{"id":2042,"date":"2017-10-01T01:00:00","date_gmt":"2017-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/ascite-et-immunodepression\/"},"modified":"2018-10-20T18:40:19","modified_gmt":"2018-10-20T16:40:19","slug":"ascite-et-immunodepression","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/ascite-et-immunodepression\/","title":{"rendered":"Ascite et immunod\u00e9pression."},"content":{"rendered":"

2017<\/strong><\/p>\n

Raef Abdallah, Luis Ferreira, Mich\u00e8le Pouteau, Florence Skinazi
\nService de gastroent\u00e9rologie, service de r\u00e9animation m\u00e9dicale H\u00f4pital DELAFONTAINE 93200 Saint Denis<\/em><\/p>\n

Endoscopie <\/strong>– \u00a02017-04-14 –\u00a0CC –<\/p>\n

________________________________<\/p>\n

Une patiente de 60 ans ancienne aide-soignante est hospitalis\u00e9e au CH de Saint Denis en janvier 2017 pour alt\u00e9ration de l\u2019\u00e9tat g\u00e9n\u00e9ral, douleurs abdominales et diarrh\u00e9e \u00e9voluant depuis 2 semaines. La patiente est trait\u00e9e pour une bronchite chronique post tabagique et a l\u2019habitude de boire du Ricard quotidiennement.
\nA l\u2019entr\u00e9e, elle est apyr\u00e9tique, l\u2019abdomen est tendu et mat.
\nBiologiquement, il existe un syndrome inflammatoire avec une hyper leucocytose \u00e0 30 000\/mm3, une CRP 200 mg\/l et une an\u00e9mie \u00e0 10 g\/dl normochrome normocytaire. Le bilan h\u00e9patique est perturb\u00e9 avec une cholestase (bilirubine T\/C 60\/42, GGT\/PAL 299\/179 UI\/L). Une ponction d\u2019ascite est r\u00e9alis\u00e9e : liquide pauvre en protides non infect\u00e9. Les s\u00e9rologies virales sont n\u00e9gatives, les anticorps anti tissus sont n\u00e9gatifs.
\nLe scanner abdominal retrouve un foie dysmorphique et homog\u00e8ne, avec une circulation veineuse collat\u00e9rale importante, une ascite assez peu abondante. La gastroscopie retrouve des varices oesophagiennes de grade 1.
\n Une cirrhose alcoolique est suspect\u00e9e.
\nL\u2019\u00e9tat clinique de la patiente se d\u00e9grade ensuite rapidement: apparition d\u2019un \u00e9tat septique avec une infection du liquide d\u2019ascite (ILA) \u00e0 Enteroccocus avium; les urines et les h\u00e9mocultures p\u00e9riph\u00e9riques sont positives \u00e0 Ent\u00e9rococcus faecalis. Une antibioth\u00e9rapie adapt\u00e9e est prescrite.
\nMalgr\u00e9 cela, l\u2019\u00e9tat clinique continue de s\u2019aggraver:
\n–\th\u00e9morragie digestive et melena: la gastroscopie retrouve des traces de sang noir dans l\u2019estomac, les VO ne saignent pas,
\n–\tr\u00e9cidive d\u2019une ILA \u00e0 Ent\u00e9robacter sakazakii
\n–\tSDRA,: le LBA est positif \u00e0 staph coagulase n\u00e9gatif et aspergillus fumigatus. L\u2019antig\u00e9n\u00e9mie aspergllaire est positive. Un traitement adapt\u00e9 est prescrit
\n–\t d\u00e9globulisation \u00e0 5g \/dl. La gastroscopie retrouve des filaments d\u00e9pos\u00e9s sur la muqueuse gastrique et de multiples l\u00e9sions arrondies en relief difficilement d\u00e9collables.<\/p>\n

Quels pr\u00e9l\u00e8vements auriez vous faits?
\nQuel est votre diagnostic?<\/p>\n","protected":false},"excerpt":{"rendered":"

2017 Raef Abdallah, Luis Ferreira, Mich\u00e8le Pouteau, Florence Skinazi Service de gastroent\u00e9rologie, service de r\u00e9animation m\u00e9dicale H\u00f4pital DELAFONTAINE 93200 Saint Denis Endoscopie – \u00a02017-04-14 –\u00a0CC – ________________________________ Une patiente de 60 ans ancienne aide-soignante est hospitalis\u00e9e au CH de Saint Denis en janvier 2017 pour alt\u00e9ration de l\u2019\u00e9tat g\u00e9n\u00e9ral, douleurs abdominales et diarrh\u00e9e \u00e9voluant depuis […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[6],"tags":[28],"class_list":["post-2042","post","type-post","status-publish","format-standard","hentry","category-endoscopie","tag-28"],"yoast_head":"\nAscite et immunod\u00e9pression. - 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