Vasculopatía sépticaSeptic vasculopathy

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Resumen

La sepsis es una de las principales causas de mortalidad en todo el mundo. Se desconoce la frecuencia con la que aparecen lesiones cutáneas en el contexto de una sepsis, pero en la mayoría de los casos constituyen una de las manifestaciones iniciales, que permitirán un diagnóstico precoz, de esta grave enfermedad que puede comprometer la vida. Se han descrito 4 mecanismos fisiopatológicos fundamentales por los que se producen lesiones cutáneas en el contexto de una sepsis: a) coagulación intravascular diseminada; b) invasión directa del microorganismo de la pared vascular; c) vasculitis de mecanismo inmune y d) embolismo séptico. Se sabe que estos mecanismos no son excluyentes y en un mismo paciente se pueden solapar varios de ellos. En esta revisión analizaremos cada uno de estos mecanismos, las manifestaciones clínicas que inducen y los hallazgos anatomopatológicos que se pueden encontrar en la biopsia cutánea.

Abstract

Sepsis is one of the commonest causes of death around the world. The real frequency of cutaneous lesions in the setting of sepsis is unknown, but when they appear, they are usually one of the earliest signs of sepsis, thus allowing a rapid diagnosis of this potentially life-threatening condition. Four are the main physiopathologic mechanisms that can induce cutaneous lesions in sepsis: a) disseminated intravascular coagulation; b) direct vessel wall invasion by the microorganism; c) immune-mediated vasculitis, and d) septic embolism. We know that more than one of these mechanisms can appear in one single patient. In this review, we analyse these four mechanisms, their clinical presentation, and the histological findings that can be found in the cutaneous biopsy.

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