A 78-year-old male was admitted to Internal Medicine of the hospital from external consultations, reporting an increase in the number and volume of stools of 2 months of evolution, along with a loss of 8-10 kg of weight.
Initially, it was attributed to Clostridium difficile infection (ELISA and positive culture), and was treated with metronidazole, obtaining an initial improvement in the gastrointestinal condition, but without achieving complete remission of the disease, with 8-10 added liquid consistency.
She did not present fever, nausea, vomiting or oral intolerance, only liquid deposition each time she ingested food, during the last 3-4 months she had lost 8-10 kg. Among her personal history she was diagnosed with leukemic phase C
He was currently on stront diet without salt, Omeprazole 20 mg: 1-0-0; Preupdia® Mass: 1-1-1; Vitamin D3: 6 drops/1⁄2nis® 6,25; Coropré1⁄2® 6,25
Physical examination revealed TA 130, Fc 80 bpm, apyretic, height 176 cm, weight 69 kg, BMI 22.
Dry mucous membranes, cervical lymphadenopathy stable.
Pulmonary hypoventilation bases.
Abdominal: 2 cm hepatomegaly with splenic border 5-6 cm from the costal margin.
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The laboratory tests performed at admission showed hypoproteinemia, anemia, lymphopenia with elevated inflammatory markers (see Table November).
Complementary tests performed during admission were: hepatic ultrasound chronic liver disease with signs of portal hypertension.
Cholestasis.
Dilatation of the axis is facial-causal.
Not free peritoneal fluid.
Cholelithiasis.
Multiple simple renal cysts.
Oral endoscopy was normal.
Colonoscopy: sessile polyp in transverse colon.
Chest X-ray showed no significant findings.
Duodenal biopsy: no pathological changes.
Red Congo duodenal biopsy: negative.- D-Xylosa: pathological stool elastase: positive stool coprocultive: negative.
Hemoculture and urinocultive: negative.
Faecal parasites were negative.
Enterobacteriaceae serology: negative.
Gastrointestinal transit: no significant alterations.
Bone marrow biopsy: a small monoclonal population, with no relevance.
The patient had incoercible diarrheas with 12-15 stools per day despite the hygienic-dietetic measures, and progressive nutritional deterioration, presenting moderate malnutrition (see table monthly parenteral nutrition kcal), so we decided to introduce the parenteral nutrition
Given the good tolerance, with a decrease in the number of daily stools, 1 or 2, the Feedback Diet is destructive until completing its energy needs 1,600 kcal. At 10 days after the introduction of good enteral nutrition is suspended.
Prior to discharge, previously negative fecal cultures were repeated, with the isolation of Criptosporidium parvum cysts in the feces being the cryptosporidium stain positive.
Stool cysts are seen in the stool.
The patient was treated with good nutritional parameters (see table showing more discomfort for gastrointestinal discomfort, as well as asymptomatic antibiotic tolerance, currently being asymptomatic, we can see the evolution and improvement throughout the initial nutritional treatment (see table month of February) and later specific diarrhea.
