No abstract

Presentamos el caso de un varón de 31 años con diagnóstico de tuberculosis pulmonar por radiografía de torax compatible y examen bacilo ácido alcohol resistente, positivo en esputo, quien 10 días después de iniciar tratamiento oral con isoniazida, etambutol, pirazinamida y rifampicina (RFP), desarrolla un síndrome hemorrágico asociado a trombocitopenia severa (2 000/mL) y paresia leve de hemicuerpo derecho. El paciente normalizó el número de plaquetas y su función motora cinco días después del retiro de los cuatro medicamentos antituberculosos. Al decidirse re-exponer al paciente en forma secuencial a las cuatro drogas, se observó que 12 horas después de haber ingerido RFP oral, desarrolla nuevamente trombocitopenia severa, lo que no ocurrió con las otras tres drogas. Las plaquetas alcanzaron niveles normales 36 horas después del retiro de la RFP. El reemplazo ulterior de RFP por estreptomicina permitió completar exitosamente el tratamiento antituberculoso. El presente caso demuestra un efecto adverso poco frecuente, producido por un fármaco antituberculoso de primera línea, el mismo que debe considerarse como muy grave y cuyo manejo debe incluir la inmediata e indefinida suspensión de la droga en el paciente afectado, a causa de la alta probabilidad de tener la misma respuesta a lo largo de su vida.

Background: A case of sudden unexpected death of an 11-year-old child with tonsillitis illustrates acute myocarditis and the difficulty in diagnosing it.Aims: Consider myocarditis among acute pediatric conditions, suggesting this disease should be included in the differential diagnosis for children who are toxemic critically ill, particularly when they have respiratory symptoms.Methods: A critical review of studies published from 1987 to 2018 was conducted. Relevant studies addressed children with deterioration of a condition initially considered benign and discussed clinical aspects suggesting various pathologies such that the presence of myocarditis was "masked." Papers on myocarditis and sudden death in children were selected by searching electronic databases (Pubmed, Scielo, Semantic Scholar, Google Scholar, Springer Link, Science Direct, NCBI, Research Gate, and others). Articles on immunology, pathology, pneumology and radiology were also included that addressed medical reasoning and might assist in early diagnosis.Results: Many cases of myocarditis remain undiagnosed due to nonspecific symptoms. Therefore, the true prevalence is unknown. The literature reports a high prevalence of histologically proven myocarditis on post-mortem examination in pediatric cases of sudden death based on the presence of a lymphocytic infiltrate necrosis of myocytes. Conclusion:Early diagnosis and treatment of myocarditis might save children who would otherwise die or develop chronic dilated cardiomyopathy. Information presented in this review may assist in better recognition of this lifethreatening disease.