54 year old woman, housewife, from longford (maule region, chile) with no history known morbid. Related that he was committed for three months in general health, feeling feverish and right hip pain. She reported having had contact with domestic animals, consuming food cooked well and had access to safe drinking water for four years.
Decided to consult at anotherfacility, two months before being hospitalized and highlighted in their examinations hematocrit 36%, hemoglobin: 11.4 g / dl:, wbc: 5.700/mm 3 (5% eosinophils) and vhs of 70 mm / h. He underwent an upper endoscopy and a protein electrophoresis with normal findings. Abdominal ultrasound showed cholelithiasis. He received therapy with oral cloxacillin and anti-inflammatory drugs, without goodresponse. Two weeks before admission showed an increase in symptoms erythema and adding local temperature rise in the right thigh with fever spike to 39 ° c axillary for which he was hospitalized and transferred to our center for management and study. The patient was admitted to the medicine department with stable hemodynamics and afebrile. On physical examination, segmental erythema highlighted in the rightbuttock, with induration and pain sensitive to manipulation and active right hip. In his entrance exams highlighted a hematocrit: 31.8%, hemoglobin: 10.4 g / dl, wbc 9.900/mm 3 (neutrophils 62%, eosinophils 6%), vhs 67 mm / h and crp 12.3 mg / dl . Liver function tests, blood glucose, plasma electrolytes, coagulation tests and platelet count were normal.he raised an infectious soft tissue withpossible involvement of the right hip joint and antibiotic therapy was started with cefazolin and clindamycin ev. Blood cultures obtained at admission were negative.
They called for a magnetic resonance imaging (mri), showing a large retroperitoneal collection right complex of approximately 13 cm in maximum diameter, with multiple partitions inside, hypointense walls, extending to the superficialsoft tissues through the inferior lumbar triangle . In addition myositis right gluteus medius ( figure 1 ).it was decided to supplement with a computed tomography (ct) confirmed the existence of a large retroperitoneal abscess extending to the subcutaneous tissue of the right lumbar region ( figure 2 ). It showed a gastrointestinal origin of the lesion in imaging studies.
It then decided toperform percutaneous abscess drainage under ct vision installing two pigtail catheters ( figure 3 ), the day before antimicrobials were suspended and extracted approximately 180 ml of thick purulent fluid with no odor. Samples were taken for aerobic and anaerobic cultures, direct gram staining and ziehl neelsen kinyoun, mycobacterium culture, staining for actinomyces sp, which were all negative,despite having been suspended antimicrobial therapy. Sample was also sent for analysis by liquid aspirated pathology.
Antibiotic therapy was resumed with ceftriaxone and clindamycin ev. In a controlled laboratory highlighted an anemia (hct 28%), wbc count 6.200/mm 3, increased to 9% eosinophilia and fall of crp 3 mg / dl. The control ct showed decreased size of the collection right retroperitonealdrain the fluid obtained was dwindling, changing aspect to serosanguineous seropurulent.
The pathology report described as laminar macroscopic three fragments of a whitish-yellow material and l translucent, 5 to 2.6 cm in diameter by less than 0.1 cm thick. Microscopic examination of fragments observed organizational structures with multilayered, dense bands and loose bands, associated with severalcalcified bodies, some hook-like structures and exudate polymorphonuclear leukocyte. No evidence of malignancy in sections examined. The sample was studied with ordinary histological technique, serial sections at various levels, histochemical and gomori-grocott staining and ziehl-neelsen. The morphological and histochemical tests were consistent with fragments of cuticle qh viable.