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tratado adecuadamente con antivirales&#46; En la exploraci&#243;n se evidencian placas hemorr&#225;gicas costrosas en el lado derecho del abdomen&#44; afectando a los dermatomas T11-T12&#46; Tambi&#233;n se aprecia distensi&#243;n abdominal en el lado derecho y sensibilidad a la palpaci&#243;n &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Se realiza ecograf&#237;a de abdomen y pelvis el mismo d&#237;a&#44; sin hallazgos anormales&#46; Se diagnostica neuralgia posherp&#233;tica y hernia fantasma&#46; Se tranquiliz&#243; al paciente respecto a la distensi&#243;n abdominal y explic&#225;ndole que se resolver&#237;a con el paso del tiempo&#44; y se le inform&#243; sobre la posible aparici&#243;n de molestias g&#225;stricas&#46; En la revisi&#243;n&#44; a los tres meses se observ&#243; una leve disminuci&#243;n de la distensi&#243;n&#44; que se resolvi&#243; por completo a los 10 meses&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Caso 2&#58; Var&#243;n de 69 a&#241;os con diabetes e hipertensi&#243;n com&#243;rbidas remitido a nuestro servicio&#46; El paciente recibi&#243; tratamiento tres meses antes por HZ en los dermatomas T10-T12 derechos&#46; En la exploraci&#243;n se observa la presencia de cicatrices atr&#243;ficas despigmentadas en el lado derecho del abdomen a lo largo de los dermatomas T10-T12 y distensi&#243;n abdominal leve &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46; No presenta sensibilidad a la palpaci&#243;n&#46; La ecograf&#237;a abdominal no evidencia hallazgos anormales y&#44; con el equipo quir&#250;rgico&#44; se confirma el diagn&#243;stico de hernia fantasma&#46; Se tranquiliz&#243; al paciente y se le ense&#241;aron ejercicios de fortalecimiento abdominal&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Una pseudohernia se define como &#171;una protrusi&#243;n de la pared abdominal en ausencia de defectos estructurales&#44; acumulaci&#243;n de l&#237;quido o masa&#44; debida a par&#225;lisis muscular&#187;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a>&#46; Entre las causas m&#225;s comunes se encuentran la radiculoneuropat&#237;a diab&#233;tica&#44; el traumatismo o la lesi&#243;n de la ra&#237;z ventral&#46; La pseudohernia por HZ es una complicaci&#243;n poco frecuente que se produce en 0&#44;17&#37; de los casos<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a>&#46; Ocurre con mayor frecuencia en personas obesas entre mediana y avanzada edad&#44; y seg&#250;n se ha observado&#44; suele afectar al dermatoma T11<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a>&#46; Se cree que esta par&#225;lisis muscular se debe a la propagaci&#243;n directa del virus desde los ganglios de la ra&#237;z dorsal hasta las c&#233;lulas del asta ventral y las ra&#237;ces nerviosas motoras<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2&#44;3</span></a>&#46; Su pron&#243;stico suele ser favorable&#44; con una recuperaci&#243;n cl&#237;nica completa en 55-78&#37; de los casos<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">5&#44;6</span></a>&#46; Esta entidad se ha descrito en muy pocas revistas de dermatolog&#237;a&#46; Dado que muchos casos acuden para seguimiento a la consulta de dermatolog&#237;a&#44; en los pacientes de edad avanzada se debe tener en cuenta el riesgo de desarrollar pseudohernias&#46; Una observaci&#243;n exhaustiva y una anamnesis detallada pueden facilitar el diagn&#243;stico cl&#237;nico de esta afecci&#243;n&#44; evitando as&#237; estudios diagn&#243;sticos e intervenciones quir&#250;rgicas innecesarios&#46; La espera vigilante es la mejor opci&#243;n terap&#233;utica en estos casos&#44; combinada con ejercicios de fortalecimiento abdominal&#46;</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financiaci&#243;n</span><p id="par0030" class="elsevierStylePara elsevierViewall">No se recibi&#243; 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CARTA CIENTÍFICO-CLÍNICA
Hernia fantasma – Dos casos de protrusión abdominal posherpética
Phantom Hernia - Two cases of Post Herpetic Abdominal Bulge
P. Suvarna
Corresponding author
punya93@gmail.com

Autor para correspondencia.
