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ISSN 0185-3252 (Impreso)
Revista de la Asociación Médica del Centro Médico ABC

2018, Número 4

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An Med Asoc Med Hosp ABC 2018; 63 (4)


Tormenta trombótica: síndrome antifosfolípido catastrófico

Palacios MP, Monter VJE, Martínez REA, Camarena AG

Idioma: Español
Referencias bibliográficas: 44
Paginas: 299-305
Archivo PDF: 206.71 Kb.


RESUMEN

El síndrome antifosfolípido catastrófico pertenece a un grupo de enfermedades cuya característica se centra en un estado de hipercoagulabilidad extrema. Se manifiesta aproximadamente en 1% de los pacientes con síndrome antifosfolípido y su impacto en la mortalidad es de hasta 50% de los casos. Se presenta el caso de una paciente de 41 años con antecedentes de hipertensión arterial y síndrome antifosfolípido quien ingresa a la unidad de terapia intensiva por síndrome antifosfolípido catastrófico con afección a sistema nervioso central, pulmonar, renal (lesión renal aguda) y cardiovascular (insuficiencia cardiaca congestiva, insuficiencia mitral grave y miocarditis). Durante su internamiento se le brindó tratamiento para suprimir el proceso trombótico con anticoagulantes, corticosteroides, plasmaféresis, inmunoglobulina intravenosa e hidroxicloroquina así como terapia de soporte con ventilación mecánica, apoyo inotrópico y terapia de sustitución renal continua en modalidad hemodiafiltración veno-venosa continua. Ante la severidad de la insuficiencia mitral se colocó mitraclip y así el grado de insuficiencia se redujo; sin embargo, ésta es fallida por desprendimiento del clip, por lo que se realizó cambio valvular quirúrgico. Posteriormente mostró mejoría clínica tanto a nivel pulmonar, hemodinámico y renal. Presentó estatus epiléptico con evolución tórpida y defunción.


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