Objective: This study aimed to report the case of a female patient with chronic myeloid leukemia affected by cryptococcal meningitis. Case report: ML, white, 48 years old, female sex, previously diagnosed with chronic myeloid leukemia that has been refractive to the use of imatinib and who has recently begun using nilotinib, was admitted complaining of sudden and disabling migraine in the last 1 month associated with asthenia, adinamia, anorexia, disinterest for daily activities, dizziness, nausea, and vomiting. She evolved with ataxia, and started to stroll with help and showed decrease of muscular strength in her upper limbs. She also presented episodes of decrease of consciousness, with look fixation, no respond to sound stimulation, and short-term hearing loss. The cerebrospinal fluid showed presence of Cryptococcus sp. and, therefore, we began treatment with intravenous liposomal amphotericin B in the dose of 3 mg/kg/day, for 6 weeks. A new cerebrospinal fluid analysis, at the end of treatment, also showed rare structures that are compatible with Cryptococcus sp. As sequelae, she continued with hearing loss in her right ear and enhancement in her right auditory canal, seen in the magnetic resonance imaging. After stabilization and clinical improvement, she was discharged. After 3 weeks, she was hospitalized again with degeneration of the condition, and died due to intracranial hypertension secondary to cryptococcal infection. Final Considerations: This report reinforces the need of reflecting on fungi pathologies, especially in immunosuppressant patients, as well as the importance of early diagnosing and making a fast intervention, with the aims of providing quality of life and comfort to the patient and of minimizing neurological sequelae to the patient.
Objetivo: Presentar el caso clínico de un paciente con pseudoaneurisma fibroso intervalvular mitroaórtico (PFIMA) con insuficiencia mitral aguda, así como el tratamiento clínico, los métodos diagnósticos y el tratamiento definitivo empleado. Detalles del caso: Este es un estudio de caso aprobado por el Comité de Ética en Investigación (CEP) con la opinión 2.696.862. Una paciente de 18 años, tras presentar un cuadro clínico de insuficiencia cardiaca aguda, fue diagnosticada de PFIMA mediante estudio ecográfico con ecocardiografía transtorácica (ETT) y complementado con ecocardiografía transesofágica. Así, fue necesario cambiar la válvula mitral por una bioprótesis mitral que se produjo en la misma hospitalización sin complicaciones, siendo dado de alta al poco tiempo de la ETT de control. Consideraciones finales: Es una entidad clínica rara, de etiología derivada de cirugía cardíaca o endocarditis, en la mayoría de los casos, o se consideran congénitas por no tener una causa definida. Las complicaciones son la principal preocupación, ya que puede complicarse con diversas entidades y con ello, puede ocurrir la muerte del paciente, sobre todo si no se reconoce precozmente y se trata adecuadamente.
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