miércoles, febrero 27, 2008

Enfermedades no raras....rarísimas.








El Dr. Sanchez Vsarilla ha presentado hoy en Sesión Clinica de M. Interna un caso clinico que en sintesis es:


Paciente de 38 años, mujer, que tiene palomas en su domicilio y que en el año 1993 consulta por tos, expectoración.Tras los estudios clincos y complementarios se objetivaron unas pequeñas bronquiectasias basales y lesiones iniciales interstiiales pulmonares. Posteriormente y sin tratamiento esteroideo la paciente empeoró de su sintomatologia respiratoria y el TAC mostraba una franca extensión de lesiones micronodulares en practicamente en todo el pulmón., más en los lobulos inferiores.En el año 2007 se practicó una biopsia pulmonar que demostró una neumonitis por hipersensibilidad. Sin embargo, las precipitinas eran negstivas. La enferma fué tratada con 1 mgrs/Kg/dia de Prednisona. Este ratamiento lo hizo durante 1 mes. Postriomente comezó con fiebre, quebrantamiento general,esputos hemoptoicos y aparición de unos nodulos cutáneos que se ulceraron algunos y otro remitieron. La paciente no tenía sintomatologia neurologica.Sin embargo fué sometida a un examen de RNM craneal.El VIH fué negativo.


El cultivo del exudado de los nodulos mostró crecimiento de NOCARDIA. La paciente ha sido tratada con TM/SMTZ a dosis muy altas y ha sido dada de alta en un estado excelente. La constancia,sagacidad,tenacidad,interés y nivel científico del Dr. D. Jose Manuel Sanchez Varilla ha puesto de manifiesto una rarisima enfermedad en pacientes inmunodeprimidos: nocardiosis subcutánea,cerebral y pulmonar.Se exponen algunas imagenes de este caso así como de la Nocardia (esta ultima tomada,no nuestra, de pathmicro.med.sc.edu/mycology/nocard-cdc1.jpg

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