{"id":3786,"date":"2008-08-15T15:07:16","date_gmt":"2008-08-15T19:07:16","guid":{"rendered":"http:\/\/piel-l.org\/blog\/?p=3786"},"modified":"2008-08-15T16:34:45","modified_gmt":"2008-08-15T20:34:45","slug":"abscesos-y-nodulos-en-paciente-con-les","status":"publish","type":"post","link":"https:\/\/piel-l.org\/blog\/3786","title":{"rendered":"Abscesos y n\u00f3dulos en paciente con LES"},"content":{"rendered":"

Nayrin S\u00fanico, Aileen Farreras, Jacobus De Waards, Ricardo P\u00e9rez Alfonzo
\nInstituto Biomedicina. Caracas.<\/strong>
\nPaciente femenino de 29 a\u00f1os, conocida con LES desde hace 13 a\u00f1os, con m\u00faltiples \u00falceras vascul\u00edticas a repetici\u00f3n\u00a0 en miembros inferiores.\u00a0 Ha recibido tratamiento con prednisona: 1 mg\/kg\/d, hidroxicloroquina: 200 mg VO OD y desde hace 1 a\u00f1o metilprednisolona: 16 mg VO OD y azatioprina: 50 mg VO BID.\u00a0 Dos semanas previas a consulta presenta lesi\u00f3n ulcerada en gl\u00fateo derecho y n\u00f3dulo fluctuante en rodilla derecha por lo que consulta.<\/p>\n

<\/p>\n

\"\"<\/a>
\nAl examen f\u00edsico, se aprecian lesiones residuales de las \u00falceras vascul\u00edticas en miembros inferiores.\u00a0 \u00dalcera de 5 cm de di\u00e1metro en gl\u00fateo derecho con secreci\u00f3n purulenta y signos de flogosis, que inicialmente era de aspecto nodular y presenta ruptura espont\u00e1nea.\u00a0 Adem\u00e1s, lesi\u00f3n nodular eritematosa fluctuante en cara lateral externa de rodilla derecha.
\n<\/span><\/span><\/p>\n

Ex\u00e1menes complementarios:<\/span><\/span><\/p>\n

<\/span><\/span><\/p>\n

\u2022<\/span> <\/span><\/span><\/span><\/span>Hematolog\u00eda completa:<\/span><\/span><\/p>\n

\u2022<\/span> <\/span><\/span><\/span><\/span>Leu: 4.400 <\/span>Seg: 73% <\/span>Linf: 19%<\/span><\/span><\/p>\n

\u2022<\/span> <\/span><\/span><\/span><\/span>Hb: 12,8 g\/dl <\/span>Hcto: 39%<\/span><\/span><\/p>\n

\u2022<\/span> <\/span><\/span><\/span><\/span>PLT: 314.000<\/span><\/span><\/p>\n

<\/span><\/span><\/p>\n

\u2022<\/span> <\/span><\/span><\/span><\/span>VIH: negativo<\/span><\/span><\/p>\n

<\/span><\/span><\/p>\n

\u2022<\/span> <\/span><\/span><\/span><\/span>AAN: +++ perif\u00e9rico<\/span><\/span><\/p>\n

\u2022<\/span> <\/span><\/span><\/span><\/span>Anti-DNA: positivo<\/span><\/span><\/p>\n

\u2022<\/span> <\/span><\/span><\/span><\/span>Anti-RNP: fuertemente positivo<\/span><\/span><\/p>\n

\u2022<\/span> <\/span><\/span><\/span><\/span>CH50: <50 UI\/ml <\/span>C3: 40 mg\/dl <\/span>C4: 9 mg\/dl<\/span><\/span><\/p>\n

\u2022<\/span> <\/span><\/span><\/span><\/span>Anti Scl-70: positivo<\/span><\/span><\/p>\n

\u2022<\/span> <\/span><\/span><\/span><\/span>ACA: negativo<\/span><\/span><\/p>\n

<\/span><\/span><\/p>\n

<\/span><\/span><\/p>\n

\n\n\n\n\n\n\n\n\n\n\n
\n

Subpoblaciones linfocitos T<\/span><\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Par\u00e1metro<\/span><\/strong><\/p>\n<\/td>\n

