{"id":25584,"date":"2012-03-23T11:59:23","date_gmt":"2012-03-23T16:29:23","guid":{"rendered":"http:\/\/piel-l.org\/blog\/?p=25584"},"modified":"2012-03-24T14:29:10","modified_gmt":"2012-03-24T18:59:10","slug":"leishmaniasis-cutanea-intermedia-reto-terapeutico","status":"publish","type":"post","link":"https:\/\/piel-l.org\/blog\/25584","title":{"rendered":"Leishmaniasis cut\u00e1nea intermedia. Reto terap\u00e9utico"},"content":{"rendered":"<p><em><strong>Rivera I, Moreno A, Portillo L, Oliver M, Rodr\u00edguez N, Angulo J, Aranzazu N, Zerpa O<\/strong><\/em><br \/><span style=\"font-size: x-small;\"><em><strong>Instituto de Biomedicina, Caracas<\/strong><\/em><\/span><\/p>\n<p><strong>IDENTIFICACI\u00d3N:<\/strong> Sexo: Masculino. Edad: 70 a\u00f1os. Natural y procedente: Caracas. Oficio: comerciante.<\/p>\n<p><!--more--><\/p>\n<p>ENFERMEDAD ACTUAL: Inicia EA en julio 2009, posterior a visita de una hacienda en Caruao \u2013 Estado Vargas, con una p\u00e1pula eritematosa en pierna derecha, que evoluciona a una placa ulcerada por lo que consulta a dermat\u00f3logo quien realiza biopsia el 18-08-09, compatible Leishmaniasis cut\u00e1nea localizada, siendo referido y consultando a nuestro centro el 25-08-09.<\/p>\n<p><strong>ANTECEDENTES PERSONALES:<\/strong> Vit\u00edligo 1988.<\/p>\n<p><strong>ANTECEDENTES FAMILIARES:<\/strong> Padres: HTA.<\/p>\n<p><strong>H\u00c1BITOS PSICOBIOL\u00d3GICOS:<\/strong> Tab\u00e1quicos y alcoh\u00f3licos acentuados.<\/p>\n<p><strong>EXAMEN F\u00cdSICO:<\/strong> Fototipo II seg\u00fan Fitzpatrick. Placa eritematosa, con \u00falcera central, 15 x 20 mm, con fondo granuloso, bordes sobre elevados, en cara anteromedial del tercio distal de pierna derecha. (Foto 1)<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-25585\" title=\"foto-1\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2012\/03\/foto-1.jpg\" alt=\"\" width=\"276\" height=\"252\" \/><br \/>Foto 1<\/p>\n<p><strong>IMPRESI\u00d3N DIAGN\u00d3STICA:<\/strong> Leishmaniasis cut\u00e1nea localizada.<\/p>\n<p><strong>PARACL\u00cdNICOS:<\/strong><\/p>\n<ul>\n<li>Hematolog\u00eda, qu\u00edmica sangu\u00ednea, PT, PTT, HIV, VDRL: normales.<\/li>\n<li>Frotis por escarificado: positivo para amastigotes de Leishmania (Foto 2)<\/li>\n<li>Pruebas intrad\u00e9rmicas: PPD negativo, Leishmanina 19 mm<\/li>\n<li>Electrocardiograma: arritmia (extras\u00edstole)<\/li>\n<\/ul>\n<p>\u00a0<img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-25586\" title=\"foto-2\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2012\/03\/foto-2.jpg\" alt=\"\" width=\"301\" height=\"252\" \/><br \/>Foto 2<\/p>\n<p><strong>TRATAMIENTO:<\/strong> Inmunoterapia (6&#215;108 promastigotes de Leishmania braziliensis m\u00e1s 0,75mg de BCG).<\/p>\n<p>\u00a0<strong>EVOLUCI\u00d3N<\/strong>:<\/p>\n<p>Sin mejor\u00eda cl\u00ednica para el 15-09-09, por lo que se inicia Miltefosina 150mg d\u00eda, que recibe por 45 d\u00edas. El 26-11-09 se evidencia mejor\u00eda con cierre de la \u00falcera, persistiendo placa eritematosa. Acude nuevamente a la consulta el 12-01-10 por presentar placas eritematosas, algunas de ellas con superficie ulcerada, distribuidas alrededor de la lesi\u00f3n inicial cicatricial, en cara anteromedial del tercio distal de pierna derecha. (Foto 3 y 4)<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-25587\" title=\"foto-3\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2012\/03\/foto-3.jpg\" alt=\"\" width=\"319\" height=\"240\" \/><br \/>Foto 3<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-25588\" title=\"foto-4\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2012\/03\/foto-4.jpg\" alt=\"\" width=\"319\" height=\"240\" \/><br \/>Foto 4<\/p>\n<p><strong>DIAGN\u00d3STICO DEFINITIVO:<\/strong> Leishmaniasis cut\u00e1nea intermedia<\/p>\n<p>TRATAMIENTO:<\/p>\n<ul>\n<li>Inmunoterapia 2\u00aa dosis 12-01-10<\/li>\n<li>Antimoniales Pentavalentes (Glucantime\u00ae), hospitalizado con monitoreo cardiaco permanente<\/li>\n<\/ul>\n<p><strong>REFERENCIAS BIBLIOGR\u00c1FICAS<\/strong><\/p>\n<ul>\n<li><span style=\"font-size: x-small;\"><em>Convit J, Leprosy and leishmaniasis. Similar clinical immunological pathological models. Ethiop Med J 1974: 12: 187-195.<\/em><\/span><\/li>\n<li><span style=\"font-size: x-small;\"><em>Convit J, Castellanos P, Ulrich M et al. Immunotherapy of localized, intermediate, and diffuse forms of American cutaneous leishmaniasis. J Infect Dis 1989: 160: 104-115.<\/em><\/span><\/li>\n<li><span style=\"font-size: x-small;\"><em>Convit J, Ulrich M, Fernandez C, et al. The clinical and immunological spectrum of American cutaneous leishmaniasis. Trans R Soc Trop Med Hyg 1993: 87: 444-448.<\/em><\/span><\/li>\n<li><span style=\"font-size: x-small;\"><em>Diaz N, Zerpa O, Ponce L, Convit J, Rondon A, Tapia F. Intermediate or chronic cutaneous leishmaniasis: leukocyte immunophenotypes and cytokine charaterisation of the lesion. Experimental Dermatology 2002: 11: 34-41.<\/em><\/span><\/li>\n<li><span style=\"font-size: x-small;\"><em>Tapia F, C\u00e1ceres-Dittmar G, S\u00e1nchez M. Inadequate epidermal homing leads to tissue damage in human cutaneous leishmaniasis. Immunol Today 1994: 15: 160-165.<\/em><\/span><\/li>\n<li><span style=\"font-size: x-small;\"><em>Tapia F, C\u00e1ceres-Dittmar G, S\u00e1nchez M, Fern\u00e1ndez C, Rond\u00f3n A, Convit J. Adhesion molecules in lesions of American cutaneous leishmaniasis. Exp Dermatol 1994: 3: 17-22.<\/em><\/span><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Inicia EA en julio 2009, posterior a visita de una hacienda en Caruao \u2013 Estado Vargas, con una p\u00e1pula eritematosa en pierna derecha, que evoluciona a una placa ulcerada por lo que consulta a dermat\u00f3logo quien realiza biopsia el 18-08-09, compatible Leishmaniasis cut\u00e1nea localizada, siendo referido y consultando a nuestro centro el 25-08-09.<\/p>\n","protected":false},"author":16,"featured_media":25585,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[29,574],"tags":[551],"class_list":["post-25584","post","type-post","status-publish","format-standard","has-post-thumbnail","","category-caso-de-la-semana","category-seccion-inicial","tag-leishmaniasis"],"_links":{"self":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts\/25584","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\/16"}],"replies":[{"embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/comments?post=25584"}],"version-history":[{"count":0,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts\/25584\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/media\/25585"}],"wp:attachment":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/media?parent=25584"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/categories?post=25584"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/tags?post=25584"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}