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Introduccion: la infeccion por dengue es una de las arbovirosis de mayor frecuencia y morbimortalidad a nivel mundial, y de gran incidencia en el pais. Colombia es el segundo pais de America con mayor numero de casos de muerte por dengue. La categorizacion de riesgo, de acuerdo a los criterios de la OMS, reconoce su relacion con complicaciones en uno o mas organos durante el curso de la virosis. No hay estudios publicados en este medio que describan en la actualidad el curso de la infeccion en pacientes adultos ni que caractericen su curso de severidad. Objetivo: caracterizar la frecuencia de aparicion de dengue y sus complicaciones en pacientes adultos que acudieron a un centro de referencia en Cartagena (Colombia), durante el periodo comprendido entre enero de 2013 y enero de 2016, y reconocer aquellos con criterios de gravedad. Materiales y metodos: estudio descriptivo, observacional, retrospectivo y transversal en pacientes mayores de 18 anos con dengue y confirmacion serologica, hospitalizados entre enero de 2013 y enero 2016 en la ESE Hospital Universitario del Caribe. Las fuentes de informacion fueron las historias clinicas del centro de estudio. Resultados: se registraron para el estudio 95 casos de dengue, de los cuales 83 (87.3%) fueron categorizados como dengue con signos de alarma y 12 casos (12.6%) como dengue grave. Desde 2013, se observo una disminucion progresiva en la incidencia del dengue en el centro estudiado. Las manifestaciones clinicas mas frecuentes fueron fiebre, cefalea, mialgias y artralgias. Las alteraciones de laboratorio mas comunes fueron trombocitopenia y la elevacion de las aminotransferasas, principalmente la AST. Los signos ecograficos de colecistitis acalculosa fueron especialmente frecuentes. No se registraron casos fatales. Conclusion: la infeccion por dengue sigue siendo una causa frecuente de hospitalizacion en este medio, pero que muestra un comportamiento en descenso. Existe dificultad en la categorizacion de pacientes de acuerdo a los criterios de severidad de la OMS. La colecistitis acalculosa es un hallazgo frecuente y aun debe precisarse su rol en el seguimiento de los pacientes. Rev.cienc.biomed. 2016;7(2):212-222. PALABRAS CLAVE Dengue; Dengue grave; Colecistitis acalculosa. SUMMARY Introduction: dengue virus infection is one of the most frequent arboviruses that causes high morbidity and mortality worldwide, especially in our country. Colombia is the second country with the highest number of fatal dengue cases in America. The categorization of the patients’ risk according to the WHO criteria illustrates the relationship with severity and complications in one or more organs during the course of the disease. There are not recent studies that describe the course of infection in this region in adult patients. Objective: to describe the frequency and profile of dengue cases in a tertiary hospital in Cartagena (Colombia), during a follow up period between January 2013 and January 2016, and to recognize those who presented severity criteria. Material and methods: a descriptive, observational, retrospective and transversal study was carried out with patients that presented dengue and were over 18 years-old with serological confirmation. They were hospitalized between January 2013 and January 2016 in the ESE Hospital Universitario del Caribe. The source of data were the medical histories and records of the hospital. Results: 95 cases confirmed dengue: 83 cases (87.3%) were categorized as dengue with alarms signs and 12 cases (12.6%) as severe dengue. There was a gradual reduction in the incidence of dengue following the first year (2013). Fever, headache, myalgia and arthralgia were the most frequent symptoms. The most common laboratory abnormalities were thrombocytopenia and elevation of aminotransferases, especially SGOT. Ultrasonographical findings were very common and compatible with acalculous cholecystitis. There were not deaths related to the disease in the evaluated period. Conclusion: dengue infection remains a frequent cause of hospitalization in our region, but shows a tendency to reduce its incidence. There’s still some difficulties to classify patients according to the WHO severity criteria. Acalculous cholecystitis was a frequent finding and its value during patient follow-up requires more attention. Rev. cienc.biomed. 2016;7(2):212-222. KEYWORDS Dengue; Severe Dengue; Acalculous cholecystitis.

