A 33-year-old man with an urban residence in the Araucanía Region with no relevant morbid history was admitted to the hospital Dr. Hernríque Generalized Hospital for rural nausea, recently complaining of myalgia.
The admission exams showed hematocrit of 47%, leukocytes 5600/mm3 and platelets 60,000/mm3 with diffuse bilateral interstitial infiltrates on chest X-ray.
Given the clinical picture and epidemiological history, a hantavirus cardiopulmonary syndrome was proposed, confirming the diagnostic suspicion by a specific rapid test (IgM immunochromatography).
Supportive management was initiated and 1 g/day of intravenous methylprednisolone was indicated for 5 days.
Established myocardial dysfunction requiring high doses of vasoactive drugs.
He developed pneumonia associated with mechanical ventilation during his hospital stay, initially treated with imipenem, vancomycin and amikacin.
In the bronchial secretion culture resistant Staphylococcus aureus was isolated, changing vancomycin to linezolid.
On the sixth day of hospitalization, progressive jaundice with hyperbilirubinemia (13.9 mg/dL) with a direct predominance (12.4 mg/dL), an increase in the same acute episode, was observed on ultrasound (854 U/dL).
During the second and third week, the patient remained febrile with the appearance of crusted lesions on the trunk and face, one of them of nasal location.
Blood cultures and endotracheal aspirate were obtained, which were informed as positive for Candida albicans and Pseudomonas aeruginosa respectively, adding the antimicrobial scheme coverage with anidula for C. albicans and cefoperazone/sul sealant.
She remained severe, although afflicted with cardiopulmonary support, requiring less ventilatory support, with modification of the parameters of vasoactive amines and vasoactive amines.
During the fourth week of hospitalization, the appearance of an ulcerated lesion on the nasal dorsum, necrotic background and irregular edges was described, as well as a sacral sacral ridge and others on the heels.
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The patient continued affliction and was treated with cefoperazone/ sulfonylurea and anidulaline.
A culture of the nasal lesion was reported as positive for C. albicans.
Biopsy of the same lesion showed abundant hyphae-like mycotic elements, compatible with mucus, in a fragment of the nasal wing.
With these results, anidulaline was discontinued and amphotericin B deoxycholate therapy was initiated in a dose adjusted according to renal function (creatininemia: 3 mg/dL).
Fundus examination, computed axial tomography (CAT) of the brain and paranasal sinuses did not demonstrate the concomitance of deep lesions.
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He remained severely ill with severe jaundice (total bilirubin: 21 mg/dL, direct bilirubinemia: 19 mg/dL, AST: alkaline U/L: 854
Abdominal-pelvic CT showed diffuse hepatomegaly without progression, with a conserved biliary tract structure.
A chest CT scan showed extensive pleural effusion to the left and ipsilateral pulmonary collapse.
Puncture of this effusion gave rise to fluid he did not clot and a pleural drainage tube was installed.
On the following days, fever appeared, in anuria, with high requirements of ventilatory and hemodynamic support.
The patient died, having completed five days of treatment with amphotericin B and after two surgical aspirations of the nasal lesion.
