50-year-old male with 80 kg body weight, non-ADPV, diagnosed with chronic hepatitis C probable elevation (HCV type 1a, IL-B28 Child CC polymorphism), fibrosis grade F4 (Fibroscan 36.8KPa), portal
His history included hemococytosis (H63D mutation in heterozygosis) with iron overload controlled by performing colds, type II diabetes mellitus in treatment with insulin and presence of metformin and small cord syndrome A.
Analytical data show the following values: Hemoglobin, Stage g/dl, alkaline phosphatase 39, Moderate 106.3%, Leucocytes 108, Platelets for IL-5, IL-144, Liverdfattin
binding to IFN monotherapy and subsequently to P-INF associated with RBV is a candidate for triple therapy with boceprevir.
Start lead in with oral RBV 1000 mg/day and subcutaneous P-INF α2b 120 mcg/week.
It did not exceed the lead in phase (CV=33,680 IU RNA/ml), so treatment was discontinued at 5 weeks without initiating boceprevir.
After the last injection of P-INF α2b, the patient came to the emergency department complaining of hematoma and local pain in the anterior aspect of the right thigh with increased volume and local temperature, and pain when moving the right hip.
Two days later he returned to the emergency department with functional impotence and dysthermic sensation.
Medium echography showed a hypoechogenic ovoid image of 21x19x9 mm. Subsequently, a computerized axial tomography showed an image compatible with soft tissue infection, as well as an abscess in the anterior muscle compartment.
The patient was treated with antibiotics (piperacillin/taxamethasone 4g/0.5g/8 hours and daptomycin 500mg/24 hours intravenously for 3 days) and surgical debridement was performed.
After surgery with complications, the patient was not admitted to the intensive care unit (ICU).
The ICU presented septic shock complicated with multiorgan dysfunction syndrome.
In muscle abscess cultures methicillin-sensitive Staphylococcus aureus was isolated, which was treated with linezolid (600mg/12 hours intravenous) and subsequently with cloxacillin (1g/6 hours intravenous) for 15 days.
Later acute respiratory distress syndrome requiring invasive mechanical ventilation; Escherichia Coli pneumonia associated with mechanical ventilation with active gastrointestinal bleeding mel bleeding with non-severe gastrointestinal haemorrhage with focal hepatic failure (1000mg/8hours intravenous)
The patient continued with basal and bilateral alveolar-interstitial infiltrates in the basal region and radiological findings in Klebsiella pneumoniae was isolated, which produces a broad spectrum of beta-acid colitis.
Despite directed treatment (intravenous and inhaled colistin adjusted for renal function) for another 4 days, the patient developed severe acute respiratory failure, multiple organ dysfunction with severe lactic acidosis and refractory septic shock and finally died.
