RESUMEN

Neonatal cholestasis is the manifestation of many different diseases. Its early etiological diagnosis is crucial, since treatment before 60 days of life changes the prognosis in children with biliary atresia. Congenital toxoplasmosis can be asymptomatic in the newborn, or have mainly neurological, ophthalmological or gastrointestinal symptoms (hepatomegaly, cholestatic jaundice). Neonatal cholestasis secondary to congenital toxoplasmosis is not a situation frequently reported. We report the case of an infant with neonatal cholestasis due to a congenital toxoplasmosis, in order to discuss the difficulties in establishing the etiological diagnostic and to review the indications of invasive studies such as liver biopsy in these situations.

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RESUMEN

La colestasis neonatal es la forma de presentación de diversas enfermedades; es necesario un diagnóstico etiológico temprano, ya que el tratamiento antes de los 60 días de vida cambia el pronóstico en los niños que presentan atresia biliar. La toxoplasmosis congénita puede ser asintomática en el recién nacido, o presentar fundamentalmente alteraciones neurológicas, oftalmológicas y hepáticas (hepatomegalia, ictericia no colestásica). La colestasis neonatal secundaria a toxoplasmosis congénita no es una situación informada con frecuencia. Se presenta el caso de un lactante con colestasis neonatal cuya etiología responde a una toxoplasmosis congénita, con el objetivo de discutir las difcultades en establecer el diagnóstico etiológico y las indicaciones de realizar estudios invasivos, como la biopsia hepática, en estas situaciones.(AU)

Neonatal cholestasis is the manifestation of many different diseases. Its early etiological diagnosis is crucial, since treatment before 60 days of life changes the prognosis in children with biliary atresia. Congenital toxoplasmosis can be asymptomatic in the newborn, or have mainly neurological, ophthalmological or gastrointestinal symptoms (hepatomegaly, cholestatic jaundice). Neonatal cholestasis secondary to congenital toxoplasmosis is not a situation frequently reported. We report the case of an infant with neonatal cholestasis due to a congenital toxoplasmosis, in order to discuss the diffculties in establishing the etiological diagnostic and to review the indications of invasive studies such as liver biopsy in these situations.(AU)

Asunto(s)

RESUMEN

La colestasis neonatal es la forma de presentación de diversas enfermedades; es necesario un diagnóstico etiológico temprano, ya que el tratamiento antes de los 60 días de vida cambia el pronóstico en los niños que presentan atresia biliar. La toxoplasmosis congénita puede ser asintomática en el recién nacido, o presentar fundamentalmente alteraciones neurológicas, oftalmológicas y hepáticas (hepatomegalia, ictericia no colestásica). La colestasis neonatal secundaria a toxoplasmosis congénita no es una situación informada con frecuencia. Se presenta el caso de un lactante con colestasis neonatal cuya etiología responde a una toxoplasmosis congénita, con el objetivo de discutir las difcultades en establecer el diagnóstico etiológico y las indicaciones de realizar estudios invasivos, como la biopsia hepática, en estas situaciones.

Neonatal cholestasis is the manifestation of many different diseases. Its early etiological diagnosis is crucial, since treatment before 60 days of life changes the prognosis in children with biliary atresia. Congenital toxoplasmosis can be asymptomatic in the newborn, or have mainly neurological, ophthalmological or gastrointestinal symptoms (hepatomegaly, cholestatic jaundice). Neonatal cholestasis secondary to congenital toxoplasmosis is not a situation frequently reported. We report the case of an infant with neonatal cholestasis due to a congenital toxoplasmosis, in order to discuss the diffculties in establishing the etiological diagnostic and to review the indications of invasive studies such as liver biopsy in these situations.

Asunto(s)

RESUMEN

Neonatal cholestasis is the manifestation of many different diseases. Its early etiological diagnosis is crucial, since treatment before 60 days of life changes the prognosis in children with biliary atresia. Congenital toxoplasmosis can be asymptomatic in the newborn, or have mainly neurological, ophthalmological or gastrointestinal symptoms (hepatomegaly, cholestatic jaundice). Neonatal cholestasis secondary to congenital toxoplasmosis is not a situation frequently reported. We report the case of an infant with neonatal cholestasis due to a congenital toxoplasmosis, in order to discuss the difficulties in establishing the etiological diagnostic and to review the indications of invasive studies such as liver biopsy in these situations.

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Chronic weight loss in marmosets is often associated with wasting marmoset syndrome (WMS), an important disease that occurs in callitrichid colonies around the world. Even though its etiology is very difficult to determine, particular variables, such as weight loss, diarrhea and alopecia, associated or not with infestation in the pancreatic ducts with Trichospirura leptossoma (Nematoda: Thelazioidea), seem to be linked with the syndrome. This study investigated the histopathology of the lungs, duodenum, liver, gallbladder, extrahepatic bile ducts and pancreatic ducts of six common marmosets (Callithrix jacchus) suffering from severe non-diarrheic weight loss. Three individuals died naturally and the other three were euthanized. Microscopic findings showed the presence of adult flukes (Platynosomum) in the liver. These flukes, which provoke common infection in cats, were also observed inside the gallbladder as well as in the intra and extrahepatic bile ducts in common marmosets. Portal fibrosis was observed in two animals, which developed chronic fibrosing hepatopathy (biliary pattern, grade 3). The disease progresses without diarrhea and without pancreatic lesions or infestation. With the progression, the animals presented with ascending cholangitis, cholestasis and portal fibrosis, sometimes culminating in secondary biliary cirrhosis. Therefore, this infirmity, associated with chronic weight loss in common marmosets, could be another etiological factor linked with WMS.

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Diarrhea caused by Cryptosporidium sp is frequent in patients with AIDS, but involvement of other organs of the digestive tract is uncommon. We report a case of Cryptosporidium-associated obstruction of the biliary tract mimicking cancer of the head of the pancreas in a 43-year-old woman with AIDS.

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La Fasciola hepática es un tremátodo que infesta accidentalmente al ser humano cuando éste ingiere plantas acuáticas y aguas contaminadas por el parásito. A pesar de que su localización natural en el hombre son las vías biliares, son poco frecuentes las manifestaciones clínicas de colangitis y pancreatitis agudas. En algunos países, el ganado ovino y bovino está infestado entre el 10 y el 90% por lo que se han producido brotes epidémicos de fascioliasis controlados adecuadamente. En nuestro país se han informado 16 casos de fascioliasis coledociana desde 1955 en que se comunicó el primer caso. La rareza de la entidad y la ausencia de manifestaciones clínicas características de la parasitosis hacen que el diagnóstico preoperatorio sea ocasional. En este artículo se informan tres casos que clínicamente experimentaron manifestaciones de obstrucción biliar y uno de ellos además, un cuadro grave de abscesos hepáticos múltiples. Se hace referencia a los métodos diagnósticos de esta parasitosis así como de su tratamiento médico y quirúrgico

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