{"id":3455,"date":"2008-07-25T23:30:10","date_gmt":"2008-07-26T03:30:10","guid":{"rendered":"http:\/\/piel-l.org\/blog\/?p=3455"},"modified":"2008-07-26T09:30:41","modified_gmt":"2008-07-26T13:30:41","slug":"205-consulte-a-un-colega-n1","status":"publish","type":"post","link":"https:\/\/piel-l.org\/blog\/3455","title":{"rendered":"205 &#8211; Consulte a un Colega N\u00b01"},"content":{"rendered":"<p>Presentado por Rolando Hern\u00e1ndez P\u00e9rez (Dermat\u00f3logo), Carmen L\u00f3pez (Anatomopat\u00f3logo), Cl\u00ednica Ntra. Se\u00f1ora del Pilar. Barinas. Venezuela<\/p>\n<p>Se trata de una paciente de 40 a\u00f1os de edad, de oficios del hogar, procedente de la zona peri-urbana de la ciudad de Barinas, quien consulta por placa nodular eritematosa-cian\u00f3tica de car\u00e1cter inflamatorio, de l\u00edmites imprecisos, oval de 3&#215;1,6 cms, ligeramente descamativa, infiltrada localizada en la cara interna tercio medio de pierna izquierda de 3 meses de evoluci\u00f3n.<\/p>\n<p><!--more--><\/p>\n<p><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/07\/dsc02046.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-3447\" title=\"dsc02046\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/07\/dsc02046-300x168.jpg\" alt=\"\" width=\"300\" height=\"168\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/07\/dsc02046-300x168.jpg 300w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/07\/dsc02046.jpg 1024w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><br \/>\nDSC02046.jpg<br \/>\n<a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/07\/dsc02042.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-3449\" title=\"dsc02042\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/07\/dsc02042-300x168.jpg\" alt=\"\" width=\"300\" height=\"168\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/07\/dsc02042-300x168.jpg 300w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/07\/dsc02042.jpg 1024w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><br \/>\nDSC02042.jpg<br \/>\n<a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/07\/dsc02043.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-3450\" title=\"dsc02043\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/07\/dsc02043-168x300.jpg\" alt=\"\" width=\"168\" height=\"300\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/07\/dsc02043-168x300.jpg 168w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/07\/dsc02043.jpg 576w\" sizes=\"auto, (max-width: 168px) 100vw, 168px\" \/><\/a><br \/>\nDSC02043.jpg<br \/>\n<a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/07\/dsc02044.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-3451\" title=\"dsc02044\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/07\/dsc02044-300x168.jpg\" alt=\"\" width=\"300\" height=\"168\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/07\/dsc02044-300x168.jpg 300w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/07\/dsc02044.jpg 1024w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><br \/>\nDSC02044.jpg<\/p>\n<p><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/07\/dsc02045.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-3452\" title=\"dsc02045\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/07\/dsc02045-300x168.jpg\" alt=\"\" width=\"300\" height=\"168\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/07\/dsc02045-300x168.jpg 300w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/07\/dsc02045.jpg 1024w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><br \/>\nDSC02045.jpg<\/p>\n<p>Antecedente de Bronquitis (\u00bf? Bronconeumonia (\u00bf?) hace 6 a\u00f1os que amerit\u00f3 su hospitalizaci\u00f3n (sic); crisis articular hace 1 a\u00f1o.<\/p>\n<p>No hay antecedente de alergia medicamentosa.<\/p>\n<p>Examen f\u00edsico dentro de la normalidad.<\/p>\n<p>Laboratorio:dentro de la normalidad (VSG alta)<\/p>\n<p>RX: T\u00f3rax:SLA<\/p>\n<p>Histopatolog\u00eda:<\/p>\n<p><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/07\/colega1-h-11.