{"id":11841,"date":"2009-11-27T20:22:33","date_gmt":"2009-11-28T00:22:33","guid":{"rendered":"http:\/\/piel-l.org\/blog\/?p=11841"},"modified":"2009-11-28T14:50:55","modified_gmt":"2009-11-28T18:50:55","slug":"interconsulta-edicion-254","status":"publish","type":"post","link":"https:\/\/piel-l.org\/blog\/11841","title":{"rendered":"A Prop\u00f3sito de un caso de DRESS"},"content":{"rendered":"<p><strong>Dra. Elisa  Cubilla. <br \/>\n Jefa del Servicio de Dermatolog\u00eda. Hospital Central de IPS. Asunci\u00f3n-  Py<\/strong><\/p>\n<p><strong>Caso Cl\u00ednico<\/strong><\/p>\n<ul>\n<li>Edad: 44 A\u00f1os Sexo: F Domicilio: Villarrica Estado  Civil: Casada <\/li>\n<li>Motivo de Consulta: Sensaci\u00f3n febril y rash  cut\u00e1neo. <\/li>\n<\/ul>\n<p><strong>Antecedentes Personales: <\/strong>APP: Hipertensa, dislipid\u00e9mica, hiperuricemia (1 mes antes del ingreso).  Medicaci\u00f3n actual: enalapril, atenolol, hidroclorotiazida, bezafibrato,  allopurinol, AAS, alprazolam.<\/p>\n<p><!--more--><\/p>\n<div id='gallery-1' class='gallery galleryid-11841 gallery-columns-2 gallery-size-thumbnail'><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/11\/254_inter_1.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/11\/254_inter_1-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" \/><\/a>\n\t\t\t<\/div><\/figure><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/11\/254_inter_2.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/11\/254_inter_2-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" \/><\/a>\n\t\t\t<\/div><\/figure><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon portrait'>\n\t\t\t\t<a href='https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/11\/254_inter_3.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/11\/254_inter_3-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" \/><\/a>\n\t\t\t<\/div><\/figure><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/11\/254_inter_4.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/11\/254_inter_4-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" \/><\/a>\n\t\t\t<\/div><\/figure>\n\t\t<\/div>\n\n<\/p>\n<p><br class=\"spacer_\" \/><\/p>\n<p><strong>AEA: <\/strong> 2  sem: sensaci\u00f3n febril con escalofr\u00edos, y exantema pruriginoso que inicia en  cara. <br \/>\n 1 sem:  se extiende a tronco y extremidades. Consulta con facultativo quien la medica  con paracetamol sin mejor\u00eda. <br \/>\n 3 ds:  n\u00e1useas y v\u00f3mitos, edema bipalpebral y de MI, disminuci\u00f3n de la diuresis.<\/p>\n<p><strong>Signos Vitales<\/strong> : PA : 125\/65 FC : 118 FR: 26 T: 38\u00baHGT: 144. Obs: se tomaron policultivos<\/p>\n<p><strong>Examen F\u00edsico: <\/strong>Fascies  abotagada, Descamaci\u00f3n perioral fina, Conjuntivas congestivas, Hepatomegalia  leve, Edema de extremidades, Exantema morbiliforme, Lesiones maculopapulosas en  palmas y plantas.<\/p>\n<p><strong>Laboratorio<\/strong>HMG:\u00a0\u00a0\u00a0  GB: 9100 (N:50% L:27% E:19% M:4%), Hb: 11,1 Plaq: 160.000, Linfocitos at\u00edpicos,  Perfiles: Urea:54,5 Cr: 1,65, GOT: 161 GPT:274 FA: 807,  \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Bilirrubina Total:  1,59 BD? BI ?, electrolitos normales, Orina:\u00a0\u00a0 Ph 6, D: 1010 leuc:  1-2 \/c CE: 1-2\/c <br \/>\n <strong>Se solicit\u00f3 adem\u00e1s: <\/strong>VDRL (-) Cultivos (-), ELISA p\/ HIV(-), Dosaje de IgE: normal, Perfil  Colag\u00e9nico: normal, Serolog\u00edas para hepatitis\u00a0 y dengue (-), Ant\u00edgenos  Febriles (-). Artritest (-), Crasis normal <br \/>\n <strong>Ex\u00e1menes Auxiliares: <\/strong>Rx de t\u00f3rax: normal. Ecocardiograma: DISFUNCION DIASTOLICA, cavidades  levemente dilatadas, motilidad conservada, pericardio normal. <br \/>\n Ecograf\u00eda abdominal: Esteatosis, hepatomegalia leve.