{"id":6345,"date":"2009-02-13T08:47:35","date_gmt":"2009-02-13T12:47:35","guid":{"rendered":"http:\/\/piel-l.org\/blog\/?p=6345"},"modified":"2009-02-14T07:56:10","modified_gmt":"2009-02-14T11:56:10","slug":"consulta-a-un-colega-n2-caso-para-diagnostico","status":"publish","type":"post","link":"https:\/\/piel-l.org\/blog\/6345","title":{"rendered":"Consulta a un Colega N\u00ba2. Caso para diagn\u00f3stico"},"content":{"rendered":"<p align=\"justify\"><strong><em>Dra.  Raquel M Ramos. Centro Policl\u00ednico La Vi\u00f1a. Valencia<br \/>\n <\/em><\/strong><em><strong>Dra.  Bego\u00f1a F. Conejero. Hospital Metropolitano del Norte. <\/strong> <br \/>\n <strong>Valencia.<\/strong><\/em><strong><\/strong><\/p>\n<p align=\"justify\">Me  encontraba con la Dr. Bego\u00f1a Conejero, y me invit\u00f3 al terminar la  cirug\u00eda a evaluar una paciente que hab\u00eda ingresado el d\u00eda  anterior. Se trata de una preescolar femenina de 3 a\u00f1os, quien  ingresa febril (39,2 \u00baC).<\/p>\n<p align=\"justify\"><!--more--><\/p>\n<p><span style=\"text-decoration: underline;\">Antecedente  Personales<\/span><\/p>\n<p align=\"justify\">&#8211;   Producto de I gesta, embarazo controlado.<\/p>\n<p align=\"justify\">&#8211;  Diabetes mellitus tipo I desde hace 1 a\u00f1os, en tratamiento con  insulina BID.<\/p>\n<p align=\"justify\">&#8211;  Esquema de Vacunaci\u00f3n completo.<\/p>\n<p align=\"justify\"><strong>\u00bfCu\u00e1l  es tu diagn\u00f3stico?<\/strong><\/p>\n<p align=\"justify\"><strong>\u00bfCu\u00e1l  ser\u00eda tu conducta?<\/strong><\/p>\n<div id='gallery-1' class='gallery galleryid-6345 gallery-columns-2 gallery-size-thumbnail'><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/02\/225-2-1.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/02\/225-2-1-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" \/><\/a>\n\t\t\t<\/div><\/figure><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/02\/225-2-2.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/02\/225-2-2-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" \/><\/a>\n\t\t\t<\/div><\/figure><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/02\/225-2-3.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/02\/225-2-3-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" \/><\/a>\n\t\t\t<\/div><\/figure><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/02\/225-2-4.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/02\/225-2-4-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" \/><\/a>\n\t\t\t<\/div><\/figure><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/02\/225-2-5.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/02\/225-2-5-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" \/><\/a>\n\t\t\t<\/div><\/figure><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/02\/225-2-6.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/02\/225-2-6-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" \/><\/a>\n\t\t\t<\/div><\/figure><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/02\/225-2-7.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/02\/225-2-7-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" \/><\/a>\n\t\t\t<\/div><\/figure><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/02\/225-2-8.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/02\/225-2-8-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" \/><\/a>\n\t\t\t<\/div><\/figure>\n\t\t<\/div>\n\n<p><br class=\"spacer_\" \/><\/p>\n<p align=\"justify\">\u00a0<\/p>\n<p align=\"justify\"><strong>PLAN  DE TRABAJO<\/strong><\/p>\n<p align=\"justify\">1-Hospitalizaci\u00f3n<\/p>\n<p align=\"justify\">2-Evaluaci\u00f3n  por Dermatolog\u00eda.<\/p>\n<p align=\"justify\">3-  Evaluaci\u00f3n por Infectolog\u00eda pedi\u00e1trica.<\/p>\n<p align=\"justify\">4-  Evaluaci\u00f3n por Endocrinolog\u00eda pedi\u00e1trica.<\/p>\n<p align=\"justify\"><strong>Ex\u00e1menes  de laboratorio.<\/strong><\/p>\n<p align=\"justify\"><strong>D\u00eda  05-04-2008<\/strong><\/p>\n<p>*Hematologia  Completa.