{"id":3119,"date":"2008-06-28T04:19:30","date_gmt":"2008-06-28T08:19:30","guid":{"rendered":"http:\/\/piel-l.org\/blog\/?p=3119"},"modified":"2008-06-28T04:19:30","modified_gmt":"2008-06-28T08:19:30","slug":"consulte-a-un-colega-n-4-placa-mamelonada-fistulosa-dolorosa-localizada-en-13-distal-y-maleolar-derecho-con-1-ano-y-4-meses-de-evolucion","status":"publish","type":"post","link":"https:\/\/piel-l.org\/blog\/3119","title":{"rendered":"Consulte a un Colega N\u00b0 4: Placa mamelonada, fistulosa, dolorosa, localizada en 1\/3 distal y maleolar derecho con 1 a\u00f1o y 4 meses de evoluci\u00f3n"},"content":{"rendered":"<p>Presentado por<br \/> Rolando Hern\u00e1ndez P\u00e9rez (M\u00e9dico dermat\u00f3logo)<br \/> Marisela Acosta Casanova (M\u00e9dico Anat\u00f3mopat\u00f3logo)<br \/> Servicio de Dermatolog\u00eda<br \/> Hospital General&nbsp; &quot; Dr. Luis Razetti&quot; Barinas. Venezuela<\/p>\n<p><!--more--> <\/p>\n<p>Paciente de 47, natural de M\u00e9xico, procede de Socop\u00f3 de Barinas (vive en esta ciudad desde hace 18 meses) Oficios del hogar y comerciante<\/p>\n<p>Vivi\u00f3 en Canad\u00e1 por 8 a\u00f1os antes de llegar a Venezuela.<\/p>\n<p>Antecedente de enfermedad inflamatoria intestinal severa.<\/p>\n<p>Placa mamelonada, fistulosa, dolorosa, localizada en 1\/3 distal y maleolar derecho con 1 a\u00f1o y 4 meses de evoluci\u00f3n. Salida de material sero-purulento. No hay garnos. (Favor ver foto cl\u00ednica: DSC01957.jpg-DSC01958.jpg-DSC01959.jpg-DSC01960.jpg)<\/p>\n<p><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/06\/201\/dsc01957.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-3120\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/06\/201\/dsc01957-150x150.jpg\" title=\"dsc01957\" width=\"150\" height=\"150\" \/><\/a><\/p>\n<p><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/06\/201\/dsc01958.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-3121\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/06\/201\/dsc01958-150x150.jpg\" title=\"dsc01958\" width=\"150\" height=\"150\" \/><\/a><\/p>\n<p><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/06\/201\/dsc01959.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-3122\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/06\/201\/dsc01959-150x150.jpg\" title=\"dsc01959\" width=\"150\" height=\"150\" \/><\/a><\/p>\n<p><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/06\/201\/dsc019601.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-3124\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/06\/201\/dsc019601-150x150.jpg\" title=\"dsc019601\" width=\"150\" height=\"150\" \/><\/a> <\/p>\n<p>ID Cl\u00ednica<\/p>\n<p>1)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Micetoma<\/p>\n<p>2)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Osteomelitis<\/p>\n<p>3)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Pioderma gangrenoso<\/p>\n<p>4)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Esporotricosis verrugosa VS TBC<\/p>\n<p>KOH Y CULTIVO DE SABOURAUD: Negativo (21 d\u00edas)<\/p>\n<p>Tomograf\u00eda: zona de inflamaci\u00f3n en parte blanda. Osteomelitis<\/p>\n<p>Laboratorio convencional dentro de la normalidad<\/p>\n<p>HISTOPATOLOG\u00cdA (Favor ver foto histopatol\u00f3gica N&ordm;: HLR-BRS255.jpg-HLR-BRS256.jpg-HLR-BRS257.jpg-HLR-BRS258.jpg-HLR-BRS259.jpg-HLR-BRS260.jpg-HLR-BRS261.jpg)<\/p>\n<p><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/06\/201\/hlr-bns255.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-3125\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/06\/201\/hlr-bns255-150x150.jpg\" title=\"hlr-bns255\" width=\"150\" height=\"150\" \/><\/a><\/p>\n<p><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/06\/201\/hlr-bns256.