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2012, Number 4

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Med Sur 2012; 19 (4)

Perforación espontánea de víscera hueca en paciente inmunosuprimido

Toapanta-Yanchapaxi LN, Órnelas-Arroyo S, Manzano-Robleda MC, García-Méndez J, Sánchez-Cortés E, Chablé-Montero F, Torres-Villalobos G

Language: Spanish
References: 17
Page: 235-239
PDF size: 274.90 Kb.


ABSTRACT

Introduction. In patients with abdominal pain and immunocompromise, if a visceral perforation is suspected, causes such as Cytomegalovirus, Cryptosporidium or lymphomas should be considered. Clinical case. Male 60 years. No toxic habits (cigarette or liquor), with a transfusion of packed red blood cells in 2008. Personal medical history: splenectomy for idiopathic thrombocytopenic purpura. Human immunodeficiency virus diagnosed and currently under treatment. Also with hypothyroidism. He was admitted with sudden abdominal pain of 6 h. Physical examination: hypotensive, dehydrated with suggestive signs of viscera perforation, so an abdomen tomography was performed. LAPE was performed and a double perforation site was identified at 30cm ileum ileocecal valve, a resection and an anastomosis terminal - terminal was performed. The pathology report documented Cytomegalovirus and Histoplasma capsulatum, he received treatment with amphotericin B and ganciclovir andf antimicrobial coverage with linezolid and meropenem. During his hospital stay, the presence of pulmonary histoplasmosis was documented. Discussion. Intestinal perforation due to Cytomegalovirus occurs in patients with CD4 less than 50cel/ microL. It represents only 4% of all the gastrointestinal infections associated with this organism. Small bowel perforation by Histoplasma capsulatum is rare, when it develops, up to 40% of patients present ulcer as a primary lesion. Intestinal perforation caused by both organisms is exceptional.


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