El síndrome nefrótico es una enfermedad crónica relativamente frecuente en niños, siendo la peritonitis bacteriana una de las complicaciones médicas más severas. A continuación presentamos el caso de un niño de 1 año de edad que es llevado al servicio de emergencias del Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", debido a síntomas y signos abdominales que indicaban la presencia de abdomen agudo; posteriormente se logra demostrar la presencia de peritonitis bacteriana espontánea asociada a síndrome nefrótico. Nephrotic syndrome is a relatively common chronic illness in childhood, in which a spectrum of clinical manifestations arises, such as lost of permeability of the glomerular capillary wall. One of the most severe medical complications of this disease is spontaneous bacterial peritonitis, being the main cause of death in these patients and it is very rare as an initial presentation of nephrotic syndrome. We present the case of a 1 year-old male who was taken to the National Children’s Hospital "Dr. Carlos Sáenz Herrera" emergency service. The patient manifested abdominal complaints that made him suspect of having a peritonic abdomen. He was initially diagnosed to have acalculous cholecystitis. Later, it was demonstrated that the patient was suffering from spontaneous bacterial peritonitis associated to nephrotic syndrome.

Se describe un caso de una niña de 12 años con diagnóstico previo de lupus eritematoso sistémico (LES) de tres años de evolución, que se presentó con dolor abdominal epigástrico tipo cólico. En la evaluación se demostró activación de la enfermedad por clínica y serología. La ecografía abdominal inicial fue normal y la endoscopia digestiva alta mostró gastritis antral, por lo cual se inicio omeprasol con dieta. Por persistencia del dolor y no mejoría con manejo medico para gastritis se repitió la ecografía abdominal 6 días después, que mostró engrosamiento de las paredes de la vesícula sin cálculos en su interior. Se hizo colecistectomía laparoscópica con mejoría de la paciente. La patología mostró evidencia de vasculitis de las arterias medias de las paredes de la vesícula. La colecistitis acalculosa por vasculitis es una complicación raramente descrita en adultos con LES; en la literatura consultada se encontró un solo caso pediátrico. Como este caso es de interés, se informa y se revisa la literatura. This is a 12 year old girl with systemic lupus erythematosus diagnosed since 9 years of age, who came in to the University Hospital in Cali Colombia with epigastric abdominal pain. Clinical and serological evidence of lupus activation was found at the admittance. Initial abdominal ultrasound was normal, and upper endoscopy showed antral gastritis. Treatment with omeprasol and diet was established. The patient did not improved and a second abdominal ultrasound was done 6 days later, which showed increased gallbladder wall thickness without gallstones. Laparoscopic cholecystectomy was performed, with improvement of the patient condition. Pathology showed evidence of vasculitis in midium size arteries of the gallbladder. Acalculous cholecystitis by vasculitis is a rare complication of adult patients with lupus and only one pediatric patient has been describe in the literature. We report the case and review the literature.

A four year old patient with known sick'e cell-lhalasseTiic anemia (a seldom seen d sease in Chile) and frequent severe infections (including meningitis, pneumonic, acute diarrhea crd acute oMis media) came 'o t"e emergency room a couple of weeks after a" acute resp.rarorv disease, because of fever,, acu'e abdo.Ti'nal pain, signs of peritoneal 'rritation and periphe'al e leva tec white blcoc cell counts. At abdominal ulrasonocrapy a bigger than normal, distended and dilated gallbladder was seen A cholecystectomy was done and the diagnosis of acalculous cholecystitis was sjrgically crd histologically comfirmed while bacteriae were not isc a ted from bile cultures. Cholecystitis was thoughto be probably secondary to cystic djct external compression oy an enlarged mese^teric lymph node. Appropriate managemen; of these patents incljdes intravenous fluids, blood transfjssions as needed, adecuate control of termo environment, body temperature and oxigenaticn and antimicrobial drugs to protect them against the ris^s of sepsis, hemolyt'C and throrrbcric cornp icatio.ns *o which 'hey ore frequently suo'ected.