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Caso Nº 158 Abril 20, 2011 (Caso con respuesta)

Caso Nº 158 Abril 20, 2011 (Caso con respuesta)

 

158-1p 158-2p 158-3p
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El paciente trae reporte de biopsia:.

biopsiap

Perfil de laboratorio : dentro de límites normales

Serología hepatitis , B,C y HIV : negativos.

Cual es su diagnóstico?

Cual sería su conducta terapeútica ?


Respuesta al Caso

1. El diagnóstico tanto por clínica como por biopsia corresponde a Un Liquen Plano Diseminado
2. Cushing Secundario por esteroides sistémicos y tópicos por varios años.

Exámenes complementarios:
Rutina de laboratorio y serologías incluido hepatitis B y C normales
Tratamiento:
Se dicidió iniciar tratamiento con ciclosporina a razón de 5 mg/kg dia por 1 mes y 3 mg/kg/día por 1 mes y 2.5mg/kg/día por 1 mes con excelente evolución y omisión del tratamiento.
Se realizó control diario de la Tensión Arterial y creatinina sérica cada 15 dias, : normal
Actualmente está en remisión.

158r1p 158r6p 158r3p
158r4p 158r2p

Francisco Gonzalez
Hospital de Clínica Caracas

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Caso Nº 157 Abril 13, 2011 (Caso con respuesta)

Caso Nº 157 Abril 13, 2011 (Caso con respuesta)
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Datos Laboratorio

  • Hb:13,7 gr/dl Hto:45,2
  • Plaquetas:258000/mm3
  • PT: 0,91 PTT: 2 Fibrinógeno:256,8
  • Leucocitos DLN
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  • Cual es su Diagnóstico
  • Cual sería su Conducta Terapeútica
  • Solicitaría algún examen complementario

 

Dra. Ana María Sáenz de Cantele
Dra. Antonietta Cirocco
Dra. Rosmary Martín
Dra. Elisa Sciamanna
Dr. Francisco González
Cátedra de Dermatología
Hospital Universitario de Caracas
Universidad Central de Venezuela

 


 

Respuesta:

 respuesta-caso-157-ANGIOMA-EN-PENACHO.pdf  

 

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Oral Corticosteroid Use Is Effective for Cutaneous Hemangiomas An Evidence-Based Evaluation

Objectives: To determine the efficacy of systemic corticosteroid therapy in treating enlarging, problematic cutaneous hemangiomas and to assess the relationship of dose to response and adverse effects.

Design: A quantitative systematic literature review was performed and inclusion and exclusion criteria were applied.

Setting: Patients were treated in primary care, referral centers, and institutional practices. Most patients were ambulatory, although some required hospitalization.

Patients: Inclusion criteria were original case series with a minimum of 5 patients with enlarging, problematic cutaneous
hemangiomas treated with systemic corticosteroids.

Exclusion criteria were being older than 2 years, receiving simultaneous other treatments, being lost to follow-up, or having insufficient information.

Twenty-four original case series met inclusion criteria; 10 case series remained (184 patients) after exclusion criteria were applied.

Intervention: Patients were given a mean prednisone equivalent daily dose of 2.9 mg/kg (95% confidence interval [CI], 2.7-3.1 mg/kg) for a mean of 1.8 months (95% CI, 1.5-2.2 months).

Main Outcome Measures: Response and rebound rates and dose-response and adverse effects–response relationships
in responders vs nonresponders.

Results: Response was 84% (95% CI, 78%-89%; range, 60%-100%) and rebound was 36% (95% CI, 29%-44%;
range, 0%-65%). A significant difference was found between the mean dose administered to responders vs nonresponders (P,.001). No significant difference was observed as to the occurrence of adverse effects (P=.3).

Conclusion: Systemic corticosteroid treatment seems to be effective for problematic cutaneous hemangiomas of infancy.

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Kasabach-merritt phenomenon: a retrospective study of treatment with vincristine

 

Erratum in:

J Pediatr Hematol Oncol 2002 Dec;24(9):794.
 

Haisley-Royster C, Enjolras O, Frieden IJ, Garzon M, Lee M, Oranje A, de Laat PC, Madern GC, Gonzalez F, Frangoul H, Le Moine P, Prose NS, Adams DM.
Duke University Medical Center, Durham, NC, USA.

PURPOSE: Kasabach-Merritt phenomenon (KMP) is characterized by profound thrombocytopenia, microangiopathic hemolytic anemia, a consumptive coagulopathy, and an enlarging vascular lesion. The syndrome develops in infancy and is associated with a high morbidity and mortality rate. The purpose of this study was to assess the effectiveness of vincristine in the treatment of KMP.

METHODS: We retrospectively reviewed the clinical and laboratory data of 15 patients with KMP treated with vincristine at 9 institutions across the United States, South America, and Europe.

RESULTS: All 15 patients had profound thrombocytopenia and consumption of fibrinogen at presentation. Ten patients had biopsies of their lesions, and results included five (33.3%) kaposiform hemangioendotheliomas, three (20%) tufted angiomas, one lesion (6.7%) with features of both kaposiform hemangioendothelioma and tufted angioma, and one (6.7%) unclassified vascular tumor. All 15 patients had an increase in platelet count of at least 20,000 with an average response time of 4.0 weeks after initiation of vincristine therapy. Thirteen patients had an increase in fibrinogen level of 50 mg/dL with an average response time of 3.4 weeks. In 13 patients there was a significant decrease in the size of the vascular lesion. The average duration of treatment was 21.5 (+/-12.6) weeks. Four patients (26%) relapsed. All four were successfully treated with a second course of vincristine. Complications included one patient with abdominal pain, one patient with transient loss of deep tendon reflexes, and one patient with irritability.

CONCLUSION: Vincristine presents a safe and sometimes effective treatment option in the management of KMP.

 

 

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Caso Nº 156 Abril 05, 2011 (Caso con Respuesta)

Caso Nº 156 Abril 05, 2011 (Caso con Respuesta)

 

caso-154-2s caso-154-3s

Francisco Gonzalez
Rosmary Martin
Hospital de Clinica Caracas

 


 

Respuesta al caso

Se concluyó el caso como un Eritema Multiforme Menor asociado a Herpes Virus,(EMAH)

No fue necesario realizar examenes complementarios ya que los aportes de la historia y la clínica son suficientes para el diagnóstico.

Inicialmente se indicó :

1. Prednisona 10mg /d v.o por 6 días
2. Aciclovir 1 gr/dia por 5 días y luego 400 mg/día por 1 año.
3. Compresas de agua con Manzanilla en mucosa labial y Povidine solución.

Archivo adjunto:

 Herpes-Associated-Erythema-Multiforme.pdf 85.88 Kb
William L Weston 

 

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