Durante la infección aguda por el SARVS-CoV-2 se produce una desregulación del sistema inmune que puede durar hasta ocho meses después de controlado el cuadro agudo. Esto, sumado a otros factores, posiblemente este asociado con un aumento del riesgo de aparición y concurrencia de enfermedades autoinmunes. La aparición simultanea del síndrome de Guillain-Barré (SGB) y púrpura trombocitopénica (PTI) se ha reportado poco en la literatura, y el SGB raramente se asocia con otra enfermedad autoinmune. Presentamos el caso de un varón que luego de un mes de tener un cuadro agudo de COVID-19 moderado, presentó concurrentemente SGB y PTI con respuesta adecuada al tratamiento.
Introduction: Case reports are a type of biomedical publication that allow us to share experiences regarding the etiology, diagnosis, therapeutics, and prognosis of anecdotal events that occur both in one and in several patients during clinical practice. Objective: to elaborate methodological recommendations for the elaboration of the discussion of a clinical case report. Methods: A narrative review of international guidelines and available evidence was carried out. Results: A total of 411,227 articles were located, finally selecting 10 narrative review articles. Discussion: The discussion is the most relevant section of the case report despite being considered by some journals as an optional contribution. We recommend for the elaboration of the discussion, to follow the following four steps: a) finding and comparison with the current evidence, b) justification of the causality of the findings, c) limitations and strengths in the management of the exposed case and d) clinical implications and prospects for the future. Conclusion: It is recommended to follow the four sequential steps for the elaboration of the discussion and to evaluate its impact on the scientific production in undergraduate and postgraduate students.
Systemic or cutaneous-visceral loxoscelism is the most severe clinical presentation of loxoscelism. Currently there is no validated laboratory diagnostic method that allows us to confirm the presence of this disease in the face of arachneism. However, there is a clinical prediction rule (CPR), which allows us to predict the evolution of a bite towards a systemic condition and which would be useful in emergency rooms. We present the case of a woman who developed the systemic picture of loxoscelism to whom a new CPR was applied for the early detection of systemic loxoscelism, presenting adequate performance for early evaluation in emergency services.
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