old male who presented with abdominal pain. Abdominal CT and MRI revealed an isolated mass, 4.5 cm in size, in the perisplenic area. An infarcted accessory spleen was suspected. The patient underwent laparoscopic accessory splenectomy. Histopathology identified the mass as splenic tissue that had undergone ischemic necrosis. A definitive diagnosis of an infarcted accessory spleen was made, and the patient was discharged on day 5 after surgery symptom-free.


Assuntos
Esplenopatias , Infarto do Baço , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Adulto , Humanos , Masculino , Esplenectomia , Infarto do Baço/diagnóstico
12.
Arch Argent Pediatr ; 119(5): e540-e544, 2021 10.
Artigo em Espanhol | MEDLINE | ID: mdl-34569759

RESUMO

The infection by Bartonela henselae (BH), the cause of cat scratch disease, it could be asymptomatic or produce local and multisystem illness. The objective of this case report is to document that the hepato-splenic involvement is unusual in BH infection, and the treatment is discussed and individualized in each patient. This case is about an eleven-year girl who presented with findings in abdominal tomography and ultrasound of hepato-splenic abscesses, with later positive serology for BH. In this way, a bibliographic review is carried out to show the low prevalence and incidence of hepato-splenic involvement where the anamnesis and the physical examination are essential to make an early diagnosis and treatment.


Assuntos
Bartonella henselae , Doença da Arranhadura de Gato , Esplenopatias , Abscesso , Doença da Arranhadura de Gato/complicações , Doença da Arranhadura de Gato/diagnóstico , Criança , Feminino , Humanos , Fígado , Esplenopatias/diagnóstico por imagem
13.
Medicina (Kaunas) ; 57(8)2021 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-34440940

RESUMO

Background and objectives: For the last three decades, non-operative management (NOM) has been the standard in the treatment of clinically stable patients with blunt spleen injury, with a success rate of up to 95%. However, there are no prospective issues in the literature dealing with the incidence and type of splenic complications after NOM. Materials and methods: This study analyzed 76 pediatric patients, up to the age of 18, with blunt splenic injury who were treated non-operatively. All patients were included in a posttraumatic follow-up protocol with ultrasound examinations 4 and 12 weeks after injury. Results: The mean age of the children was 9.58 ± 3.97 years (range 1.98 to 17.75 years), with no statistically significant difference between the genders. The severity of the injury was determined according to the American Association for Surgery of Trauma (AAST) classification: 7 patients had grade I injuries (89.21%), 21 patients had grade II injuries (27.63%), 33 patients had grade III injuries (43.42%), and 15 patients had grade IV injuries (19.73%). The majority of the injuries were so-called high-energy ones, which were recorded in 45 patients (59.21%). According to a previously created posttraumatic follow-up protocol, complications were detected in 16 patients (21.05%). Hematomas had the highest incidence and were detected in 11 patients (14.47%), while pseudocysts were detected in 3 (3.94%), and a splenic abscess and pseudoaneurysm were detected in 1 patient (1.31%), respectively. The complications were in a direct correlation with injury grade: seven occurred in patients with grade IV injuries (9.21%), five occurred in children with grade III injuries (6.57%), three occurred in patients with grade II injuries (3.94%), and one occurred in a patient with a grade I injury (1.31%). Conclusion: Based on the severity of the spleen injury, it is difficult to predict the further course of developing complications, but complications are more common in high-grade injuries. The implementation of a follow-up ultrasound protocol is mandatory in all patients with NOM of spleen injuries for the early detection of potentially dangerous and fatal complications.


Assuntos
Esplenopatias , Ferimentos não Penetrantes , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Escala de Gravidade do Ferimento , Masculino , Estudos Retrospectivos , Esplenopatias/diagnóstico por imagem , Esplenopatias/epidemiologia , Esplenopatias/etiologia , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/terapia
14.
BMJ Case Rep ; 14(8)2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34389594

RESUMO

A 2-year-old female child from South India presented with persistent fever for 3 weeks, pallor and hepatosplenomegaly. There was no history of contact with tuberculosis (TB) and BCG scar was absent. Tests for TB (Mantoux and gastric aspirate) were negative. Blood and bone marrow tests for other infections, inflammation and infiltration were inconclusive. Chest X-ray was normal. Ultrasound study (USS) of abdomen showed multiple microabscesses in the liver and spleen. USS-guided fine needle aspiration cytology from splenic lesion demonstrated epithelioid granuloma while bacteriology was negative. Commencement of anti-tubercular therapy (ATT) resulted in remarkable clinical improvement in a week with resolution of lesions on follow-up USS in 2 months. Isolated hepatosplenic TB in children, though rare, has a wide, non-specific clinical spectrum and potential of delaying diagnosis. Probability diagnosis and therapeutic trials of ATT are accepted approaches, using treatment response as indirect confirmation of the likely cause.


