La etiología del derrame pericárdico es altamente variable en diferentes regiones del mundo. Este estudio describe las características clínicas y la etiología del derrame pericárdico severo en una serie de casos atendidos en un hospital de tercer nivel de la ciudad de Medellín, Colombia. Material y métodos: Serie de casos retrospectiva basada en registros clínicos. Se incluyeron todos los pacientes atendidos entre 2006 y 2018 que presentaron derrame pericárdico severo y requirieron intervención para extracción del líquido pericárdico. Los criterios de exclusión fueron la ausencia de más de 50% de los datos en la historia clínica. Para el análisis únicamente se tuvo en cuenta el primer derrame pericárdico y no la recurrencia de éste. Se describen etiología, indicación de drenaje y comorbilidades de los pacientes. Resultados: Se incluyeron 48 pacientes, 50% hombres, edad media 52.4 años (DE 17.5). Las etiologías no infecciosas fueron las más frecuentes (66.7%), seguidas por derrames pericárdicos idiopáticos (20.8%) y etiologías infecciosas (12.5%), la mayoría secundarias a tuberculosis. La principal indicación de drenaje fue búsqueda etiológica (58.0%) y la principal comorbilidad fue hipertensión (40.0%). Conclusiones: Las causas no infecciosas fueron las más comunes, contrario a lo reportado en otras series para países en vía de desarrollo donde las causas infecciosas son las más frecuentes. Aunque la etiología idiopática fue inferior a las reportadas en otras series, continúa siendo un número representativo de pacientes en los que no se logra establecer la etiología.
Patient: Male, 28Final Diagnosis: Disseminated paracoccidioidomycosisSymptoms: Fever • rashMedication: —Clinical Procedure: —Specialty: Infectious DiseasesObjective:Unusual clinical courseBackground:Paracoccidioidomycosis is an endemic mycosis in Central and South America caused by the thermally dimorphic fungus Paracoccidioides brasiliensis. Despite its self-limited course and usually asymptomatic infection, some patients may present with a systemic illness mimicking multiple conditions and thus question the general state of their immune system.Case Report:A 28-year-old male presented to the hospital with fever, dry cough, and non-pruritic rash with no characteristic distribution for the past 10 days. Past medical history revealed that the patient had worked as a farmer three years ago, had abused cocaine paste over the same period, and also had in the last month presented to the hospital for acute appendicitis. Initial laboratory tests revealed hypereosinophilia greater than 10,000 eosinophils/mL. Infection of P. brasiliensis was confirmed by lymph node, skin, and colonoscopy biopsies. After treatment with itraconazole, the patient’s eosinophil count returned to normal and his symptoms resolved.Conclusions:Paracoccidioidomycosis may present as a systemic illness with only marked eosinophilia on initial diagnostic tests. Furthermore, in our patient’s case, the high degree of eosinophilia may have contributed towards the patient’s appendicitis in the weeks preceding the subacute infection. It is possible that the patient’s history of working at a farm and abusing cocaine paste may have contributed to the initial colonization by the fungus.
Multiple myeloma can have different clinical manifestations, and not all patients present with classic CRAB component. We describe a 46-year-old woman admitted to our hospital with a complaint of a bluish-to-black discoloration of the second toe that was rapidly progressive and acute kidney injury. We documented a Kappa light chain monoclonal gammopathy, increased presence of plasmacytes in bone marrow aspiration, and multiple lytic bone lesions, which led to a diagnosis of multiple myeloma. Although multiple myeloma presenting with blue finger syndrome is uncommon, it must always be considered as a differential diagnosis with this clinical finding.
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