RESUMO
Cryptococcosis is an opportunistic infection caused by the Basidiomycota Cryptococcus neoformans (Cryptococcus gattii), which affects immunosuppressed patients and less frequently immunocompetent patients. Solid-organ transplant recipients are a particularly high-risk group, depending on the net state of immunosuppression. In these patients, the infection usually appears after the first year after transplant, although it may occur earlier in liver transplant recipients. In most cases, the infection is secondary to the reactivation of a latent infection, although it may be due to an unidentified pretransplant infection by primary infection. Less frequently, it may be transmitted by the graft. The lung and central nervous system are most frequently involved. Extrapulmonary involvement is seen in 75% of the cases, and disseminated disease occurs in 61%, with mortality ranging from 17% to 50% when the central nervous system is involved. Here, we report a case of disseminated cryptococcosis (lymphadenitis, meningitis, pulmonary nodules, and possibly sacroiliitis) in a patient after liver transplant, with good clinical and microbiological outcomes and without relapse.
Assuntos
Criptococose/microbiologia , Transplante de Fígado/efeitos adversos , Pneumopatias Fúngicas/microbiologia , Linfadenite/microbiologia , Infecções Oportunistas/microbiologia , Sacroileíte/microbiologia , Adulto , Antifúngicos/uso terapêutico , Criptococose/diagnóstico , Criptococose/tratamento farmacológico , Criptococose/imunologia , Feminino , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/imunologia , Linfadenite/diagnóstico , Linfadenite/tratamento farmacológico , Linfadenite/imunologia , Meningite Criptocócica/tratamento farmacológico , Meningite Criptocócica/imunologia , Meningite Criptocócica/microbiologia , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/imunologia , Sacroileíte/diagnóstico , Sacroileíte/tratamento farmacológico , Sacroileíte/imunologia , Resultado do TratamentoRESUMO
Resumen La toxoplasmosis posterior al trasplante renal es una condición infrecuente, pero asociada con alta morbilidad y mortalidad. Generalmente ocurre en los primeros tres meses cuando la inmunosupresión es mayor, siendo más común la presentación con encefalitis y neumonitis. El compromiso del tracto gastrointestinal es inusual y con síntomas inespecíficos. Su diagnóstico es un reto pues no siempre existe seroconversión en estadios tempranos de la infección o no hay evidencia histológica del parásito; es aquí donde la biología molecular y la historia clínica pueden resultar útiles para el diagnóstico oportuno que favorezca un buen desenlace. Describimos el caso de un paciente con síntomas generales, náuseas y emesis en el periodo postrasplante renal temprano atribuidos primero a reactivación de citomegalovirus con diagnóstico posterior de gastritis por Toxoplasma gondii. Recibió tratamiento con trimetoprim sulfametoxazol por seis semanas con resolución completa de los síntomas. (Acta Med Colomb 2016; 40: 266-268).
Abstract Toxoplasmosis following renal transplantation is an uncommon condition, but is associated with high morbidity and mortality. It usually occurs in the first three months when immunosuppression is greater, being more common the presentation with encephalitis and pneumonitis. The involvement of the gastrointestinal tract is unusual and with nonspecific symptoms. Its diagnosis is a challenge because there is not always seroconversion in the early stages of infection or there is no histological evidence of the parasite; it is here that molecular biology and clinical history can be useful for a timely diagnosis that may favor a good outcome. The case of a patient with general symptoms, nausea and emesis in the early renal transplant period attributed initially to reactivation of cytomegalovirus with subsequent diagnosis of gastritis by Toxoplasma gondii, is described. He received treatment with trimethoprim sulfamethoxazole for six weeks with complete resolution of symptoms. (Acta Med Colomb 2016; 40: 266-268).
Assuntos
Humanos , Masculino , Adulto , Transplante de Rim , Parasitos , Pacientes , Toxoplasmose , Citomegalovirus , Trato Gastrointestinal , GastriteRESUMO
We describe the case of a young HIV-positive man who presented to the emergency room in hypovolemic shock. During subsequent evaluation, we documented a huge aortic aneurysm consistent with tertiary syphilis. The final autopsy demonstrated the extent of cardiovascular compromise caused by this aneurysm.