{"id":35741,"date":"2014-05-09T10:14:22","date_gmt":"2014-05-09T14:44:22","guid":{"rendered":"http:\/\/piel-l.org\/blog\/?p=35741"},"modified":"2014-05-19T05:58:12","modified_gmt":"2014-05-19T10:28:12","slug":"caso-clinico-no-66-dermatosis-generalizada","status":"publish","type":"post","link":"https:\/\/piel-l.org\/blog\/35741","title":{"rendered":"Caso cl\u00ednico N\u00ba 66. Dermatosis Generalizada"},"content":{"rendered":"<p><em><strong>Dr. V. Quintero (Inmun\u00f3logo), <\/strong><\/em><br \/>\n<em><strong>Fernando G\u00f3mez Daza. <\/strong><\/em><br \/>\n<span style=\"color: #999999;\"><em><strong>Valencia, Venezuela<\/strong><\/em><\/span><\/p>\n<p><!--more--><\/p>\n<p>Masculino de 63 a\u00f1os con m\u00faltiples placas eritematosas ligeramente descamativas localizadas de forma generalizada de varios meses de evoluci\u00f3n. El paciente ha consultado a diferentes galenos (Generales, Internistas, Infect\u00f3logos, Inmun\u00f3logos) sin mejor\u00eda cl\u00ednica por lo cual el Inmun\u00f3logo me lo refirieren para descartar micosis superficial.<\/p>\n<p>&nbsp;<\/p>\n<figure id=\"attachment_35742\" aria-describedby=\"caption-attachment-35742\" style=\"width: 360px\" class=\"wp-caption alignnone\"><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2014\/05\/01.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-35742\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2014\/05\/01-360x480.jpg\" alt=\"Foto 1\" width=\"360\" height=\"480\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2014\/05\/01-360x480.jpg 360w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2014\/05\/01-768x1024.jpg 768w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2014\/05\/01.jpg 900w\" sizes=\"auto, (max-width: 360px) 100vw, 360px\" \/><\/a><figcaption id=\"caption-attachment-35742\" class=\"wp-caption-text\">Foto 1<\/figcaption><\/figure>\n<figure id=\"attachment_35743\" aria-describedby=\"caption-attachment-35743\" style=\"width: 390px\" class=\"wp-caption alignnone\"><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2014\/05\/02.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-35743\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2014\/05\/02-390x292.jpg\" alt=\"Foto 2\" width=\"390\" height=\"292\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2014\/05\/02-390x292.jpg 390w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2014\/05\/02-1024x768.jpg 1024w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2014\/05\/02.jpg 1200w\" sizes=\"auto, (max-width: 390px) 100vw, 390px\" \/><\/a><figcaption id=\"caption-attachment-35743\" class=\"wp-caption-text\">Foto 2<\/figcaption><\/figure>\n<figure id=\"attachment_35744\" aria-describedby=\"caption-attachment-35744\" style=\"width: 390px\" class=\"wp-caption alignnone\"><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2014\/05\/03.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-35744\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2014\/05\/03-390x292.jpg\" alt=\"Foto 3\" width=\"390\" height=\"292\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2014\/05\/03-390x292.jpg 390w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2014\/05\/03-1024x768.jpg 1024w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2014\/05\/03.jpg 1200w\" sizes=\"auto, (max-width: 390px) 100vw, 390px\" \/><\/a><figcaption id=\"caption-attachment-35744\" class=\"wp-caption-text\">Foto 3<\/figcaption><\/figure>\n<figure id=\"attachment_35745\" aria-describedby=\"caption-attachment-35745\" style=\"width: 360px\" class=\"wp-caption alignnone\"><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2014\/05\/04.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-35745\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2014\/05\/04-360x480.jpg\" alt=\"Foto 4\" width=\"360\" height=\"480\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2014\/05\/04-360x480.jpg 360w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2014\/05\/04-768x1024.jpg 768w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2014\/05\/04.jpg 900w\" sizes=\"auto, (max-width: 360px) 100vw, 360px\" \/><\/a><figcaption id=\"caption-attachment-35745\" class=\"wp-caption-text\">Foto 4<\/figcaption><\/figure>\n<figure id=\"attachment_35746\" aria-describedby=\"caption-attachment-35746\" style=\"width: 390px\" class=\"wp-caption alignnone\"><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2014\/05\/05.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-35746\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2014\/05\/05-390x292.jpg\" alt=\"Foto 5\" width=\"390\" height=\"292\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2014\/05\/05-390x292.jpg 390w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2014\/05\/05-1024x768.jpg 1024w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2014\/05\/05.jpg 1200w\" sizes=\"auto, (max-width: 390px) 100vw, 390px\" \/><\/a><figcaption id=\"caption-attachment-35746\" class=\"wp-caption-text\">Foto 5<\/figcaption><\/figure>\n<figure id=\"attachment_35747\" aria-describedby=\"caption-attachment-35747\" style=\"width: 390px\" class=\"wp-caption alignnone\"><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2014\/05\/06.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-35747\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2014\/05\/06-390x292.jpg\" alt=\"Foto 6\" width=\"390\" height=\"292\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2014\/05\/06-390x292.jpg 390w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2014\/05\/06-1024x768.jpg 1024w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2014\/05\/06.jpg 1200w\" sizes=\"auto, (max-width: 390px) 100vw, 390px\" \/><\/a><figcaption id=\"caption-attachment-35747\" class=\"wp-caption-text\">Foto 6<\/figcaption><\/figure>\n<figure id=\"attachment_35748\" aria-describedby=\"caption-attachment-35748\" style=\"width: 390px\" class=\"wp-caption alignnone\"><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2014\/05\/07.