Assuntos
Esplenopatias , Tuberculose , Criança , Pré-Escolar , Feminino , Granuloma , Humanos , Esplenopatias/diagnóstico por imagem , Esplenopatias/tratamento farmacológico , Teste Tuberculínico , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Ultrassonografia
15.
Am J Case Rep ; 22: e932577, 2021 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-34417433

RESUMO

BACKGROUND Delayed splenic rupture is a rare complication of non-operative management of a primary splenic trauma which, without proper clinical vigilance, may result in life-threatening events. It usually occurs 4-8 days after injury and, in most cases, surgery is the treatment of choice. Since non-operative management of splenic trauma, which allows splenic salvage, has become increasingly popular, the same approach could also be applied in delayed splenic rupture. We herein present a case of delayed splenic rupture that occurred 4 months after the trauma and was successfully managed non-operatively. CASE REPORT A 32-year-old woman presented with diffuse abdominal pain, chest pain, and dyspnea 4 months after sustaining minor thoracoabdominal blunt trauma due to a car accident. That event was inadequately investigated and was not admitted for further monitoring. Computerized tomography revealed a rupture of a splenic hematoma in the context of the previous splenic trauma. She was closely monitored and remained hemodynamically stable. She was discharged and followed up, with no reported relapse of her clinical condition. CONCLUSIONS Delayed splenic rupture occurring 4 months after the primary splenic trauma is extremely rare. Due to its prolonged delay, delayed rupture of the spleen can easily be overlooked and not be included in the original differential diagnosis. Negligence of this event can result in dreaded complications with hemodynamic instability or even death. Furthermore, its higher mortality rate compared to primary splenic rupture highlights the importance of proper clinical vigilance. Non-operative management should be attempted in hemodynamically stable patients.


Assuntos
Traumatismos Abdominais , Esplenopatias , Ruptura Esplênica , Ferimentos não Penetrantes , Traumatismos Abdominais/complicações , Traumatismos Abdominais/terapia , Adulto , Feminino , Humanos , Ruptura Esplênica/diagnóstico por imagem , Ruptura Esplênica/etiologia , Ruptura Esplênica/cirurgia , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/terapia
16.
Sci Rep ; 11(1): 16394, 2021 08 12.
Artigo em Inglês | MEDLINE | ID: mdl-34385480

RESUMO

The spleen, a secondary lymphoid tissue (SLT), has an important role in generation of adaptive immune responses. Although splenectomy remains a common procedure, recent studies reported poor prognosis and increased risk of haematological malignancies in asplenic patients. The high baseline trafficking of T lymphocytes to splenic tissue suggests splenectomy may lead to loss of blood-borne malignant immunosurveillance that is not compensated for by the remaining SLT. To date, no quantitative analysis of the impact of splenectomy on the human T cell trafficking dynamics and tissue localisation has been reported. We developed a quantitative computational model that describes organ distribution and trafficking of human lymphocytes to explore the likely impact of splenectomy on immune cell distributions. In silico splenectomy resulted in an average reduction of T cell numbers in SLT by 35% (95%CI 0.12-0.97) and a comparatively lower, 9% (95%CI 0.17-1.43), mean decrease of T cell concentration in SLT. These results suggest that the surveillance capacity of the remaining SLT insufficiently compensates for the absence of the spleen. This may, in part, explain haematological malignancy risk in asplenic patients and raises the question of whether splenectomy has a clinically meaningful impact on patient responses to immunotherapy.