, S.B. Pai, S.S. Prabhu
Department of Dermatology, Venereology and Leprosy, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">El herpes z&#243;ster &#40;HZ&#41; es causado por la reactivaci&#243;n del virus varicela-z&#243;ster &#40;VVZ&#41; de su estado latente en los ganglios de la ra&#237;z dorsal&#46; Tras su aparici&#243;n&#44; la complicaci&#243;n m&#225;s frecuente es la neuralgia posherp&#233;tica&#46; En raras ocasiones el virus puede afectar las c&#233;lulas del asta anterior del nervio espinal&#44; produciendo complicaciones motoras como la hernia fantasma abdominal<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a>&#46; Describimos dos casos que acudieron a nuestro servicio&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Caso 1&#58; Var&#243;n de 72 a&#241;os que acude por inflamaci&#243;n y dolor en el lado derecho del abdomen de 10 d&#237;as de evoluci&#243;n&#46; El paciente tiene antecedentes de HZ el mes anterior&#44; tratado adecuadamente con antivirales&#46; En la exploraci&#243;n se evidencian placas hemorr&#225;gicas costrosas en el lado derecho del abdomen&#44; afectando a los dermatomas T11-T12&#46; Tambi&#233;n se aprecia distensi&#243;n abdominal en el lado derecho y sensibilidad a la palpaci&#243;n &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Se realiza ecograf&#237;a de abdomen y pelvis el mismo d&#237;a&#44; sin hallazgos anormales&#46; Se diagnostica neuralgia posherp&#233;tica y hernia fantasma&#46; Se tranquiliz&#243; al paciente respecto a la distensi&#243;n abdominal y explic&#225;ndole que se resolver&#237;a con el paso del tiempo&#44; y se le inform&#243; sobre la posible aparici&#243;n de molestias g&#225;stricas&#46; En la revisi&#243;n&#44; a los tres meses se observ&#243; una leve disminuci&#243;n de la distensi&#243;n&#44; que se resolvi&#243; por completo a los 10 meses&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Caso 2&#58; Var&#243;n de 69 a&#241;os con diabetes e hipertensi&#243;n com&#243;rbidas remitido a nuestro servicio&#46; El paciente recibi&#243; tratamiento tres meses antes por HZ en los dermatomas T10-T12 derechos&#46; En la exploraci&#243;n se observa la presencia de cicatrices atr&#243;ficas despigmentadas en el lado derecho del abdomen a lo largo de los dermatomas T10-T12 y distensi&#243;n abdominal leve &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46; No presenta sensibilidad a la palpaci&#243;n&#46; La ecograf&#237;a abdominal no evidencia hallazgos anormales y&#44; con el equipo quir&#250;rgico&#44; se confirma el diagn&#243;stico de hernia fantasma&#46; Se tranquiliz&#243; al paciente y se le ense&#241;aron ejercicios de fortalecimiento abdominal&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Una pseudohernia se define como &#171;una protrusi&#243;n de la pared abdominal en ausencia de defectos estructurales&#44; acumulaci&#243;n de l&#237;quido o masa&#44; debida a par&#225;lisis muscular&#187;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a>&#46; Entre las causas m&#225;s comunes se encuentran la radiculoneuropat&#237;a diab&#233;tica&#44; el traumatismo o la lesi&#243;n de la ra&#237;z ventral&#46; La pseudohernia por HZ es una complicaci&#243;n poco frecuente que se produce en 0&#44;17&#37; de los casos<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a>&#46; Ocurre con mayor frecuencia en personas obesas entre mediana y avanzada edad&#44; y seg&#250;n se ha observado&#44; suele afectar al dermatoma T11<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a>&#46; Se cree que esta par&#225;lisis muscular se debe a la propagaci&#243;n directa del virus desde los ganglios de la ra&#237;z dorsal hasta las c&#233;lulas del asta ventral y las ra&#237;ces nerviosas motoras<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2&#44;3</span></a>&#46; Su pron&#243;stico suele ser favorable&#44; con una recuperaci&#243;n cl&#237;nica completa en 55-78&#37; de los casos<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">5&#44;6</span></a>&#46; Esta entidad se ha descrito en muy pocas revistas de dermatolog&#237;a&#46; Dado que muchos casos acuden para seguimiento a la consulta de dermatolog&#237;a&#44; en los pacientes de edad avanzada se debe tener en cuenta el riesgo de desarrollar pseudohernias&#46; Una observaci&#243;n exhaustiva y una anamnesis detallada pueden facilitar el diagn&#243;stico cl&#237;nico de esta afecci&#243;n&#44; evitando as&#237; estudios diagn&#243;sticos e intervenciones quir&#250;rgicas innecesarios&#46; La espera vigilante es la mejor opci&#243;n terap&#233;utica en estos casos&#44; combinada con ejercicios de fortalecimiento abdominal&#46;</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financiaci&#243;n</span><p id="par0030" class="elsevierStylePara elsevierViewall">No se recibi&#243; 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ISSN: 00017310
Original language: Spanish
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