ABSTRACT
Allopurinol-induced hypersensitivity syndrome is characterized by an idiosyncratic reaction involving multiple-organs, which usually begins 2 to 6 weeks after starting allopurinol. In rare cases, the adverse reactions to allopurinol are accompanied by a variety of liver injury, such as reactive hepatitis, granulomatous hepatitis, vanishing bile duct syndrome, or fulminant hepatic failure. Here we report a case with granulomatous hepatitis and ductopenia. A 69-year-old man with chronic renal failure, hyperuricemia, and previously normal liver function presented with jaundice, skin rash, and fever 2 weeks after taking allopurinol (200 mg/day). In histopathology, a liver biopsy specimen showed mild spotty necrosis of hepatocytes, marked cholestasis in parenchyma, and some granulomas in the portal area. There were vacuolar degeneration in the interlobular bile ducts and ductopenia in the portal tracts. Pathologic criteria strongly suggested the presence of allopurinol-induced granulomatous hepatitis with ductopenia and cholestasis. The patient fully recovered following the early administration of systemic corticosteroid therapy.
Subject(s)
Aged , Humans , Male , Allopurinol/adverse effects , Antimetabolites/adverse effects , Bile Duct Diseases/chemically induced , Bile Ducts, Intrahepatic/drug effects , Cholestasis/chemically induced , Drug Eruptions/pathology , Granuloma/chemically induced , Chemical and Drug Induced Liver Injury/pathology , Kidney Failure, Chronic/complicationsABSTRACT
A previously healthy 44-year-old woman who was diagnosed as having dermatomyositis suddenly developed severe dyspnea while being in the state of improved condition of muscle weakness. Interstitial lung disease was found on high resolution computed tomography (HRCT). In spite of the treatment with the immune-modulating agent (high dose steroid, cyclophosphamide, immunoglubulin and cyclosporine), her condition deteriorated further and rapidly, leading to death. More intensive agent such as FK506 would be necessary in those cases of dermatomyositis-related interstitial lung disease that have poor prognostic factors.
Subject(s)
Adult , Female , Humans , Cyclophosphamide , Dermatomyositis , Dyspnea , Lung Diseases, Interstitial , Muscle Weakness , TacrolimusABSTRACT
Pneumatosis cystoides intestinalis is an uncommon condition of unknown etiology, characterized by the presence of multiple gas filled cysts in the gastrointestinal tract. Many different causes of pneumatosis cystoides intestinalis have been proposed, including mechanical, pulmonary, and bacterial causes. Approximately 85% of cases are thought to be secondary to coexisting disorders of the gastrointestinal tract or the respiratory system. The condition has been associated with the therapeutic uses of lactulose, steroids, and various cancer chemotherapeutic regimens. Lactitol is a disaccharide analogue of lactulose which is available as a pure crystalline powder. There are three previous case reports suggestive of lactulose causing pnumatosis intestinalis. We report a case of recurrent pneumatosis cystoides intestinalis associated with benign recurrent pneumoperitoneum developed probably secondary to lactitol therapy.
Subject(s)
Adult , Female , Humans , Cathartics/adverse effects , Pneumatosis Cystoides Intestinalis/diagnosis , Pneumoperitoneum/complications , Recurrence , Sugar Alcohols/adverse effects , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: The aim of this study is to evaluate the effectiveness of automated ozonated water endoscopic reprocessing system (AORS). MATERIALS AND METHODS: Thirty cases were collected and randomly assigned to 3 groups according to the disinfection methods (Group A, AORS for 5 minutes; Group B, AORS for 10 minutes; Group C, automated disinfection with superoxidized water for 3 minutes 30 seconds). After disinfection was finished, samples were collected from the tip of scopes (Site 1, S1) and rinsing water through biopsy channel (Site 2, S2). Samples were inoculated in blood agar plate for 48 hrs, and then colony count was evaluated. RESULTS: Culture positive rate of S1 was 0% in all three groups. Culture positive rates of S2 were 70% (7/10), 70% (7/10) and 90% (9/10) in group A, group B and group C, respectively. High culture rate group (> or = 1 CFU/ml rinsing water) was 0% (0/10), 30% (3/10) and 70% (7/10) in group A, group B and group C, respectively. Disinfection efficacy between group A and C showed a significant difference in high culture rate (P<0.05). CONCLUSIONS: AORS for 5min was at least equally effective in endoscopic reprocessing compared with the conventional superoxidized water system.
Subject(s)
Agar , Biopsy , Disinfection , Endoscopes , WaterABSTRACT
BACKGROUND: The aim of this study is to evaluate the effectiveness of automated ozonated water endoscopic reprocessing system (AORS). MATERIALS AND METHODS: Thirty cases were collected and randomly assigned to 3 groups according to the disinfection methods (Group A, AORS for 5 minutes; Group B, AORS for 10 minutes; Group C, automated disinfection with superoxidized water for 3 minutes 30 seconds). After disinfection was finished, samples were collected from the tip of scopes (Site 1, S1) and rinsing water through biopsy channel (Site 2, S2). Samples were inoculated in blood agar plate for 48 hrs, and then colony count was evaluated. RESULTS: Culture positive rate of S1 was 0% in all three groups. Culture positive rates of S2 were 70% (7/10), 70% (7/10) and 90% (9/10) in group A, group B and group C, respectively. High culture rate group (> or = 1 CFU/ml rinsing water) was 0% (0/10), 30% (3/10) and 70% (7/10) in group A, group B and group C, respectively. Disinfection efficacy between group A and C showed a significant difference in high culture rate (P<0.05). CONCLUSIONS: AORS for 5min was at least equally effective in endoscopic reprocessing compared with the conventional superoxidized water system.