The bite by snakes of the Bothriechis genus is common in certain areas of Colombia such as the Coffee-growing Region. Due to their arboreal habits and defensiveness, these snakes usually bite farmers in their upper limbs and face. In Colombia, the incidence of accidents caused by these snakes has not been accurately estimated yet because of deficiencies in recording this type of cases, as well as of the ignorance on this reptile by health personnel working in its area of influence. This paper describes two cases of bites by B. schlegelii occurred in Colombia during 2015. The first case is about a 55-year-old man who was bitten on the left hand, and subsequently developed paresthesia and edema until the forearm, with no other findings; the patient underwent treatment with polyvalent antivenin from Probiol®, with complete resolution of the event. The second case portrays a 62-year-old man, bitten on the left hand, presenting with emesis, diaphoresis, edema until shoulder, prolonged clotting times, and no bleeding; the patient required eight vials of polyvalent antivenin from Instituto Nacional de Salud (National Institute of Health, Colombia), thereby normalizing clotting times. Complete resolution of the event was achieved.

Clinical case reports date back to 1600 B. C., when Egyptian papyri first described injuries or disorders of the head and the back (1). Likewise, cases reported by Hippocrates, 460 B.C (2), or the first uterus (3) and face transplants (4) can be found in the literature, as well as cases on the recent Zika epidemic and its relation to microcephaly (5). All of them have greatly contributed to the evolution of medical science during different periods, both in research and learning processes.

Dengue fever is the biggest public health issue in tropical countries. A significant percentage of patients who suffer from this disease require admission to the intensive care unit (ICU) due to the severity of the clinical picture. This case reports the clinical evolution of an eight-week pregnant woman with dengue fever associated with thrombocytopenia and leukopenia. The patient comes from an endemic area for tropical diseases, fact that led to diagnose dengue fever with hemorrhagic characteristics. During her stay in the ICU, the patient presented with first trimester bleeding and placental hematoma. Therefore, and considering the pregnancy and the risk of loss, the hematological function was monitored through thromboelastography. The transfusion of blood products was decided according to the specific findings. Controlling and reversing the obstetric bleeding process was possible, the patient condition evolved favorably, and she was subsequently discharged from the ICU. This article reports on the usefulness of dynamic monitoring the hematological function using thromboelastography in patients with hemorrhagic dengue fever and special conditions such as pregnancy.

Stump appendicitis is a rare cause of acute abdomen in the pediatric population, therefore, it is not suspected frequently. This paper presents the case report of a 2-year-old child admitted into the emergency room due to vomiting, abdominal pain and fever. On admission, the patient presented with tachypnea, tachycardia, abdominal bloating and abdominal tenderness; laboratories showed leukocytosis, thrombocytosis and an elevated C-reactive protein (CPR) levels. Abdominal obstruction was considered because of a prior history of peritonitis associated with perforated appendicitis. However, an emergency laparotomy had to be performed during hospitalization due to hemodynamic deterioration and worsening of abdominal pain. Peritonitis, appendicitis, intestinal perforation and an incidental Meckel’s diverticulum were found. After surgery, the patient was taken to the intensive care unit, where antibiotic therapy was administered for 14 days and multiple peritoneal lavages were performed; finally, the patient was discharged. Even though stump appendicitis is not a common cause of acute abdomen, it should be kept in mind in patients with history of appendectomy accompanied by abdominal pain, who attend the emergency service. Delay in diagnosis and treatment is associated with higher morbidity rates and an increase in medical costs.

Extranodal natural killer (NK)/T-cell lymphoma, nasal type, is a rare entity in otorhinolaryngology. Its management requires skilled physicians in order to suspect this disease and making a proper diagnosis at early stages. This paper reports the case of a 31-year-old male patient, with one month of nasal obstruction, recurrent sinusitis, palatal ulceration and a necrotizing lesion. Histopathology reported lymphoid infiltrate polymorph angiocentric growth pattern and extensive areas of necrosis. Immunohistochemistry confirmed the phenotype for T/NK cells: positive CD3, BCL2, CD4 and CD56. IgG for Epstein-Barr virus was also positive. The initial staging was T4, N1, M0, ?Eastern Cooperative Oncology Group (ECOG) scale was 1, with intermediate risk, and low? International Prognostic Index (IPI); based on this results, the patient was referred to oncology to initiate treatment. After a ten-month follow-up, the patient’s condition improved, with complete remission of nasal and palate injuries; no relapse has occurred to date. This case is a clear example of the importance of early diagnostic through multiple biopsies in order to establish a specific treatment to decrease complication rates and improve prognosis.

Introduction. Pulmonary infarction occurs in 29% to 32% of patients with pulmonary thromboembolism (PTE). The infection of a pulmonary infarction is a complication in approximately 2 to 7% of the cases, which makes it a rare entity. Case description. 49-year-old woman with pleuritic pain in the left hemithorax that irradiated to the dorsal region, associated with dyspnea and painful edema in the left lower limb of two days of evolution. Two weeks prior to admission, the patient suffered from a left knee trauma that required surgical intervention; however, due to unknown reasons, she did not receive antithrombotic prophylaxis. Physical examination showed tachycardia, tachypnea and painful edema with erythema in the left leg. After suspecting a pulmonary thromboembolism, anticoagulation medication was administered and a chest angiotomography was requested to confirm the diagnosis. The patient experienced signs of systemic inflammatory response, and respiratory deterioration. A control tomography was performed, suggesting infected pulmonary infarction. Antibiotic treatment was initiated, obtaining progressive improvement; the patient was subsequently discharged, and continued with anticoagulation medication and follow-up on an outpatient basis. Conclusions. Pulmonary infarction is a frequent complication in patients with PTE. Therefore, infected pulmonary infarction should be suspected in patients with clinical deterioration and systemic inflammatory response. The radiological difference between pulmonary infarction and pneumonia is not easily identified, thus the diagnostic approach is clinical, and anticoagulant and antimicrobial treatment should be initiated in a timely manner.