Search

Resumen La neumonitis por Pneumocystis jirovecii es una infección infrecuente en pacientes con trasplante de riñón, que se presenta de forma aguda y puede progresar rápidamente hasta la insuficiencia respiratoria y la muerte. El período de mayor riesgo es el de los primeros seis meses después del trasplante, y se asocia con las altas dosis de medicamentos inmunosupresores que reciben los pacientes. La condición también puede presentarse de manera tardía, asociada con la suspensión de la profilaxis con trimetoprim-sulfametoxazol. Se reportan dos casos de pacientes con trasplante renal que presentaron insuficiencia respiratoria hipoxémica grave por P. jirovecii pasados seis años del trasplante, y que fueron tratados con trimetoprim-sulfametoxazol y esteroides. Uno de los pacientes murió y el otro se recuperó sin que hubiera efectos en la función del injerto renal. Abstract Pneumonia caused by Pneumocystis jirovecii is an uncommon infection in kidney transplant patients that can have an acute and rapid progression to respiratory failure and death. The period of greatest risk occurs in the first six months after the transplant, and it relates to the high doses of immunosuppression drugs required by patients. However, it may occur late, associated with the suspension of prophylaxis with trimethoprim-sulfamethoxazole. We present two cases of renal transplant patients who had severe hypoxemic respiratory failure due to P. jirovecii six years after transplantation. In addition to steroids, they received treatment with trimethoprim-sulfamethoxazole. One patient died, while the other had clinical recovery, with preservation of the renal graft function.

Resumen La insuficiencia adrenal es una endocrinopatía cuya principal causa se debe a la deficiencia en la producción de hormona adrenocorticotrópica, generalmente explicada por factores iatrogénicos y en menor número de casos al defecto primario de la glándula adrenal (enfermedad de Adisson). Su diagnóstico y la búsqueda de una etiología específica es muy importante, dado las implicaciones a largo plazo que conlleva por necesidad de suplencia hormonal, manejo en condiciones críticas, riesgo de muerte y compromiso de la actividad laboral. Presentamos el caso de una mujer quien consultó por ganancia excesiva de peso, signos de hipercortisolismo e hipertensión, se documentó una probable fuente exógena de esteroides, encontrando un cortisol sérico suprimido. Dos años antes estaba recibiendo artrivid PLUS, un producto natural para el manejo del dolor articular. Después de suspender ésta medicación presentó síntomas compatibles con insuficiencia adrenal, requiriendo el reinicio de prednisolona, con mejoría clínica y logrando su desmonte gradual posterior. (Acta Med Colomb 2017; 42: 243-246). Abstract Adrenal insufficiency is an endocrinopathy whose main cause is due to the deficiency in the production of adrenocorticotropic hormone, usually explained by iatrogenic factors and in a smaller number of cases to the primary defect of the adrenal gland (Adisson's disease). Diagnosis and the search for a specific etiology is very important, given the long-term implications involved by the need of hormone replacement, management in critical conditions, risk of death and the compromise of work activity. The case of a woman who consulted for excessive weight gain, signs of hypercortisolism and hypertension, is presented. A probable exogenous source of steroids was documented, finding a suppressed serum cortisol. Two years before she was receiving artrivid PLUS, a natural product for joint pain management. After stopping this medication, she presented symptoms compatible with adrenal insufficiency, requiring the resumption of prednisolone, with clinical improvement and achieving its subsequent gradual removal. (Acta Med Colomb 2017; 42: 243-246).

Resumo A gencitabina é um fármaco utilizado no tratamento de vários tipos de neoplasias malignas. Há poucas descrições de associação entre a droga e a síndrome hemolítico-urêmica (SHU), apesar de os pacientes em questão terem ido a óbito em pelo menos 50% dos casos. O presente artigo relata o caso de uma paciente com 25 anos de idade em remissão diagnosticada com colangiocarcinoma que apresentou anemia hemolítica microangiopática acompanhada de insuficiência renal aguda anúrica após cinco ciclos de quimioterapia com gencitabina; as manifestações eram condizentes com SHU causada pelos efeitos colaterais do medicamento. A administração de gencitabina foi interrompida, e a paciente foi tratada com hemodiálise, transfusões de sangue, trocas de plasma, corticosteroides, doxiciclina e rituximabe. Foi atingido um desfecho favorável; mais especificamente, a hemólise foi controlada e a função renal foi plenamente restabelecida. Abstract Gemcitabine is a medication used to treat various types of malignant neoplasms. Its association with hemolytic uremic syndrome (HUS) has been described in few cases, although these cases have resulted in mortality rates of at least 50%. We report on the case of a 25-year-old patient with cholangiocarcinoma in remission who developed microangiopathic hemolytic anemia with acute anuric renal failure after receiving 5 cycles of gemcitabine chemotherapy; this condition was consistent with HUS caused by the side effects of this drug. The administration of gemcitabine was stopped, and hemodialysis, blood transfusions, plasma exchanges, steroids, doxycycline, and rituximab were used to treat the patient. A favorable outcome was achieved; in particular, hemolysis was controlled, and renal function was completely recovered.

La enfermedad por citomegalovirus es una entidad con importante morbilidad y mortalidad en pacientes trasplantados de órgano sólido, que se puede presentar como primoinfección o reactivación y con manifestaciones clínicas muy variables. A continuación se reporta el caso de un paciente con dolor epigástrico intenso postural como síntoma inicial de primoinfección por citomegalovirus Cytomegalovirus is an entity which causes significant morbidity and mortality among solid organ transplant patients. It may occur as a primary infection or be reactivated. In either case clinical manifestations vary. We report the case of a patient with severe epigastric pain related to posture which was the primary symptom of a cytomegalovirus infection

La meningitis recurrente no es una entidad común pero tiene el potencial de generar secuelas importantes a mediano y largo plazo. Su cuadro clínico depende del agente causal aunque en la mayoría de los pacientes se conserva al menos uno de los síntomas clásicos de la meningitis aguda (cefalea intensa, fiebre y rigidez de nuca). Debido a su variabilidad clínica se requieren un alto nivel de sospecha y usar bien las pruebas de laboratorio para llegar oportunamente al diagnóstico. El presente artículo contiene una revisión de la literatura sobre la epidemiología, la etiología, el cuadro clínico, el diagnóstico y el tratamiento de esta enfermedad. Recurrent meningitis is an uncommon condition with the capability of causing important midand long-term sequelae. Its clinical presentation depends on the etiologic agent, although most patients exhibit at least one of the classical symptoms of acute meningitis (intense headache, fever and neck stiffness). Due to the clinical variability of the disease, a high level of suspicion and an adequate use of laboratory tests are required in order to establish a timely diagnosis. This article contains a literature review regarding epidemiology, etiology, clinical presentation, diagnosis and management of recurrent meningitis.