Infección grave de piel y tejidos blandos en paciente con linfoma de Hodgkin metastásico en manejo paliativo
Palabras clave:
enfermedad de Hodgkin, infecciones, sepsis, celulitis
Resumen
Las infecciones graves de piel y tejidos blandos son complicaciones comunes en pacientes con linfoma de Hodgkin (LH), especialmente aquellos en etapas avanzadas de la enfermedad que reciben tratamiento paliativo. El LH es un tipo de linfoma caracterizado por la proliferación de linfocitos anormales, y su tratamiento, que incluye quimioterapia e inmunoterapia, conlleva una inmunosupresión significativa, lo que incrementa el riesgo de infecciones. En estos pacientes, las infecciones pueden evolucionar rápidamente y presentar características atípicas, complicando el diagnóstico y el manejo.
El objetivo de este reporte es describir el caso de una paciente de 73 años con LH metastásico en tratamiento paliativo que desarrolló una infección grave de piel y tejidos blandos, que evidenció el desafío en el manejo de infecciones en pacientes inmunocomprometidos. A pesar de recibir tratamiento antimicrobiano dirigido y drenaje quirúrgico, la paciente presentó un deterioro clínico progresivo debido a la persistencia de la infección y la sepsis refractaria, que culminó en un fallo multiorgánico. Este caso resalta la importancia de un enfoque multidisciplinario que considere no solo el manejo antimicrobiano, sino también la atención integral al paciente, priorizando el manejo sintomático y la comunicación con los familiares en escenarios de mal pronóstico.
Citas
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2. Anderson LA, Atman AA, McShane CM, Titmarsh GJ, Engels EA, Koshiol J. Common infection-related conditions and risk of lymphoid malignancies in older individuals. Br J Cancer [Internet]. 2014 [cited 2024 Nov 28];110(11):2796–803. Available from: https://pubmed.ncbi.nlm.nih.gov/24691420/. doi: 10.1038/bjc.2014.173
3. Daniëls LA, Krol ADG, Schaapveld M, Putter H, Jansen PM, Marijt EWA, et al. Long-term risk of secondary skin cancers after radiation therapy for Hodgkin’s lymphoma. Radiother Oncol. 2013;109(1):140–5. doi: 10.1016/j.radonc.2013.06.041
4. Connors JM, Cozen W, Steidl Ch, Carbone A, Hoppe RT, Flechtner HH, Bartlett NL. Hodgkin lymphoma. Nat Rev Dis Primers. 2020;6(1): 61. doi: 10.1038/s41572-020-0189-6
5. Eichenauer DA, Engert A. How I treat nodular lymphocyte-predominant Hodgkin lymphoma. Blood [Internet]. 2020 [cited 2024 Dec 1];136(26):2987–93. Available from: https://pubmed.ncbi.nlm.nih.gov/32877522/. doi: 10.1182/blood.2019004044
6. Kristinsson SY, Gao Y, Björkholm M, Lund SH, Sjöberg J, Caporaso N, et al. Hodgkin lymphoma risk following infectious and chronic inflammatory diseases: a large population-based case-control study from Sweden. Int J Hematol. 2015 ;101(6):563–8. doi: 10.1007/s12185-015-1772-6
7. Baden LR, Swaminathan S, Angarone M, Blouin G, Camins BC, Casper C, et al. Prevention and treatment of cancer-related infections, version 2.2016, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw [Internet]. 2016 [cited 2024 Nov 28];14(7):882–913. Available from: https://pubmed.ncbi.nlm.nih.gov/27407129/. doi: 10.6004/jnccn.2016.0093
8. Taplitz RA, Kennedy EB, Bow EJ, Crews J, Gleason Ch, Hawley DK, et al. Antimicrobial prophylaxis for adult patients with cancer-related immunosuppression: ASCO and IDSA clinical practice guideline update. J Clin Oncol [Internet]. 2018 [cited 2024 Nov 28];36(30):3043–54. Available from: https://pubmed.ncbi.nlm.nih.gov/30179565/. doi: 10.1200/JCO.18.00374
9. Velasco-Suelto J, Gálvez-Carvajal L, Comino-Méndez I, Rueda-Domínguez A. Hodgkin lymphoma and liquid biopsy: a story to be told. J Exp Clin Cancer Res [Internet]. 2024 [cited 2024 Dec 1];43(1): 184. Available from: https://pubmed.ncbi.nlm.nih.gov/38956619/. doi: 10.1186/s13046-024-03108-6/
10. Facheris P, Valenti M, Pavia G, Grizzi F, Narcisi A, Costanzo A, Borroni RG. Specific infiltrate of Hodgkin lymphoma at site of cellulitis mimicking secondary cutaneous involvement. J Cutan Pathol. 2020;47(5):462–5. doi: 10.1111/cup.13618
11. Ungaro R, Mikulska M. The skin and soft tissue infections in hematological patients. Curr Opin Infect Dis [Internet]. 2020 [cited 2024 Nov 28];33(2):101–9. Available from: https://pubmed.ncbi.nlm.nih.gov/32022740/. doi: 10.1097/QCO.0000000000000632
12. Souza EM, Baiocchi OCG, Zanichelli MA, Alves AC, Oliveira JSR. Comparison between hybrid MOPPABV and ABVD chemotherapy protocols for Hodgkin’s lymphoma in public hospitals of the largest South American city - A retrospective 14-year study. Ann Hematol. 2009;88(7):633–7. doi: 10.1007/s00277-008-0635-0
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15. Pandey S, Dolan A, Norton-Westbrook M, Desai AV. “Knock Me Out”: The challenges of managing pain due to cutaneous T cell lymphomas: A case report. J Palliat Med [Internet]. 2022 [cited 2024 Nov 28];25(11):1740–6. Available from: https://pubmed.ncbi.nlm.nih.gov/35420490/. doi: 10.1089/jpm.2021.0561
16. Sica A, Casale B, Sagnelli C, Di Dato MT, Buonavolontà P, Salzano AM, et al. All-in-One spinal cord stimulation in lymphoproliferative diseases. Front Neurol [Internet]. 2020 [cited 2024 Nov 28];11: 550554. Available from: https://pubmed.ncbi.nlm.nih.gov/33281699/. doi: 10.3389/fneur.2020.550554
17. Aman MM, Mahmoud A, Deer T, Sayed D, Hagedorn JM, Brogan SE, et al. The American Society of Pain and Neuroscience (ASPN) best practices and guidelines for the interventional management of cancer-associated pain. J Pain Res [Internet]. 2021 [cited 2024 Nov 28];14: 2139–64. Available from: https://pubmed.ncbi.nlm.nih.gov/34295184/. doi: 10.2147/JPR.S315585
18. Paice JA, Portenoy R, Lacchetti Ch, Campbell T, Cheville A, Citron M, et al. Management of chronic pain in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol [Internet]. 2016 [cited 2024 Nov 28];34(27):3325–45. Available from: https://pubmed.ncbi.nlm.nih.gov/27458286/. doi: 10.1200/JCO.2016.68.5206
19. Akhtar S, Khafaga Y, Edesa W, Al-Mubarak M, Rauf MS, Maghfoor I. Hodgkin lymphoma involving extranodal sites in head and neck: report of twenty-nine cases and review of three-hundred and fifty-seven cases. Hematology [Internet]. 2021 [cited 2024 Dec 1];26(1):103–10. Available from: https://pubmed.ncbi.nlm.nih.gov/33478377/. doi: 10.1080/16078454.2020.1865667
