We present the case of a 31 year-old patient with the diagnosis of lung tuberculosis by lung X-ray and positive acid alcohol resistant bacillus in sputum, who after 10 days of oral treatment with isoniazid, ethambutol, pyrazinamide and rifampicin (RFP), developed severe hemorrhagic manifestations associated with severe thrombocytopenia (2 000/mL) and slight right body hemiparesis. There was complete normalization of platelet count and motor function five days after suspension of the four drugs. We decided to re-expose the patient sequentially to the four drugs and after 12 hours of receiving RFP again developed severe thrombocytopenia (2 000/mL) not occurring with the other three drugs, and normalized completely after 36 hours of drug suspension. Later on, the addition of parenteral streptomycin successfully completed the treatment. The current case demonstrates a not very frequent adver...

This is the case of a 33 years old man with history of homosexual relations and heavy alcohol drinking. Tobacco, marijuana, cocaine, basic paste and cocaine hydrochloride consumption since age 18. Because of human immunodeficiency virus infection he received irregular treatment (2006-2008) with highly active antiretroviral therapy (HAAT), regulated in the past 12 months. As the patient showed positive resistant acid-fast bacilli he received since June 2008 standard antituberculous treatment [2RHZE/4(HR)2)] (R: rifampicin; H: isoniazid; Z: pirazinamide; E: ethambutol) that was withdrawn 6 months later when the patient showed pulmonary negative acid fast bacilli. In March 2009 he felt intense lumbar pain, difficulty in walking, hypertrophy of cervical lymph nodes, cough and fever. Cervical lymph node discharge culture disclosed M. tuberculosis resistant to rifampicin. Imagenology showed se...

Varón de 36 años con diagnóstico de infección VIH-1 por siete años y sin tratamiento que presentó convulsiones generalizadas en los últimos cinco meses y marcada baja de peso. Se le halló hemiparesia izquierda y rigidez de nuca moderada, disartria y un tumor palpable frontoparietal derecho. La tomografía reveló un tumor de 11 x 9 cm en la zona frontal, con edema peritumoral que comprimía los ventrículos laterales y desviaba la línea media en más de 5 mm. La biopsia reveló un linfoma primario difuso, a células B grandes, VEB (+), CD 20 (+), Ki 67:80%. El conteo de CD4 fue 9 células/mm3 y la carga viral VIH fue 54 352 copias/mL. Fue tratado con TARGA, mejorando su condición general y disminuyendo las convulsiones.

Varón de70años, diabético, que desconoce a susfamiliares, conamnesia transitoria de eventos recientes e inestabilidad en la marcha asociada a caídas frecuentes. Dos años antes,tuvo un episodio depresivo y pérdida progresiva de peso. Seis meses antes de su ingreso, presentó alucinaciones visuales e hipotiroidismo. Pálido, con cuadriparesia espástica. Los estudios mostraron una anemia megaloblástica, con niveles séricos muy bajos de vitamina B12, autoanticuerpos para factor intrínseco, células parietales y antiroideos, atrofia cerebral y compromiso de los cordones posteriores de C1 a D5. Tras dosmeses de tratamiento concianobalamina, el paciente recuperó el 50%de su capacidad cognitiva y motora.

This is the story of a 50 year-old male subject with a 7-month illness characterized by myalgia, fatigue, and malaise. 5 months before being admitted to Dos de Mayo National Hospital (HNDM), he developed right pleural effusion requiring pleural drainage (1500-2500 mL/day). While in HNDM, the patient developed bilateral pleural effusion with increased triglycerides. A multiple-slice contrast spiral CT (TEM) of the chest showed mediastinal lymph node enlargement, bilateral pleural effusion, and the presence of fluid within the right posterior mediastinal pleura adjacent to D10-D11-D12, and an osteolytic image in D11 vertebral body. A left axillary lymph node biopsy revealed non- Hodgkin lymphoma (NHL), follicular type with large and small cells. The patient received a diet rich in medium-chain triglycerides and olive oil as a supplement, and he also received chemotherapy (dexamethasone, cy...

