RESUMO
La presencia de infiltrados pulmonares es un hallazgo frecuente que incluye un amplio diagnóstico diferencial basado en muchas ocasiones en la historia clínica. Entre ellas, la neumonía lipoidea exógena representa una entidad poco frecuente y es preciso un elevado índice de sospecha para alcanzar su diagnóstico y evitar su progresión. En estos casos, un contexto clínico adecuado y una TC con opacidades y áreas de baja densidad pueden ser altamente sugestivos de la enfermedad. Se presenta un caso de neumonía lipoidea exógena secundaria a la utilización continuada de sustancias oleosas intranasal, que debido a los antecedentes del paciente y a las posibilidades diagnósticas tras los hallazgos de la TC, precisó confirmación histológica.
The presence of pulmonary infiltrates is a frequent finding that includes a large differential diagnosis based on many occasions in the clinical history. Among them, exogenous lipoid pneumonia represents a rare entity and a high index of suspicion is necessary to reach its diagnosis and prevent its progression. In these cases, an adequate clinical context and a CT with opacities and low density areas are highly suggestive of the disease. We present a case of exogenous lipoid pneumonia secondary to the continued use of oily substances at the nasal level, due to his antecedents and the diagnostic possibilities after the CT findings, histological confirmation was required.
Assuntos
Humanos , Masculino , Idoso , Vaselina/efeitos adversos , Pneumonia Lipoide/diagnóstico por imagem , Pneumonia Lipoide/etiologia , Pneumonia Lipoide/patologia , Biópsia , Administração Intranasal , Tomografia Computadorizada por Raios X , Diagnóstico DiferencialRESUMO
La neumonía lipoidea es una patología pulmonar poco conocida que resulta de la acumulación de lípidos de origen endógenos o exógenos a nivel alveolar pulmonar. Suele ser subdiagnosticada dada que la presentación clínica es inespecífica, por lo que suele confundirse con otras patologías broncopulmonares, muchas veces no llegándose al diagnóstico preciso de esta. Dentro de los datos anamnesticos el antecedente, ya sea de uso reciente o de larga data, de la ingesta y/o inhalación accidental o voluntaria de alguna sustancia que contenga algún componente lipídico en su base es primordial. Pacientes de edades extremas suelen ser los más afectados y en quienes debemos tener la sospecha diagnóstica. Su diagnóstico es complejo requiriendo historia clínica, imágenes que apoyen un compromiso pulmonar (de preferencia tomografía computada) e idealmente la detección intraalveolar de lípidos y macrófagos cargados de éstos en el lavado broncopulmonar. Actualmente, no existe consenso sobre el manejo específico de esta patología. Lo importante es identificar la causa y descontinuar su uso. En neumonía lipoidea de causa exógena se recomienda manejo de soporte según sea la presentación clínica del paciente.
Lipoid pneumonia (LN) is an unknown lung disease due to lipid accumulation, of endogenous or exogenous origin, at the pulmonary alveolar level. Often it is underdiagnosed because of its nonespecific presentation whose differential diagnosis are other bronchopulmonary diseases. Anamnestic data, either recent or long-standing use of the intake and / or accidental or deliberate inhalationof any substance containing a lipid component as its base is relevant information. Extreme age groups are the most affected, and in whom wemust suspect LN diagnosis. The diagnosis of LN is complex and requires a complete medical history, images that support lung involvement (preferably computed tomography), and ideally intraalveolar detection of lipid-ladenmacrophages in the bronchoalveolar lavage. Currently, there is no consensus on the specific management of this disease. It is important to identify the cause and discontinue its exposure. Whatever the varity of the clinical presentation, support magement is recommended to treat LN.
Assuntos
Humanos , Feminino , Lactente , Pneumonia Lipoide/induzido quimicamente , Pneumonia Lipoide/terapia , Vaselina/efeitos adversos , Pneumonia Lipoide/diagnósticoRESUMO
A petrolatum and zinc oxide-based ointment containing 0.25% miconazole nitrate is reported to be effective and well tolerated in the treatment of diaper dermatitis complicated by cutaneous candidiasis (DDCC). This prospective, multicenter, open-label, long-term, phase IV study investigated the potential resistance of Candida spp. to repeated topical use of 0.25% miconazole nitrate in infants age 15 months and younger with moderate to severe DDCC. For initial and recurring episodes of DDCC over the 2-year study period, subjects were treated with a 7-day course of 0.25% miconazole nitrate ointment (active components: miconazole nitrate 0.25%, zinc oxide 15%, and white petrolatum 81.35%) with a 7-day follow-up. Clinical and mycologic evaluations were conducted before treatment (day 0) and 7 days after treatment (day 14). Potential resistance to miconazole was defined using an arbitrary breakpoint of minimum inhibitory concentration of 2 µg/mL. There was no evidence of resistance to miconazole in Candida spp. after single or repeated treatment courses of 0.25% miconazole nitrate ointment. For the initial episode of DDCC, 83 of 168 subjects (49.4%) achieved a clinical cure, 77 (45.8%) achieved a mycologic cure, and 49 (29.2%) achieved an overall cure (clinical and mycologic). The overall cure rate for recurrent episodes of DDCC was similar to or numerically greater than rates observed for the initial episode. Treatment of DDCC with 0.25% miconazole nitrate ointment was effective and generally well tolerated. No evidence of the development of resistance to miconazole in Candida spp. was observed.
Assuntos
Antifúngicos/administração & dosagem , Candidíase/tratamento farmacológico , Dermatite das Fraldas/tratamento farmacológico , Farmacorresistência Fúngica , Miconazol/administração & dosagem , Antifúngicos/efeitos adversos , Dermatite/tratamento farmacológico , Fármacos Dermatológicos/administração & dosagem , Fármacos Dermatológicos/efeitos adversos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Miconazol/efeitos adversos , Testes de Sensibilidade Microbiana , Pomadas/administração & dosagem , Pomadas/efeitos adversos , Vaselina/administração & dosagem , Vaselina/efeitos adversos , Estudos Prospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Óxido de Zinco/administração & dosagem , Óxido de Zinco/efeitos adversosAssuntos
Alérgenos/efeitos adversos , Dermatite Alérgica de Contato/diagnóstico , Vaselina/efeitos adversos , Idoso , Braço , Dermatite Alérgica de Contato/etiologia , Dermatite Alérgica de Contato/patologia , Diagnóstico Diferencial , Feminino , Humanos , Perna (Membro) , Testes do Emplastro , TóraxRESUMO
Os autores relatam um caso de granuloma da conjuntiva que ocorreu em consequência de uma complicaçäo de uma cirurgia dos seios para-nasais. Fraturas bilaterais dos ossos etmoidais possibilitaram a infiltraçäo subconjuntival da vaselina comumente utilizada ao final dessas cirurgias