Mujer de 47 años con cirrosis hepática que consulta por fiebre y hematemesis, detectándose pancitopenia y acidosis metabólica.

Resumen

47 year old woman with liver cirrhosis who was admitted with fever, abdominal pain, hematemesis and melena and 48 hour progression epistaxis. The patient developed hypoglycemia and during hospitalization showed elongation of prothrombin time, pancytopenia, hyperbilirrubin, GOT 258 U/L, GPT 76 U/L and metabolic acidosis. The abdomen and lateral decubitus x-ray radiographies showed moderately distended small bowel loops with central distribution, silence in the contour of the colon, "gray" abdomen (ascites), establishing the radiological suspicion of small bowel obstruction, paralytic ileus and ascites. The patient died of cardiorespiratory arrest. The autopsy on the neutropenic patient showed an acute enterocolitis (typhlitis), an acute peritonitis and a septic shock with acute pulmonary edema (adult respiratory distress syndrome). The patient also showed micronodular liver cirrhosis and upper gastrointestinal bleeding from bleeding esophageal varices, blocking maturation of myeloid series with absence of granulocytes (agranulocytosis) and papillary thyroid microcarcinoma.