RESUMEN
Sporotrichosis is an infection caused by the fungus of the Sporothrix schenckii complex and can be particularly harmful in immunocompromised patients. We report the case of a 26-year-old male patient with a previous history of pulmonary infection who underwent a liver transplant for Budd-Chiari syndrome. After the procedure, he presented with persistent fever and leukocytosis. On the 13th post-operative day, he was diagnosed with thrombosis of the hepatic artery and underwent a second liver transplant 15 days after the first procedure. After the retransplant, he presented daily episodes of fever, even after the use of several antimicrobial, antiviral, and antifungal agents. A number of negative cultures from different sites were obtained. After an acute episode of mental confusion, the growth of S schenckii was observed in cultures from cerebrospinal fluid and ascites obtained from a diagnostic paracentesis. Treatment with amphotericin B was started but the patient died on the fourth day of antifungal treatment, from a massive gastrointestinal hemorrhage. We found no previous report in the literature of spontaneous dissemination of S schenckii to the abdominal cavity causing peritonitis.
Asunto(s)
Huésped Inmunocomprometido , Trasplante de Hígado , Esporotricosis/inmunología , Adulto , Antifúngicos/uso terapéutico , Síndrome de Budd-Chiari/cirugía , Resultado Fatal , Humanos , Trasplante de Hígado/efectos adversos , Masculino , Peritonitis/etiologíaRESUMEN
BACKGROUND: The Frontal Assessment Battery (FAB) is a short tool for the assessment of executive functions consisting of six subtests that explore different abilities related to the frontal lobes. Several studies have indicated that executive dysfunction is the main neuropsychological feature in Parkinson's disease (PD). GOALS: To evaluate the clinical usefulness of the FAB in identifying executive dysfunction in PD; to determine if FAB scores in PD are correlated with formal measures of executive functions; and to provide normative data for the Portuguese version of the FAB. METHODS: The study involved 122 healthy participants and 50 idiopathic PD patients. We compared FAB scores in normal controls and in PD patients matched for age, education and Mini-Mental State Examination (MMSE) score. In PD patients, FAB results were compared to the performance on tests of executive functioning. RESULTS: In the healthy subjects, FAB scores varied as a function of age, education and MMSE. In PD, FAB scores were significantly decreased compared to normal controls, and correlated with measures of executive functions such as phonemic and semantic verbal fluency tests, Wisconsin Card Sorting Test and Trail Making Test Part A and Part B. CONCLUSION: The FAB is a useful tool for the screening of executive dysfunction in PD, showing good discriminant and concurrent validities. Normative data provided for the Portuguese version of this test improve the accuracy and confidence in the clinical use of the FAB.
Asunto(s)
Procesos Mentales , Pruebas Neuropsicológicas , Enfermedad de Parkinson/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Cognición , Humanos , Persona de Mediana Edad , Enfermedad de Parkinson/psicología , Portugal , Adulto JovenRESUMEN
Group B streptococcus (Streptococcus agalactiae) is a common etiology of bacteremia among adults. Pyomyoma is a rare infectious complication of uterine leiomyomas. We report the case of a diabetic postmenopausal woman with a giant pyomyoma simulating an ovarian cancer. It was associated with S. agalactiae endocarditis and deep venous thrombosis of the right external iliac and femoral veins. Treated initially with intravenous penicillin, amikacin, and anticoagulation, the patient later had abdominal hysterectomy with an uneventful recovery. We also review the cases of pyomyoma reported since 1945. Of 14 cases described (including ours), mortality was 21%. Endocarditis was never reported in association with pyomyoma. The presence of bacteremia and a leiomyoma should raise suspicion for this disease.
Asunto(s)
Absceso/diagnóstico , Endocarditis Bacteriana/diagnóstico , Leiomioma/diagnóstico , Neoplasias Ováricas/diagnóstico , Infecciones Estreptocócicas/diagnóstico , Streptococcus agalactiae , Absceso/microbiología , Absceso/cirugía , Diagnóstico Diferencial , Endocarditis Bacteriana/complicaciones , Femenino , Humanos , Leiomioma/microbiología , Leiomioma/cirugía , Persona de Mediana Edad , Factores de Riesgo , Infecciones Estreptocócicas/complicaciones , Tomografía Computarizada por Rayos XRESUMEN
Primary biliary cirrhosis (PBC) is a cholestatic liver disease, which is characterized by a chronic inflammatory destruction of intrahepatic bile ducts. It is a rare disorder whose precise etiology is still to be elucidated. Even though the liver is the principal target of PBC, other organ systems also might be affected. Muscular involvement has rarely been described in this disease, and in the majority of cases, muscular weakness has been interpreted as polymyositis. We report the case of a 48-year-old woman suffering from classic PBC, in association with a myopathy whose histological features are distinct from the cases reported before. We also performed a MEDLINE research for PBC and concomitant muscular diseases.
Asunto(s)
Cirrosis Hepática Biliar/complicaciones , Polimiositis/etiología , Femenino , Humanos , Cirrosis Hepática Biliar/diagnóstico , Cirrosis Hepática Biliar/patología , Persona de Mediana Edad , Polimiositis/patologíaRESUMEN
Legionella sp has been emerging over the last decade as an important cause of pneumonia both hospital and community-acquired. Following an outbreak in a Renal-Transplant Unit stocked serum was tested for antibodies against Legionella pneumophila serogroup 1, and 5 cases of Legionnaires' Disease were reviewed. Two of the cases were nosocomial and three cases were community-acquired. Clinical and laboratorial aspects were similar to those expected for other causes of pneumonia, however jaundice was encountered in two cases. This study suggests that the real incidence of pneumonia caused by Legionella sp is being underestimated and the authors emphasize the importance of considering Legionnaires' Disease when empirically treating community-acquired pneumonia.