Artery of Percheron occlusion is a rare cause of ischaemic stroke characterized by bilateral thalamus infarction. Presentation is varied and non-specific, with the most frequent manifestations being altered level of consciousness, hypersomnolence or altered oculomotor movements. We describe the case of a 37-year-old man hospitalized for hypersomnia and hypomnesia with 3 days of evolution, who was diagnosed with a bilateral thalamus stroke due to artery of Percheron occlusion.
Current scientific evidence shows that SARS-CoV-2 infection is associated with an increased risk of thromboembolic events. In patients with ischaemic heart disease and heart failure, thrombi of the left ventricle can increase patient mortality, mainly due to the risk of systemic embolization. Given the hypercoagulable state associated with COVID-19, such events may be more likely. We describe a patient hospitalized for congestive heart failure and SARS-CoV-2 infection who was diagnosed with a thrombus in the left ventricle. After the thrombus was identified on echocardiography and treated with anticoagulation, it completely resolved and cardiac function improved.
The use of propylthiouracil (PTU) is associated with the development of autoantibodies, namely, antineutrophil cytoplasmic antibodies (ANCAs), which are associated with the pathogenesis of ANCAassociated systemic vasculitis, most often related to the myeloperoxidase subtype (ANCA-MPO). The authors report the case of a 61-year-old woman on PTU for one year who was referred to Internal Medicine for a three-month evolution of painless non-blanching purple patches, non-pruriginous, involving the chest and legs. The autoimmunity revealed ANCA antibody positivity, with a cutaneous biopsy compatible with leukocytoclastic vasculitis/necrotizing vasculitis with involvement of small and medium-sized vessels. Clinical improvement was noted after the drug was discontinued, with the resolution of the analytical changes.
A self-employed 76-year-old-woman had a personal history of type 2 diabetes mellitus, arterial hypertension, dyslipidemia, and ischemic heart disease (acute myocardial infarction in 2005). She went to the emergency department due to diffuse abdominal pain, vomiting and dysuria with 2 days of evolution. Abdomen was soft and painful to deep palpation in the lower quadrants and suprapubic region. Laboratory test showed leukocytosis and CPR 152 mg/dL. Urine revealed leukocyturia and nitrites. Urinary culture revealed Escherichia coli. Abdominal -pelvic CT scan was performed, describing a poorly filled bladder with multiple gas bubbles, apparently including in its wall, compatible with emphysematous cystitis (Figures 1, 2). Emphysematous cystitis (EC) was described by Bailey in 1961 in an autopsy. It is a rare complication of urinary tract infections caused by gas-producing bacteria. Most cases are caused by Escherichia coli or Klebsiella pneumoniae. Other common pathogens include Enterobacteria, Staphylococcus aureus, Proteus mirabilis, Pseudomonas aeruginosa, Streptococcus and fungi such as Candida. 1 Mostly affects women over 60 years 2 with diabetes mellitus as main risk factor. Also, anatomical malformations, obstructive uropathies, immunosuppression, recurrent urinary infections and neurogenic bladder are described with a high link to this entity 3 . The main symptom (up to 80% of the cases) is abdominal pain. 4 The diagnosis is made through an imaging exam due to the presence of air inside the bladder wall. 1Palabras clave: infecciones del tracto urinario, cistitis, diabetes mellitus
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