INTRODUCCIÓN: Las infecciones virales como la emergente por el COVID-19 producen estados de hipercoagulabilidad y proinflamatorios, que pueden desencadenar tromboembolismo pulmonar y representan un reto diagnóstico y terapéutico para el personal de salud. Debido a que es una enfermedad nueva, aún no se conocen la totalidad de sus síntomas. Se presenta el caso clínico de un paciente con disnea aguda y hemoptisis secundario a un tromboembolismo pulmonar segmentario, en contexto de infección confirmada por COVID-19. PRESENTACIÓN DE CASO: paciente masculino de 37 años con antecedentes de hipertensión arterial, sin factores de riesgo protrombóticos, con cuadro agudo de dolor torácico, disnea y hemoptisis franca. Paraclínicos con dímero D y ferritina elevada, prueba de PCR para SARS CoV-2 positiva, angiotomografía de tórax con evidencia de tromboembolismo pulmonar segmentario y patrón de vidrio esmerilado en segmento basal anterior del lóbulo inferior. Cumplió manejo antibiótico y anticoagulante con enoxaparina a dosis plena y posteriomente, con anticoagulante oral directo y rivaroxaban de manera ambulatoria. CONCLUSIÓN: La infección por el nuevo coronavirus puede desencadenar eventos trombóticos como embolismo pulmonar, que se convierten en un reto diagnóstico y terapéutico para los clínicos, con presentación que va desde síntomas generales hasta más específicos, entre los que destaca la hemoptisis, razón por la cual, el presente artículo tiene como objetivo mostrar la importancia de una evaluación secuencial al momento de realizar el diagnóstico clínico. De igual forma, se expone la necesidad de no descuidar las manifestaciones atípicas relacionadas con estados de hipercoagulabilidad, ya que pueden sugerir patologías que ponen en riesgo la vida del paciente.
The pandemic caused by the SARS-CoV-2 or COVID-19 infection has had an unimaginable impact on health systems worldwide. Cardiorespiratory arrest remains a potentially reversible medical emergency that requires the performance of a set of maneuvers designed to replace and restore spontaneous breathing and circulation. Suspending cardiopulmonary resuscitation (CPR) usually corresponds to an ethical-clinical dilemma that the health professional in charge must assume. The “Lazarus phenomenon” is an unusual syndrome with a difficult pathophysiological explanation, defined as the spontaneous return of circulation in the absence of any life support technique or after the cessation of failed CPR maneuvers. We present the case of a 79-year-old patient hospitalized in the intensive care unit for septic shock of pulmonary origin associated with COVID-19 infection who presented cardiorespiratory arrest that required unsuccessful resuscitation maneuvers for 40 minutes, declared deceased. After 20 minutes of death, he presented a return to spontaneous circulation. The pathophysiological changes of the Lazarus phenomenon remind us of the limitations we have in determining when to end cardiopulmonary resuscitation and that its interruption must be approached with more caution, especially in the context of the COVID-19 pandemic.
Background Although uncommon, there is increasing interest and public health concerns of the pathogen Prototheca spp, a ubiquitous achlorophilic microalgae that can affect both humans and animals. High mortality rates have been reported in immunocompromised patients with disseminated infection, but no data is available in the immunocompetent population. Case Presentation We present the case of a 59-year-old man from rural area of Colombia who was admitted to the intensive care unit due to decompensated heart failure that was difficult to medically manage, with development of septic shock and isolation of Prototheca wickerhamii from blood culture. Fluconazole and Amphotericin B were given with successful outcome. Conclusions To date, protothecosis and its virulence factors and pathogenesis remain to be fully understood, in our case the isolation of this microalga and its implication of exacerbating chronic conditions such as heart failure is unclear. The medical-scientific community is invited to study this microorganism to determine effective management strategies, as well as its timely identification, treatment, and control, to avoid fatal outcomes.
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