Powered by TCPDF (www.tcpdf.org) Case reports 2017; 3(2) Editorial: CASE REPORTS José Ricardo Navarro-Vargas Universidad Nacional de Colombia Bogotá Campus Faculty of Medicine Department of Surgery Bogotá, D.C. – Colombia Corresponding author José Ricardo Navarro-Vargas Departamento de Cirugía Facultad de Medicina Universidad Nacional de Colombia Bogotá. Colombia. Email: [email protected] https://doi.org/10.15446/cr.v3n2.69219 Case reports Vol. 3 No. 2: 57-9 58 Observing and recording that which may be amazement, since a control group represents relevant and disseminating it through a con- the expected course of the disease regarding crete and well-written text are the teachings the occurrence of a new phenomenon. All of Charles Darwin (1809-1882) and William this makes it necessary to review the literatu- Osler (1849-1919). Darwin published one of re and make new associations, new interpre- the greatest scientific books of all time, On the tations, generate new knowledge. Origin of Species (1859), which was the re- For example, the case of Mary Mallon (bet- sult of multiple observations written down by ter known as Typhoid Mary) was groundbrea- the author on a daily basis. For his part, Osler king, since she was the first patient diagno- was an outstanding doctor, a great semiolo- sed as a healthy carrier of Salmonella Typhi in gist, the father of modern medicine, and did North America. However, thanks to the report not waste a moment to write down his scien- of 53 infected patients and 3 deaths who tific concerns and make them public. had contact with her through her services as Evidence-based medicine displaced case a cook, the necessary associations could be series and case reports in the medical literatu- established from a public health perspective re. However, according to Vandenbroucke, “all and she was left in quarantine (at that time, it kinds of research have a place in science, as was the best treatment to prevent the trans- well as their own space”, in other words, they mission of contagious diseases). must be understood as complementary to me- In order to prepare a good case report, it is dical research. Reporting particular or rare di- necessary to ask the following questions: why seases is one of the objectives of case reports, exactly is this observation important? What but it is not the only one, since many of them teaching does it bring? Do you object to any have served as the basis for the development previous evidence? Is it against some scienti- of major controlled clinical trials that have led to fic concept or current evidence? Is there any discover and describe new diseases, pharma- unexpected association? Was it a provoked cological side effects (beneficial or deleterious), observation that led to study a mechanism? the mechanisms of diseases, to provide educa- Can this mechanism be generalized? Is it a tion and promote medical audit, and to recogni- rare entity that, if reported, brings a great bene- ze rare manifestations of certain diseases. fit to the scientific community and to patients? Some researchers consider case reports Once these questions have been answered, it as the first line of evidence-based medicine is recommended to follow the IMRaD format research. For example, finding a strange coa- (Introduction - Methods - Results –and - Dis- gulation property in a person coming from a cussion), although it is not always the most family that has had multiple venous thrombo- appropriate method to report a case or series sis events led to discover activated protein C of cases. resistance, which is the most frequent cause This issue presents case reports as broad of the congenital anomaly that leads to deep as medicine itself: spontaneous pneumome- vein thrombosis: Factor V Leiden. diastinum, Ekbom’s syndrome, appendiceal Case reports foster new ideas, new pro- cystic dilation, pulmonary paracoccidioidomy- posals and new theories; they allow to indu- cosis and septic shock in an immunocompe- ce, infer, and even develop new projects from tent patient, congenital laryngeal saccular cyst, editorial splenic rupture associated with thrombocyto- As you can see, case reports will continue 59 penic purpura due to mononucleosis infection, to give us a lot to talk and teach about, I would dissection of ascending aorta in a patient with say, forever, since they are the starting point Marfan syndrome, and vesicular agenesis and for macro studies done with the best available choledocholithiasis. clinical evidence. Case reports 2017; 3(2) https://doi.org/10.15446/cr.v3n2.62212 PULMONARY PARACOCCIDIOIDOMYCOSIS ASSOCIATED WITH SEPTIC SHOCK IN AN IMMUNOCOMPETENT PATIENT. CASE REPORT Keywords: Paracoccidioidomycosis, Fungus, Paracoccidioides, amphotericin B, Sepsis, Klebsiella pneumoniae. Palabras