A Case of Complete Resolution of Mediastinal Pseudocyst and Pleural Effusion by Endoscopic Stenting of Pancreatic Duct

We report a case of a mediastinal pseudocyst with a pleural effusion that developed in a patient suffering from alcohol-related chronic pancreatitis. A 53-year-old man was admitted to another institution complaining of pleuritic chest pain and coughing. A chest X-ray revealed a pleural effusion with a collapse of the right middle and lower lobes. Pleural fluid taken by thoracentesis was exudative, and the patient was transferred to our institution. A CT scan showed a loculated cystic lesion in the mediastinum and pancreatic changes that were consistent with chronic pancreatitis. The endoscopic retrograde cholangiopancreatography (ERCP) findings were compatible with chronic pancreatitis showing severe pancreatic ductal stricture at the head with an upstream dilation and distal bile duct stricture. After a one week of treatment with fasting and octreotide without improvement, both pancreatic and biliary stents were placed endoscopically. After stenting, the pleural effusion and pseudocyst rapidly resolved. The stents were changed 3 months later, at which time a repeated CT demonstrated a complete resolution of the pseudocyst. Since the initial stenting, he has been followed up for 7 months and is doing well with no recurrence of the symptoms, but he will need to undergo regular stent changes. Overall, endoscopic pancreatic stenting appears to be a good option for managing selected cases of mediastinal pancreatic pseudocysts.

A Case of Clozapine-Induced Eosinophilia Combined with Bilateral Pleural Effusion, Ascites, Cholecysctitis, and Hepatitis / 대한정신약물학회지

Several blood dyscrasias associated with clozapine have been well known to clinicians and potentially life threatening agranulocytosis has been widely reported. However, there is little report regarding incidence, progression and associated features of eosinophilia associated with clozapine. In clinical studies, the onset of eosinophilia usually occurs artier 3 to 5 weeks of treatment and rarely were cases fatal with medical complication. We report the first case of severe eosinophilia, bilateral pleural effusion, asicites, hepatitis and cholecystitis associated with clozapine that would be fatal. Eosinophilia occurred after 19 days of treatment with clozapine and all the clinical conditions improved along with interruption of clozapine treatment. It is suggested that eosinophilia may be more severe side effort than has ether been known and close hematologic monitoring should be done during early treatment of clozapine.