\n

% <\/span><\/span><\/strong><\/p>\n<\/td>\n

\n

Valor (cel\/<\/span><\/strong>\u00b5<\/span><\/strong>l)<\/span><\/strong><\/p>\n<\/td>\n

\n

L\u00edmites de Referenc<\/span><\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Leucocitos<\/span><\/strong><\/p>\n<\/td>\n

\n

<\/span><\/p>\n<\/td>\n

\n

3400<\/span><\/strong><\/p>\n<\/td>\n

\n

7500\u00b13000<\/span><\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Linfocitos totales<\/span><\/strong><\/p>\n<\/td>\n

\n

4<\/span><\/strong><\/p>\n<\/td>\n

\n

1394<\/span><\/strong><\/p>\n<\/td>\n

\n

2200<\/span><\/strong>\u00b11000<\/span><\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Linf T total CD3+<\/span><\/strong><\/p>\n<\/td>\n

\n

85<\/span><\/strong><\/p>\n<\/td>\n

\n

1185<\/span><\/strong><\/p>\n<\/td>\n

\n

1400<\/span><\/strong>\u00b1700<\/span><\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Linf TCD4+<\/span><\/strong><\/p>\n<\/td>\n

\n

31<\/span><\/strong><\/p>\n<\/td>\n

\n

432<\/span><\/strong><\/p>\n<\/td>\n

\n

950<\/span><\/strong>\u00b1450<\/span><\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Linf TCD4<\/span><\/strong><\/p>\n<\/td>\n

\n

51<\/span><\/strong><\/p>\n<\/td>\n

\n

711<\/span><\/strong><\/p>\n<\/td>\n

\n

650<\/span><\/strong>\u00b1300<\/span><\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

\u00cdndice CD4\/CD8 0,61 (2,1<\/span><\/strong>\u00b11,1)<\/span><\/strong><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n

<\/span><\/span><\/p>\n

En los ex\u00e1menes complementarios destaca la positividad del perfil seroinmunol\u00f3gico como AAN, Anti DNA, hipocomplementemia. <\/span>Con leucopenia y CD4 bajos.<\/span><\/span><\/p>\n

<\/span><\/span><\/p>\n

\u00bfCu\u00e1l ser\u00eda su diagn\u00f3stico?<\/span><\/span><\/strong><\/p>\n

<\/span><\/span><\/p>\n

– <\/span>\u00dalceras vascul\u00edticas<\/span><\/span><\/p>\n

– <\/span>\u00dalceras vascul\u00edticas + Infecci\u00f3n bacteriana<\/span><\/span><\/p>\n

– <\/span>Infecci\u00f3n por micobacterias tuberculosas<\/span><\/span><\/p>\n

– <\/span>Infecci\u00f3n por micobacterias no tuberculosas<\/span><\/span><\/p>\n

– <\/span>Periarteritis nodosa cut\u00e1nea<\/span><\/span><\/p>\n

– <\/span>Actinomicosis<\/span><\/span><\/p>\n

<\/span><\/span><\/p>\n

\u00bfQu\u00e9 otros ex\u00e1menes solicitar\u00eda?<\/span><\/span><\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"

Nayrin S\u00fanico, Aileen Farreras, Jacobus De Waards, Ricardo P\u00e9rez Alfonzo Instituto Biomedicina. Caracas. Paciente femenino de 29 a\u00f1os, conocida con LES desde hace 13 a\u00f1os, con m\u00faltiples \u00falceras vascul\u00edticas a repetici\u00f3n\u00a0 en miembros inferiores.\u00a0 Ha recibido tratamiento con prednisona: 1 mg\/kg\/d, hidroxicloroquina: 200 mg VO OD y desde hace 1 a\u00f1o metilprednisolona: 16 mg VO …<\/p>\n","protected":false},"author":43,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[132],"tags":[206,207],"class_list":["post-3786","post","type-post","status-publish","format-standard","","category-como-trataria-usted","tag-abscesos","tag-nodulos"],"_links":{"self":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts\/3786","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\/43"}],"replies":[{"embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/comments?post=3786"}],"version-history":[{"count":0,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts\/3786\/revisions"}],"wp:attachment":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/media?parent=3786"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/categories?post=3786"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/tags?post=3786"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}