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-35748\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2014\/05\/07-390x292.jpg\" alt=\"Foto 7\" width=\"390\" height=\"292\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2014\/05\/07-390x292.jpg 390w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2014\/05\/07-1024x768.jpg 1024w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2014\/05\/07.jpg 1200w\" sizes=\"auto, (max-width: 390px) 100vw, 390px\" \/><\/a><figcaption id=\"caption-attachment-35748\" class=\"wp-caption-text\">Foto 7<\/figcaption><\/figure>\n<figure id=\"attachment_35749\" aria-describedby=\"caption-attachment-35749\" style=\"width: 390px\" class=\"wp-caption alignnone\"><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2014\/05\/08.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-35749\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2014\/05\/08-390x292.jpg\" alt=\"Foto 8\" width=\"390\" height=\"292\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2014\/05\/08-390x292.jpg 390w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2014\/05\/08-1024x768.jpg 1024w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2014\/05\/08.jpg 1200w\" sizes=\"auto, (max-width: 390px) 100vw, 390px\" \/><\/a><figcaption id=\"caption-attachment-35749\" class=\"wp-caption-text\">Foto 8<\/figcaption><\/figure>\n<p>Caso presentado previo consentimiento informado del paciente.<\/p>\n<p><strong>\u00bfCu\u00e1les ser\u00edan sus diagn\u00f3sticos presuntivos y sus respectivos paracl\u00ednicos?<\/strong><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"color: #339966;\"><strong>Actualizaci\u00f3n 17-Mayo-2014<\/strong><\/span><\/p>\n<blockquote><p><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2014\/05\/09.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-35880\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2014\/05\/09-390x292.jpg\" alt=\"09\" width=\"390\" height=\"292\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2014\/05\/09-390x292.jpg 390w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2014\/05\/09-1024x768.jpg 1024w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2014\/05\/09.jpg 1200w\" sizes=\"auto, (max-width: 390px) 100vw, 390px\" \/><\/a><\/p>\n<p>Al realizarle la toma de la muestra por raspado con hoja de bistut\u00ed N\u00ba 15 de forma vigorosa para el estudio micol\u00f3gico indicado por el facultativo, le hice una pregunta debido a la sospecha cl\u00ednica que ten\u00eda en mente, \u00bfsi le molestaba lo que le estaba haciendo? La respuesta fue que no le molestaba y no sent\u00eda nada. Acto seguido le dije que le iba a realizar otro procedimiento que orientar\u00eda al cl\u00ednico en el diagn\u00f3stico definitivo de su patolog\u00eda. Le realic\u00e9 una peque\u00f1a incisi\u00f3n con otra hoja de bistut\u00ed N\u00ba 15 previa hipoxia con pinza curva en borde de una lesi\u00f3n de gl\u00fateo la cual tampoco le molest\u00f3 el procedimiento. Inmediatamente proced\u00ed a realizar extendido en l\u00e1mina portaobjeto de la linfa obtenida y se ti\u00f1\u00f3 con Ziehl-Neelsen observando un bacilo \u00e1cido alcohol resistente s\u00f3lido en aproximadamente 100 campos examinados.<\/p>\n<p>Este caso se presenta para justificar el valor que existe en el binomio m\u00e9dico-bioanalista para llegar al diagn\u00f3stico definitivo de la patolog\u00eda y la necesidad de realizar el bioanalista otros ex\u00e1menes no indicados en beneficio del paciente. Posteriormente el cl\u00ednico refiri\u00f3 al paciente con el Dr. Eusebio Plasencia Jefe de Servicio de Dermatolog\u00eda Sanitaria del Edo. Carabobo para confirmar diagn\u00f3stico, clasificaci\u00f3n cl\u00ednica y tratamiento.<\/p><\/blockquote>\n<p><strong>Biopsia<\/strong><\/p>\n<blockquote><p><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2014\/05\/10.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-35882\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2014\/05\/10.png\" alt=\"10\" width=\"593\" height=\"921\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2014\/05\/10.png 593w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2014\/05\/10-309x480.png 309w\" sizes=\"auto, (max-width: 593px) 100vw, 593px\" \/><\/a><\/p><\/blockquote>\n","protected":false},"excerpt":{"rendered":"<p>Dr. V. Quintero (Inmun\u00f3logo), Fernando G\u00f3mez Daza. Valencia, Venezuela<\/p>\n","protected":false},"author":7,"featured_media":35742,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11,13],"tags":[],"class_list":["post-35741","post","type-post","status-publish","format-standard","has-post-thumbnail","","category-secciones-de-colaboradores","category-micopiel"],"_links":{"self":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts\/35741","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\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/comments?post=35741"}],"version-history":[{"count":0,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts\/35741\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/media\/35742"}],"wp:attachment":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/media?parent=35741"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/categories?post=35741"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/tags?post=35741"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}