We present the case of an 84-year old male farmer, who was diagnosed in 2001 with megaloblastic anemia associated to vitamin B12 deficiency, sensory-motor polyneuropathy in his lower limbs and gastric atrophy with intestinal metaplasia. The patient was treated with a combination including 1000 mcg folic acid and 8 mcg cyanocobalamin. He improved his hemoglobin levels back to normal after 2 months of therapy. One year later, he stooped therapy because he was feeling better. In 2008, anemia and the sensorial motor polyneuropathy reappeared, together with an inadequate perception of normal flavor. At this time studies showed the following: pancytopenia, severe megaloblastic anemia, vitamin B12 deficiency, gastric atrophy, gastric polyps and xanthomas, intestinal metaplasia, serum lipid abnormalities, facial xerosis and generalized white spotted macular lesions (2-3 mm). He was treated with ...

Varón de 36 años con diagnóstico de infección VIH-1 por siete años y sin tratamiento que presentó convulsiones generalizadas en los últimos cinco meses y marcada baja de peso. Se le halló hemiparesia izquierda y rigidez de nuca moderada, disartria y un tumor palpable frontoparietal derecho. La tomografía reveló un tumor de 11 x 9 cm en la zona frontal, con edema peritumoral que comprimía los ventrículos laterales y desviaba la línea media en más de 5 mm. La biopsia reveló un linfoma primario difuso, a células B grandes, VEB (+), CD 20 (+), Ki 67:80%. El conteo de CD4 fue 9 células/mm3 y la carga viral VIH fue 54 352 copias/mL. Fue tratado con TARGA, mejorando su condición general y disminuyendo las convulsiones.

Varón de70años, diabético, que desconoce a susfamiliares, conamnesia transitoria de eventos recientes e inestabilidad en la marcha asociada a caídas frecuentes. Dos años antes,tuvo un episodio depresivo y pérdida progresiva de peso. Seis meses antes de su ingreso, presentó alucinaciones visuales e hipotiroidismo. Pálido, con cuadriparesia espástica. Los estudios mostraron una anemia megaloblástica, con niveles séricos muy bajos de vitamina B12, autoanticuerpos para factor intrínseco, células parietales y antiroideos, atrofia cerebral y compromiso de los cordones posteriores de C1 a D5. Tras dosmeses de tratamiento concianobalamina, el paciente recuperó el 50%de su capacidad cognitiva y motora.

This is the story of a 50 year-old male subject with a 7-month illness characterized by myalgia, fatigue, and malaise. 5 months before being admitted to Dos de Mayo National Hospital (HNDM), he developed right pleural effusion requiring pleural drainage (1500-2500 mL/day). While in HNDM, the patient developed bilateral pleural effusion with increased triglycerides. A multiple-slice contrast spiral CT (TEM) of the chest showed mediastinal lymph node enlargement, bilateral pleural effusion, and the presence of fluid within the right posterior mediastinal pleura adjacent to D10-D11-D12, and an osteolytic image in D11 vertebral body. A left axillary lymph node biopsy revealed non- Hodgkin lymphoma (NHL), follicular type with large and small cells. The patient received a diet rich in medium-chain triglycerides and olive oil as a supplement, and he also received chemotherapy (dexamethasone, cy...

We present the case of an 84-year old male farmer, who was diagnosed in 2001 with megaloblastic anemia associated to vitamin B12 deficiency, sensory-motor polyneuropathy in his lower limbs and gastric atrophy with intestinal metaplasia. The patient was treated with a combination including 1000 mcg folic acid and 8 mcg cyanocobalamin. He improved his hemoglobin levels back to normal after 2 months of therapy. One year later, he stooped therapy because he was feeling better. In 2008, anemia and the sensorial motor polyneuropathy reappeared, together with an inadequate perception of normal flavor. At this time studies showed the following: pancytopenia, severe megaloblastic anemia, vitamin B12 deficiency, gastric atrophy, gastric polyps and xanthomas, intestinal metaplasia, serum lipid abnormalities, facial xerosis and generalized white spotted macular lesions (2-3 mm). He was treated with ...