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-3458\" title=\"colega1-h-11\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/07\/colega1-h-11-300x213.jpg\" alt=\"\" width=\"300\" height=\"213\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/07\/colega1-h-11-300x213.jpg 300w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/07\/colega1-h-11.jpg 1051w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><\/p>\n<p><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/07\/colega1-h-2.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-3454\" title=\"colega1-h-2\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/07\/colega1-h-2-300x221.jpg\" alt=\"\" width=\"300\" height=\"221\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/07\/colega1-h-2-300x221.jpg 300w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2008\/07\/colega1-h-2.jpg 1064w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><\/p>\n<p><strong>MUESTRA RECIBIDA: PIEL ( CARA INTERNA DE PIERNA IZQUIERDA).<\/strong><\/p>\n<p>DESCRIPCION CLINICA:  placa nodular eritematosa-cian\u00f3tica de l\u00edmites imprecisos, oval de 3&#215;1,6 cms, ligeramente descamativa, infiltrada locaizada en en la cara interna de pierna izquierda de 3 meses de evoluci\u00f3n. Refiere dolor articular en crisis. Impresione diagn\u00f3sticas: paniculitis nodular vs eritema indurado de Bazn vs. vasculitis nodular vs. manifestaciones cut\u00e1neas de artritis.<\/p>\n<p><strong>DESCRIPCI\u00d3N MACROSC\u00d3PICA<\/strong><\/p>\n<p>Se recibe fijado en formol cilindro de piel que mide 0,8&#215;0,7 cms.A la superficie de corte sin lesiones macrosc\u00f3picas. Se incluye completo para estudio histol\u00f3gico (1 Ft)<\/p>\n<p><strong>DESCRIPCI\u00d3N MICROSC\u00d3PICA<\/strong><\/p>\n<ul>\n<li>Epitelio con acantosis regular leve.<\/li>\n<li>Infiltrado linfocitario perivascular superficial leve.<\/li>\n<li>En el tejido celular subcut\u00e1neo se aprecia paniculitis lobulillar predominante con extensa necrosis grasa y de tipo fibrinoide.<\/li>\n<li>Presencia de granulomas epitelioides bien difrenciados en los septos del paniculo con discretos focos de vasculitis.<\/li>\n<li>Coloraci\u00f3n de FITE-FARACO: negativa para miocobacterias.<\/li>\n<\/ul>\n<p>Piel; biopsia:<\/p>\n<p><strong>DIAGNOSTICO:<\/strong><\/p>\n<p>PANICULITIS GRANULOMATOSA PREDOMINANTEMENTE LOBULILLAR CON EXTENSA     NECROSIS; HALLAZGOS HISTOLOGICOS COMPATIBLES DE ERITEMA INDURADO DE      BAZIN.<\/p>\n<p>NOTA: Los hallazgos histol\u00f3gicos son compatibles con la entidad antes se\u00f1alada, a pesar de no observarse bacilos en el fite-faraco. En muchos casos hay que recurrir a estudios de cultivos y PCR para demostrar el BAAR.<\/p>\n<p>Nota: la interpretaci\u00f3n de la biopsia estuvo a cargo de la Dra. Carmen L\u00f3pez (Caracas- Venezuela)<\/p>\n<p>Se contact\u00f3 al Dr. Jacobus D\u00a8Waard (Instituto de Biomedicina-Caracas) para realizar PCR.<\/p>\n<p><strong>\u00bfC\u00f3mo manejar\u00eda usted este caso?\u00bf\u00a1Esperar\u00eda el resultado del PCR para tratarlo como una TBC?<\/strong><\/p>\n<p><strong>Lo tratar\u00eda como una Vasculitis Nodular?<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Presentado por Rolando Hern\u00e1ndez P\u00e9rez (Dermat\u00f3logo), Carmen L\u00f3pez (Anatomopat\u00f3logo), Cl\u00ednica Ntra. Se\u00f1ora del Pilar. Barinas. Venezuela Se trata de una paciente de 40 a\u00f1os de edad, de oficios del hogar, procedente de la zona peri-urbana de la ciudad de Barinas, quien consulta por placa nodular eritematosa-cian\u00f3tica de car\u00e1cter inflamatorio, de l\u00edmites imprecisos, oval de 3&#215;1,6 &hellip;<\/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":[],"class_list":["post-3455","post","type-post","status-publish","format-standard","","category-consulte-a-un-colega"],"_links":{"self":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts\/3455","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=3455"}],"version-history":[{"count":0,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts\/3455\/revisions"}],"wp:attachment":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/media?parent=3455"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/categories?post=3455"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/tags?post=3455"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}