Assuntos
Neoplasias Hematológicas/imunologia , Tecido Linfoide/imunologia , Esplenopatias/imunologia , Linfócitos T/imunologia , Humanos , Linfócitos/imunologia , Baço/imunologia , Esplenectomia/métodos
17.
J Laparoendosc Adv Surg Tech A ; 31(11): 1331-1336, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34424747

RESUMO

Purpose: We performed a retrospective study to determine the effectiveness and feasibility of articulating linear stapler in laparoscopic total splenectomy (LTS) and laparoscopic partial splenectomy (LPS), focusing on technical laparoscopic skills that could help pediatric surgeons to avoid intra- and postoperative complications. Methods: Retrospective cohort study of children younger than 18 years who underwent laparoscopic spleen surgery between January 2008 and March 2020. Age, sex, indication for surgery, operative time (OT), intra- and postoperative complications, and postoperative length of hospital stay (LHS) were analyzed. Data from parenchymal resection and vessels sealing techniques were obtained. Results: Thirty patients, 19 LTS and 11 LPS, were included. The mean age of the patients was 10.9 years, and 16 patients were male and 14 were female. For hematologic diseases, LTS was the elective surgery, associated with cholecystectomy in 5 cases. LPS was the common procedure for splenic cysts. The stapler was used in LTS to close the hilum vessels and in LPS for parenchymal resection. No statistically significant differences in OT were observed comparing LTS and LPS. Two conversions occurred in LTS; none in LPS. The mean LHS was 6 days in both groups. No recurrence or major complications appeared in both groups at 1-12 years of follow-up. In particular for LPS, there are no relapse of cyst neither reduction in splenic function. Conclusions: This study shows the effectiveness, feasibility, and safety of mechanic stapler in splenic surgery both for hilum vessels sealing and for parenchymal resection. The use of this device can reduce risk of hemorrhagic recurrences or major surgical complications improving the safety of the operation.


Assuntos
Laparoscopia , Esplenectomia , Esplenopatias , Criança , Feminino , Humanos , Laparoscopia/instrumentação , Masculino , Estudos Retrospectivos , Esplenectomia/instrumentação , Esplenopatias/cirurgia
18.
J Coll Physicians Surg Pak ; 30(7): 855-857, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34271792

RESUMO

Extensively drug-resistant (XDR) typhoid emerged in Hyderabad, Pakistan in 2016. It spread regionally and globally due to fast travelling. An immuno-competent young male referred by general practitioner, was diagnosed and managed as XDR salmonella typhi with multiple splenic abscesses. We faced challenges in its management, like little suspicion of potentially lethal disease; non-availability of evidence-based medicine and further delay in diagnosis as he was already on antibiotics therapy. Patient was diagnosed by radiology and blood cultures. In our case, option of conservative treatment with sensitive antibiotics (azithromycin and meropenem) was successful, though with increased hospital stay. There is no data on treatment duration and choice between two sensitive antibiotics or both in combination. In the present situation, sensitisation of clinicians to salmonella drug resistance, rational use of antibiotics and prompt public health awareness is the need of the day, especially in endemic areas. KEY WORDS: Extensively drug-resistant (XDR) typhoid,Splenic abscesses, Azithromycin, Meropenem.


Assuntos
Preparações Farmacêuticas , Esplenopatias , Febre Tifoide , Abscesso/tratamento farmacológico , Antibacterianos/uso terapêutico , Humanos , Masculino , Paquistão , Salmonella typhi , Esplenopatias/tratamento farmacológico , Febre Tifoide/diagnóstico , Febre Tifoide/tratamento farmacológico
19.
Pediatr Rheumatol Online J ; 19(1): 104, 2021 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-34193201

RESUMO

BACKGROUND: H syndrome (HS) is a rare autoinflammatory disease caused by a mutation in the solute carrier family 29, member 3 (SCL29A3) gene. It has a variable clinical presentation and little phenotype-genotype correlation. The pathognomonic sign of HS is cutaneous hyperpigmentation located mainly in the inner thighs and often accompanied by other systemic manifestations. Improvement after tocilizumab treatment has been reported in a few patients with HS. We report the first patient with HS who presented cardiogenic shock, multiorgan infiltration, and digital ischemia. CASE PRESENTATION: 8-year-old boy born to consanguineous parents of Moroccan origin who was admitted to the intensive care unit during the Coronavirus Disease-2019 (COVID-19) pandemic with tachypnoea, tachycardia, and oliguria. Echocardiography showed dilated cardiomyopathy and severe systolic dysfunction compatible with cardiogenic shock. Additionally, he presented with multiple organ dysfunction syndrome. SARS-CoV-2 polymerase chain reaction (PCR) and antibody detection by chromatographic immunoassay were negative. A previously ordered gene panel for pre-existing sensorineural hearing loss showed a pathological mutation in the SCL29A3 gene compatible with H syndrome. Computed tomography scan revealed extensive alveolar infiltrates in the lungs and multiple poor defined hypodense lesions in liver, spleen, and kidneys; adenopathy; and cardiomegaly with left ventricle subendocardial nodules. Invasive mechanical ventilation, broad antibiotic and antifungal coverage showed no significant response. Therefore, Tocilizumab as compassionate use together with pulsed intravenous methylprednisolone was initiated. Improvement was impressive leading to normalization of inflammation markers, liver and kidney function, and stabilising heart function. Two weeks later, he was discharged and has been clinically well since then on two weekly administration of Tocilizumab. CONCLUSIONS: We report the most severe disease course produced by HS described so far in the literature. Our patient's manifestations included uncommon, new complications such as acute heart failure with severe systolic dysfunction, multi-organ cell infiltrate, and digital ischemia. Most of the clinical symptoms of our patient could have been explained by SARS-CoV-2, demonstrating the importance of a detailed differential diagnosis to ensure optimal treatment. Although the mechanism of autoinflammation of HS remains uncertain, the good response of our patient to Tocilizumab makes a case for the important role of IL-6 in this syndrome and for considering Tocilizumab as a first-line treatment, at least in severely affected patients.


