La histoplasmosis es la micosis sistémica endémica más frecuente en Argentina. La mayoría de los casos son asintomáticos o presentan manifestaciones respiratorias leves, que resuelven espontáneamente; sin embargo, puede cursar con formas clínicas graves cuando la inmunidad se halla comprometida. Si bien el compromiso hepático en la infección diseminada es bien conocido, la histoplasmosis hepática focal es extremadamente rara. Presentamos el caso de una paciente con hepatitis granulomatosa focal y compromiso peritoneal por Histoplasma capsulatum simulando una neoplasia primaria de hígado, que fue intervenida quirúrgicamente.

Introduction: Liver transplantation (LT) aims not only to obtain long survival, but also to achieve an excellent quality of life (QOL). The purpose of our study is to assess several QOL aspects of recipients after 1 year of LT and to identify potential factors that might be associated with impaired QOL. Materials and Methods: Retrospective analysis including LT between 2013 to 2021. The Liver Disease Quality of Life questionnaire (LDQOL 1.0), and the consent form to participate of this study were given personally or sent by e-mail. This questionnaire includes 111 items distributed within 20 domains. Fulminant liver failure, hepatorenal transplantation and underaged patients were excluded. Significance was explored using T tests. Differences were considered statistically significant at p < 0.05. Results: This study included 89 patients out of 360 LT (56% male) who answered the survey, age range 24.8-75 years (mean: 52.5). On average, the patients had to wait 360 days before undergoing LT. Primary etiologies of liver disease were: hepatitis C virus (22.5%), alcohol (22.5%), autoimmune cirrhosis (22.5%), primary biliary cirrhosis (14.6%), NASH (6.7%), primary sclerosing cholangitis (3.3%), cryptogenic (2.2%), and others (5.6%). Thirtyone LT also presented hepatocarcinoma (HCC). The vast majority (93%) had moderate to severe liver disease, with 46% Child-Pugh B and 47% Child-Pugh C. After 1 year LT, QOL was improved resulting with a mean of 83,69%. The general well-being domain rated lowest with 69%. Higher scores (89 -90%) were obtained on effects of liver disease, stigma of liver disease, physical limitations, emotional limitations and loneliness. There was a significant association between the Child-Pugh classification and body pain, emotional well-being, memory and stigma of liver disease (p< 0,05). Lower MELD scores (<18) showed better results after 1 year LT in energy/fatigue, emotional well-being, liver disease symptoms, effects of liver disease and hopelessness domains (p < 0,05). There was no significant difference when QOL was compared according etiology of chronic liver disease, gender, or age. Conclusion: After 1 year of LT, patients result on QOL show a significant improvement, even similar to results published on the common population, in most of the domains surveyed except for body pain, energy and emotional well-being which still need upgrade.

La fístula colecistocolónica (FCC) es la segunda fístula colecistoentérica más común, asociada en la mayoría de los casos a enfermedad litiásica. Los síntomas suelen ser mínimos o inespecíficos, siendo infrecuente su diagnóstico preoperatorio. Si bien la incidencia de FCC causada por cáncer de vesícula biliar comprende el 1,7 % de los casos, es necesario sospecharla para adoptar la mejor estrategia terapéutica.