We present the case of a 38 year-old male, farmer, born in Lamas, San Martin (Peruvian jungle), who for the past 8 months suffered of diarrhea, intermittent fever, abdominal pain, weight loss and severe anemia. On admission the patient was lucid and exhibited malaise, pallor and generalized lymphadenopathy (size less than 0.5 cm) hepatosplenomegaly and abdominal displaceable dullness. Abdominal computed tomography showed hepatosplenomegaly and retroperitoneal, mesenteric and other adenopathies. Node biopsy revealed Reed-Sternberg cells, mononuclear cells, eosinophiles and scarce lymphocytes. Immunohistochemical node staining was positive for CD15 and CD30 antibodies. Bone biopsy showed diffuse fibrosis, mononuclear cells and scarcity of lymphocytes. In situ hybridization for EBV Epstein Barr virus was positive in neoplastic cells.

A case of a 48 year-old male with uncontrolled type 2 diabetes mellitus for the past ten years who presented pulmonary tuberculosis by clinical, radiographic signs and Mycobacterium tuberculosis sputum culture, sensitive to first line treatment drugs, is reported. He received standard treatment with isoniazid, rifampicin, ethambutol, pyrazinamide showing two months later drug hypersensitivity consisting in generalized skin rash, pruritus, positive Coombs anemia, eosinophilia and systemic symptoms compatible with DRESS syndrome (drug rash with eosinophilia and systemic symptoms). The antituberculous drugs were suspended and systemic antihistaminic drugs and corticoids were administered with remission and improvement of symptoms. Afterwards individualized treatment scheme for tuberculosis consisting in minimal hemato-hepatotoxic drugs similar to those indicated to immunosuppressed patients...

Mujer de 42 años de edad, con tres años de enfermedad caracterizada por episodios de tos productiva, fiebre y disnea, tratada con antibióticos por infecciones bronquiales recurrentes que coincidían con episodios de ruborfacial, diarreas acuosas, de una a dos veces por mes, de carácter autolimitado. Presentó episodios de hemoptisis leve. Pese a tener frotis negativo para M. tuberculosis, recibió tratamiento por supuesta tuberculosis pleural, en un centro de salud, sin mejoría clínica, por lo que fue hospitalizada. La radiografía de tórax mostró atelectasia del lóbulo medio e inferior derecho. La tomografía evidenció neoproliferación hiliobasal derecha con marcada captación de medio de contraste, linfonodos metastásicos en hilioy mediastino derecho, incluidos los del grupo subcarinal, con atelectasia crónica en lóbulo medio con bronquiectasias cilíndricas. En la primer...

Mujer de 42 años de edad, con tres años de enfermedad caracterizada por episodios de tos productiva, fiebre y disnea, tratada con antibióticos por infecciones bronquiales recurrentes que coincidían con episodios de ruborfacial, diarreas acuosas, de una a dos veces por mes, de carácter autolimitado. Presentó episodios de hemoptisis leve. Pese a tener frotis negativo para M. tuberculosis, recibió tratamiento por supuesta tuberculosis pleural, en un centro de salud, sin mejoría clínica, por lo que fue hospitalizada. La radiografía de tórax mostró atelectasia del lóbulo medio e inferior derecho. La tomografía evidenció neoproliferación hiliobasal derecha con marcada captación de medio de contraste, linfonodos metastásicos en hilioy mediastino derecho, incluidos los del grupo subcarinal, con atelectasia crónica en lóbulo medio con bronquiectasias cilíndricas. En la primer...

We report the case of a 31 year-old male from Cajamarca, Peru, with cognitive problems since childhood, who at 12 year-old developed increased volume and deformation of his right lower limb and to a lesser extent of his left, associated to massive skin folding, growth of subcutaneous nodules, elephantine look due to nerve cords formation in thigh and leg, pain and functional walking limitation. Concomitantly generalized skin café au lait spots, subcutaneous nodules, and Lisch nodules in both irides. Magnetic resonance and contrast TAC revealed abundant uniform plexiform nodules in abdomino-pelvic cavity forming masses and cords that continued throughout his thigh as lumps and cords. In addition, the patient presented bone dysplasia (thinning of femur and tibia cortex, pseudoarthrosis, new left cotyle formation). Contrast magnetic resonance showed triventricular normotensive hydrocephalu...