<\/p>\n<p>Se inicia protocolo para Sx  febril agudo.<\/p>\n<p>Se solicita interconsulta con Dermatolog\u00eda. <br \/>\n Diagn\u00f3stico Presuntivo: <strong>S\u00cdNDROME DRESS<\/strong> <br \/>\n <strong>Tratamiento<\/strong><\/p>\n<ul>\n<li>Suspensi\u00f3n de f\u00e1rmacos (allopurinol) <\/li>\n<li>T\u00f3pico: corticoide (betametasona) y\u00a0 ATB (ac.  fus\u00eddico) <\/li>\n<li>Prednisona 75 mg\/d\u00eda (1 mg\/Kp\/Dia) <\/li>\n<\/ul>\n<p><strong>Evoluci\u00f3n<\/strong><\/p>\n<p>\u00a1Perfiles renal y hep\u00e1tico en ascenso!<\/p>\n<p>GOT: 1375 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 GPT: 532  \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 FA: 491 <br \/>\n B.T: 2,05 \u00a0 B.D: 0,855 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 B.I: 1,2 <br \/>\n Urea: 77 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Cr:  2,42.<\/p>\n<p>Clearence de creatinina: 34,98 , Proteinuria:  476,525.<\/p>\n<p><strong>Evoluci\u00f3n<\/strong> <br \/>\n 4\u00ba DDI:  presenta disnea, rales pulmonares y disminuci\u00f3n del MV.<\/p>\n<ul>\n<li>TAC de t\u00f3rax: infiltrado intersticial y  peribronquial. Derrame pleural moderado. <\/li>\n<\/ul>\n<p><strong><em>Se  interpreta como cuadro infeccioso pulmonar y se inicia ATB<\/em><\/strong><\/p>\n<p><strong>Evoluci\u00f3n<\/strong><\/p>\n<ul>\n<li>Mejor\u00eda notoria de lesiones. <\/li>\n<li>IC con Neumolog\u00eda: imagen compatible con  sobrecarga. Se indica completar ATB por 14 d\u00edas. <\/li>\n<li>Perfil renal se normaliza. <\/li>\n<li>Perfil hep\u00e1tico desciende (se espera normalizaci\u00f3n  de las enzimas en ~6 ms) <\/li>\n<\/ul>\n<p><strong>Diagn\u00f3sticos finales<\/strong><\/p>\n<ul>\n<li>Sx de Dress <\/li>\n<li>IRA superada <\/li>\n<li>NIH resuelta (?) <\/li>\n<li>HTA <\/li>\n<li>Dislipidemia <\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Dra. Elisa Cubilla. Jefa del Servicio de Dermatolog\u00eda. Hospital Central de IPS. Asunci\u00f3n- Py Caso Cl\u00ednico Edad: 44 A\u00f1os Sexo: F Domicilio: Villarrica Estado Civil: Casada Motivo de Consulta: Sensaci\u00f3n febril y rash cut\u00e1neo. Antecedentes Personales: APP: Hipertensa, dislipid\u00e9mica, hiperuricemia (1 mes antes del ingreso). Medicaci\u00f3n actual: enalapril, atenolol, hidroclorotiazida, bezafibrato, allopurinol, AAS, alprazolam.<\/p>\n","protected":false},"author":46,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[252],"tags":[],"class_list":["post-11841","post","type-post","status-publish","format-standard","","category-psicodermatosis"],"_links":{"self":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts\/11841","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/users\/46"}],"replies":[{"embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/comments?post=11841"}],"version-history":[{"count":0,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts\/11841\/revisions"}],"wp:attachment":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/media?parent=11841"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/categories?post=11841"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/tags?post=11841"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}