RESUMEN
We present a case of an 87-year-old nonsmoker female who recovered after infection by SARS-CoV-2 and was readmitted two weeks laterdue to respiratory sepsis. Radiological imaging showed a significant radiological worsening with extensive areas of bronchopneumonia andground-glass opacities suggestive of organizing pneumonia. Empirical treatment with meropenem 1g/8h was started; however, clinical worseningpersisted with tachypnea and desaturation requiring heated high-flow nasal cannula oxygen therapy, with poor response. Methicillin-resistantStaphylococcus aureus was isolated both in nasal screening swab and sputum, and RNA polymerase chain reaction in induced sputum waspositive for P. jirovecii. Serum (1-3)-beta-D-glucan was normal, and blood cultures were sterile. Antibiotic therapy was adjusted with intravenouslinezolid 600mg/12h and trimethoprim-sulfamethoxazole 320/1600mg/6h, plus methylprednisolone 40mg/day. Unfortunately, the patient hadno response to optimized treatment and finally died. Clinicians should be aware of opportunistic and resistant microorganisms superinfections inrelation to SARS-CoV-2 infection, even more, when corticosteroids are widely used. (AU)
Asunto(s)
Humanos , Femenino , Anciano de 80 o más Años , Pneumocystis carinii , Staphylococcus aureus Resistente a Meticilina , Pandemias , Infecciones por Coronavirus/epidemiología , Coronavirus Relacionado al Síndrome Respiratorio Agudo Severo , CorticoesteroidesRESUMEN
Behçet's Disease (BD) is a rare, chronic and recurrent inflammatory multisystemic condition of unknown origin that can affect any tissue. The vascular system is involved in 5-40% of cases of BD, including venous and arterial beds and it has a relapsing course. Budd-Chiari syndrome (BCS) is a rare complication of BD with a frequency of < 5% among patients with vascular involvement and is more frequent in men (89.5%). Two clinical presentation groups of BCS related to BD have been described: the "symptomatic" form and the "silent" form. We present a case of BD in a young woman presented as symptomatic severe BCS with rapid progression of coagulopathy reaching a spontaneous INR of 1.74 and increased ascites by ultrasound control. BD was confirmed through clinical history. The patient was treated with a high-dose pulse of corticosteroids and cyclophosphamide with a strikingly favorable response in the first forty-eight hours. Although several studies have demonstrated a survival improvement with the use of transjugular intrahepatic portosystemic shunt in patients with severe BCS, it was discarded due to the lack of evidence of this procedure in patients with BD and the fact that it could trigger a vascular pathergy phenomenon. Vascular BD should be suspected in recurrent venous and/or arterial thrombosis since it is associated with high morbidity and mortality. Immunosuppressive treatment is critical for the management of vascular involvement in BD. However, the role of anticoagulation is debatable. We suggest an algorithm for the management of BCS associated with BD.