clave: Paracoccidioidomicosis; Hongo; Paracoccidioides; Anfotericina B; Sepsis; Klebsiella pneumoniae. Freddy Mauricio Quintero-Álvarez Juan Pablo Báez-Duarte Jessica Paola Montes-Ortíz Sergio Andrés Mendinueta-Giacometto Emergency Service Hospital Universitario de Santander Bucaramanga – Colombia. José Mauricio García-Habeych Department of Internal Medicine Faculty of Health Universidad Industrial de Santander Bucaramanga – Colombia. Corresponding author: Freddy Mauricio Quintero-Álvarez. Email: [email protected] Received: 26/1/2017 Accepted: 25/7/2017 pulmonary paracoccidioidomycosis associated with septic shock ABSTRACT described in 1908 by Adolfo Lutz. This is a 61 chronic granulomatous disease caused by Introduction. Paracoccidioidomycosis (PCM) the dimorphic fungus known as Paracoc- is a chronic granulomatous disease caused by cidioides brasiliensis. It is endemic in Latin the dimorphic fungus known as Paracoccidioi- America, with predominance in Brazil —with des brasiliensis. This entity compromises main- the highest incidence in the southeast of the ly the lungs, but can spread to other organs, country— followed by Venezuela, Colombia, with particular trophism, through oral mucosa, Ecuador and Argentina. (1). The dimorphic adrenal glands, lymph nodes, among others. fungus grows as a yeast in the tissues of the host and in cultures at 36-37ºC, but it devel- Case presentation. This paper reports ops as a slow growing mold at temperatures the case of a male patient with pulmonary <28ºC (2). PCM treated at the Hospital Universitario de This disease compromises mainly the lungs, Santander. The patient was admitted with ini- but can spread to other organs, with particular tial suspicion of active pulmonary tuberculo- trophism, through oral mucosa, adrenal glands, sis due to the presence of multiple cavitations reticuloendothelial system, skin and bones. (3) and nodules of random distribution in the lung This paper reports a case of pulmonary PCM in parenchyma observed in the chest tomogra- an immunocompetent patient —a rare disease phy, and subsequent isolation of yeasts com- in Colombia— who was diagnosed in a tertiary patible with Paracoccidioides. Amphotericin care hospital in Santander, Colombia, and had B deoxycholate was administered without fa- a fatal outcome. vorable outcomes and development of septic shock by extended spectrum Klebsiella pneu- CASE PRESENtatiON moniae. In spite of multi-conjugate antibiotic management, the patient presented multiple 67-year-old mestizo male from the rural area organ failure syndrome with fatal outcome at of the municipality of Aratoca (where tem- 21 days of hospitalization. peratures vary between 16ºC and 26ºC), who worked as a farmer (mostly in coffee Conclusion. Pulmonary PCM is an endemic crops), with unclear pathological history of disease that leads to an inadequate immune epilepsy without treatment, chronic smoking response of the host that —along with risk associated with regular consumption of alco- factors such as smoking, alcohol abuse, mal- holic drinks, and without exposure to individ- nutrition and low socioeconomic status— fa- uals with a history of tuberculosis. cilitates the onset of life-threatening infec- The patient visited a primary health cen- tions or coexisting diseases. Timely diagnosis ter referring symptoms of 4 months evolution based on early clinical suspicion potentially including productive cough with mucopuru- influences the patient’s survival. lent expectoration, progressive dyspnea even when putting small efforts, fever, chills and un- INTRODUCTION intentional progressive weight loss. He stated that the symptoms exacerbated 7 days before Paracoccidioidomycosis (PCM), also known with hemoptoic cough and evening diaphore- as South American blastomycosis, was first sis. The patient was referred to a secondary Case reports Vol. 3 No. 2: 60-9 62 care health center where a chest x-ray was intracytoplasmic vacuoles with multiple or performed, showing abundant alveolar opaci- chain budding. The results were compatible ties in both pulmonary fields, formation of dif- with paracoccidioides, so he was assessed fuse pneumatoceles, and signs of air trapping by the internal medicine service and referred (Figure 1). A sputum KOH test was performed, to the Hospital Universitario de Santander due reporting a double refractory wall of yeast with to the high risk of ventilatory failure. Figure 1. Chest x-ray with abundant alveolar opacities in both lung fields with formation of pneumatoceles. Source: Own elaboration based on the data obtained in the study. On physical examination at admission, the ation ELISA technique. Three serial sputum patient presented with respiratory distress at smears were performed, which reported neg- rest despite