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-3126\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/06\/201\/hlr-bns256-150x150.jpg\" title=\"hlr-bns256\" width=\"150\" height=\"150\" \/><\/a><\/p>\n<p><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/06\/201\/hlr-bns257.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-3127\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/06\/201\/hlr-bns257-150x150.jpg\" title=\"hlr-bns257\" width=\"150\" height=\"150\" \/><\/a><\/p>\n<p><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/06\/201\/hlr-bns258.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-3128\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/06\/201\/hlr-bns258-150x150.jpg\" title=\"hlr-bns258\" width=\"150\" height=\"150\" \/><\/a><\/p>\n<p><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/06\/201\/hlr-bns259.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-3129\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/06\/201\/hlr-bns259-150x150.jpg\" title=\"hlr-bns259\" width=\"150\" height=\"150\" \/><\/a><\/p>\n<p><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/06\/201\/hlr-bns260.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-3130\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/06\/201\/hlr-bns260-150x150.jpg\" title=\"hlr-bns260\" width=\"150\" height=\"150\" \/><\/a><\/p>\n<p><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/06\/201\/hlr-bns261.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-3131\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/06\/201\/hlr-bns261-150x150.jpg\" title=\"hlr-bns261\" width=\"150\" height=\"150\" \/><\/a> <\/p>\n<p>Hiperquetatosis, acantosis, hiperplasia psoriasiforme,<\/p>\n<p>Infiltrado inflamatorio denso,&nbsp; linfo-plasmocitario y neutrofilico, desde dermis pailar hasta profunda, difuso.<\/p>\n<p>Se observa trayecto fistuloso abscedado, con abundante \u00e1reas de necrosis y detritos celulares, adyacente neoformaci\u00f3n vascular de peque\u00f1os vasos, edema moderado estromal.<\/p>\n<p>En la profundidad se observa histiocitos modificados en c\u00e9lulas epiteliodes, delimitando al centro necr\u00f3tico.<\/p>\n<p>Vaso venosos con engrosamiento conc\u00e9ntrico de la pared, con obstrucci\u00f3n parcial y recanalizaci\u00f3n de la luz.<\/p>\n<p>Grocott: presencia de numerosas hifas&nbsp; septadas desde el epitelio escamoso hasta la parte m\u00e1s profunda de la preparaci\u00f3n.<\/p>\n<p>Fitte-Faraco: negativo<\/p>\n<p>ID: Proceso inflamatorio cr\u00f3nico supurativo fistuloso a posible agente vivo<\/p>\n<p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Enfermedad de Crohn metast\u00e1sica<\/p>\n<p>\u00bf;Est\u00e1 usted de acuerdo con el diagnostico?<\/p>\n<p>\u00bf;Que otro diagnostico sugiere usted?<\/p>\n<p>\u00bf;Como lo tratar\u00eda?<\/p>\n<p>Nota: la paciente viaj\u00f3 a M\u00e9xico DF en busca de su familia y ayuda m\u00e9dica.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Presentado por Rolando Hern\u00e1ndez P\u00e9rez (M\u00e9dico dermat\u00f3logo) Marisela Acosta Casanova (M\u00e9dico Anat\u00f3mopat\u00f3logo) Servicio de Dermatolog\u00eda Hospital General&nbsp; &quot; Dr. Luis Razetti&quot; Barinas. Venezuela<\/p>\n","protected":false},"author":16,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[25],"tags":[111],"class_list":["post-3119","post","type-post","status-publish","format-standard","","category-consulte-a-un-colega","tag-crohn"],"_links":{"self":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts\/3119","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=3119"}],"version-history":[{"count":0,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts\/3119\/revisions"}],"wp:attachment":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/media?parent=3119"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/categories?post=3119"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/tags?post=3119"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}