<\/p>\n<p>Hb.  15,3<\/p>\n<p>GB:  18.800   Segmentados: 68%, Linfocitos: 24%, Monocitos:5%,<\/p>\n<p>Eosin\u00f3filos:  3%<\/p>\n<p>Plaquetas:  368.000<\/p>\n<p>*Qu\u00edmica  Sangu\u00ednea<\/p>\n<p>Glicemia:  115 mg\/ml<\/p>\n<p lang=\"en-GB\" xml:lang=\"en-GB\">TGO.  21  TGP:9<\/p>\n<p lang=\"en-GB\" xml:lang=\"en-GB\">*VSG  22mm<\/p>\n<p lang=\"en-GB\" xml:lang=\"en-GB\">*PC  Reactiva 9,6<\/p>\n<p>*Gram  de lesiones de Piel: Cocos Gram +, en pares , aislados, escasos por  campo. PMN incontables.<\/p>\n<p>*Directo  KOH 10%: No se observaron hifas ni blastoconidias.<\/p>\n<ul>\n<li>\n<p>Cultivo  \ty Antibiograma de Secrecion de Piel: Microorganismo  Estreptococcus <em>viridans<\/em>,  \tsensible a ampicilina, ampicilina sulbactam,  \tgentamicina,vancomicina.<\/p>\n<\/li>\n<\/ul>\n<p>*Hemocultivo:  No hubo crecimiento bacteriano a las 120 horas.<\/p>\n<p>*Urocultivo:  E . <em>coli<\/em>.  Se detect\u00f3 producci\u00f3n de <em>B<\/em> lactamasa de espectro extendido. El uso de cefalosporinas en este  tipo de cepas se ha asociado a fracaso terap\u00e9utico.<\/p>\n<p>Al  momento del ingreso y antes de tener resultados de laboratorio se  indica administraci\u00f3n de Oxacilina. En vista de obtener en el Gram   de piel cocos Gram + se pasa a Ceftriazona 700 mg IV cada 12 horas.<\/p>\n<p>Se  obtuvo buena evoluci\u00f3n a pesar de que en orina hab\u00efa E coli, con  producci\u00f3n de enzima beta lactamasas.<\/p>\n<p>SE  administro soluci\u00f3n dilu\u00edda con betadine para lavar a la paciente y  aplicaci\u00f3n de emolientes y bacitracina ung\u00fcento.<\/p>\n<p><strong>D\u00eda  06-04-2008<\/strong><\/p>\n<p>Orina:  Glucosuria 4 +, cetonuria y PSEDOHIFAS.<\/p>\n<p>Se  decide introducci\u00f3n de Fluconazol 140 mg VEV dilu\u00eddo, diclofenac  pot\u00e1sico, protector g\u00e1strico y acetaminof\u00e9n.<\/p>\n<p>Se  sigue administrando emolientes y bacitracina en piel.<\/p>\n<p><strong>D\u00eda  08-04-2008<\/strong><\/p>\n<p><span style=\"text-decoration: underline;\">Hematolog\u00eda  completa:<\/span><\/p>\n<p>HB:  11,6  Globulos Blancos: 14.700  Seg: 56%, Linf: 26%, Mon:<\/p>\n<p>11%, Eosin: 7%.<\/p>\n<p><span style=\"text-decoration: underline;\">Qu\u00edmica  Sangu\u00ednea<\/span><\/p>\n<p>Glicemia:  100 mg\/dl<\/p>\n<p>Creatinina:  o,2<\/p>\n<p lang=\"en-GB\" xml:lang=\"en-GB\">TGO:  12  TGP: 15<\/p>\n<p lang=\"en-GB\" xml:lang=\"en-GB\">Prot  C Reactiva: 5,7<\/p>\n<p>VSG:  16,25<\/p>\n<p>Mejor\u00eda  de las lesiones cut\u00e1neas. Se administra combinaci\u00f3n de esteroides y  antimic\u00f3ticos locales.<\/p>\n<p><strong>D\u00efa  11-04-2008<\/strong><\/p>\n<p><span style=\"text-decoration: underline;\">Hematolog\u00eda  completa:<\/span><\/p>\n<p>HB:  12.2<\/p>\n<p>Gl\u00f3bulos  Blancos: 10.100  Seg: 49%; Linf: 38%, Mon: 4%, Eos: 9%<\/p>\n<p><span style=\"text-decoration: underline;\">VSG:  14,5%<\/span><\/p>\n<p><span style=\"text-decoration: underline;\">Prot  C reactiva<\/span>: 3,4<\/p>\n<p>En  vista de la mejor\u00eda cl\u00ednica y de laboratorio se decide el alta de  la paciente.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Dra. Raquel M Ramos. Centro Policl\u00ednico La Vi\u00f1a. Valencia Dra. Bego\u00f1a F. Conejero. Hospital Metropolitano del Norte. Valencia. Me encontraba con la Dr. Bego\u00f1a Conejero, y me invit\u00f3 al terminar la cirug\u00eda a evaluar una paciente que hab\u00eda ingresado el d\u00eda anterior. Se trata de una preescolar femenina de 3 a\u00f1os, quien ingresa febril (39,2 &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-6345","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\/6345","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=6345"}],"version-history":[{"count":0,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts\/6345\/revisions"}],"wp:attachment":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/media?parent=6345"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/categories?post=6345"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/tags?post=6345"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}