Image in medicine
Fever of unknown origin in a solid organ transplant recipient
Fiebre de origen desconocido en un paciente con trasplante de órgano sólido
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Ondas U prominentes con intervalo QT prolongado en todas las derivaciones.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Paula de Vera McMullan, Elena Corella Aznar, Miguel Ángel Granados Ruiz" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Paula" "apellidos" => "de Vera McMullan" ] 1 => array:2 [ "nombre" => "Elena" "apellidos" => "Corella Aznar" ] 2 => array:2 [ "nombre" => "Miguel Ángel" "apellidos" => "Granados Ruiz" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020624000676" "doi" => "10.1016/j.medcle.2023.10.021" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020624000676?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775323006711?idApp=UINPBA00004N" "url" => "/00257753/0000016200000006/v1_202403190527/S0025775323006711/v1_202403190527/es/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Image in medicine</span>" "titulo" => "Fever of unknown origin in a solid organ transplant recipient" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "312" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Edwin U. Suárez, Carlos Soto, Elizabet Petkova Saiz" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Edwin U." "apellidos" => "Suárez" "email" => array:1 [ 0 => "edwin.suarez@quironsalud.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Carlos" "apellidos" => "Soto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Elizabet" "apellidos" => "Petkova Saiz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Hematology, Health Research Institute-Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Division of Infectious Diseases, Health Research Institute-Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Fiebre de origen desconocido en un paciente con trasplante de órgano sólido" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 241 "Ancho" => 1005 "Tamanyo" => 73032 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 54-year-old Venezuelan woman who received a kidney transplant 4 years ago due to end-stage polycystic kidney disease was presented with one month of fever and fatigue. On examination she was pallid and had hepatomegaly and non-massive splenomegaly. Laboratory studies showed moderate anaemia, mild thrombocytopenia and hyperferritinemia. After several negative blood microbiological studies (blood cultures and serological tests), examination of bone marrow aspirate identified oval intracellular organisms and erythrophagocytosis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. Panel A and B. <span class="elsevierStyleItalic">Wright</span> stain; 100× objective. Oval intracellular structures, arrows and erythrophagocytosis, asterisk). Biopsy showed granulomatous inflammation with similar structures also compatible with yeasts (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. Panel C. <span class="elsevierStyleItalic">Grocott</span> stain; 400× objective, arrows) of <span class="elsevierStyleItalic">Histoplasma capsulatum</span> that was confirmed with positive polymerase chain reaction test and bone marrow culture (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. Panel D. Culture at room temperature stained by lactophenol cotton blue; <span class="elsevierStyleItalic">H. capsulatum</span> rows as a hyphal form). The patient started treatment with liposomal amphotericin B and itraconazole. The etiologic spectrum of fever of unknown origin in solid organ transplantation is broad. However, one of the most frequent infections in patients with underlying conditions that impair their ability to defend against intracellular pathogens in the Latin American countries, related with cytopenias and visceromegaly is histoplasmosis, particularly demonstrated in this case from the blood marrow.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Patient consent</span><p id="par0025" class="elsevierStylePara elsevierViewall">Patient consent obtained.</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors’ contributions</span><p id="par0010" class="elsevierStylePara elsevierViewall">All authors wrote and edited the manuscript. The patient provided written informed consent for the publication of this Clinical Picture.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Funding</span><p id="par0020" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflict of interest</span><p id="par0015" class="elsevierStylePara elsevierViewall">The authors report no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Patient consent" ] 1 => array:2 [ "identificador" => "sec0005" "titulo" => "Authors’ contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Funding" ] 3 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interest" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 241 "Ancho" => 1005 "Tamanyo" => 73032 ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/00257753/0000016200000006/v1_202403190527/S0025775323005791/v1_202403190527/en/main.assets" "Apartado" => array:4 [ "identificador" => "75088" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Imagen médica" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/00257753/0000016200000006/v1_202403190527/S0025775323005791/v1_202403190527/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775323005791?idApp=UINPBA00004N" ]
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