Assuntos
Cardiomiopatia Dilatada/fisiopatologia , Doenças Hereditárias Autoinflamatórias/fisiopatologia , Isquemia/fisiopatologia , Insuficiência de Múltiplos Órgãos/fisiopatologia , Choque Cardiogênico/fisiopatologia , Anticorpos Monoclonais Humanizados/uso terapêutico , COVID-19 , Cardiomiopatia Dilatada/diagnóstico por imagem , Cardiomiopatia Dilatada/terapia , Criança , Glucocorticoides/uso terapêutico , Doenças Hereditárias Autoinflamatórias/diagnóstico , Doenças Hereditárias Autoinflamatórias/genética , Doenças Hereditárias Autoinflamatórias/terapia , Humanos , Isquemia/terapia , Nefropatias/diagnóstico por imagem , Nefropatias/fisiopatologia , Nefropatias/terapia , Hepatopatias/diagnóstico por imagem , Hepatopatias/fisiopatologia , Hepatopatias/terapia , Pneumopatias/diagnóstico por imagem , Pneumopatias/fisiopatologia , Pneumopatias/terapia , Linfadenopatia/diagnóstico por imagem , Linfadenopatia/fisiopatologia , Linfadenopatia/terapia , Masculino , Metilprednisolona/uso terapêutico , Insuficiência de Múltiplos Órgãos/terapia , Proteínas de Transporte de Nucleosídeos/genética , Pulsoterapia , Respiração Artificial , SARS-CoV-2 , Choque Cardiogênico/terapia , Esplenopatias/diagnóstico por imagem , Esplenopatias/fisiopatologia , Esplenopatias/terapia , Dedos do Pé/irrigação sanguínea , Tomografia Computadorizada por Raios X , Resultado do Tratamento
20.
Am J Case Rep ; 22: e931195, 2021 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-34315846

RESUMO

BACKGROUND Extrahepatic and extrapulmonary localizations of cystic echinococcosis (CE) are rare and the incidence of splenic involvement is seen in 1.0% to 3.3% of all cases in the endemic areas of the Middle East and Asia. The diagnostic pathway consists of a detailed travel history, physical examination, abdominal ultrasonography, computed tomography, and serological tests. The efficacy of perioperative administration of albendazole (400 mg twice a day) has been proven; however, the appropriate surgical procedure for the treatment of giant, centrally located splenic hydatid cysts remains controversial. CASE REPORT We present the case of a 49-year-old woman referred to our hospital for a suspected isolated splenic hydatid cyst causing a compression of the right kidney, stomach, and the tail of the pancreas. She reported chronic pain in the left upper quadrant and a history of contact with animals. She underwent open splenectomy via a medial to lateral approach to minimize manipulation of the spleen. In addition, she received perioperative parasitostatic drug therapy with albendazole. The postoperative period was uneventful and the histologic analysis confirmed the diagnosis. CONCLUSIONS The spleen is a rare location for isolated CE, especially in non-endemic areas and must be considered in the differential diagnosis of splenic cystic masses. Surgical resection remains the most effective treatment that completely resolves this condition. A comparison of randomized trials is needed to compare the recurrence rates between splenectomy and spleen-preserving procedures in the treatment of giant splenic hydatid cysts.


Assuntos
Equinococose , Esplenopatias , Animais , Equinococose/diagnóstico , Equinococose/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Baço , Esplenectomia , Esplenopatias/cirurgia , Vísceras
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