RESUMEN
Vancomycin induced agranulocytosis is a rare but life-threatening complication. We here report a case of vancomycin induced agranulocytosis in a patient with chronic renal failure. A 36-year-old woman receiving hemodialysis via jugular cannulation developed staphylococcus sepsis. The catheter was removed and she was started on vancomycin therapy (1.0 g/week). New catheter was inserted for next hemodialysis. Second sepsis of same organism developed 12 days after initial sepsis inspite of vancomycin therapy. We removed this catheter and continued vancomycin therapy. After 19 days of vancomycin treatment, the patient developed a severe agranulocytosis with white blood cell count of 1, 600/ mm3 and the complete absence of neutrophil. Vancomycin was discontinued and teicoplanin was substituted for vancomycin therapy and G-CSF (granulocyte colony stimulating factor) therapy was begun. White blood cell count including neutropil was completely recovered after 13 days of discontinuation of vancomycin.
Asunto(s)
Adulto , Femenino , Humanos , Agranulocitosis , Cateterismo , Catéteres , Factor Estimulante de Colonias de Granulocitos , Fallo Renal Crónico , Recuento de Leucocitos , Nefritis Lúpica , Neutrófilos , Diálisis Renal , Sepsis , Staphylococcus , Teicoplanina , VancomicinaRESUMEN
Ischemic colitis can be caused either by vascular or colonic wall factor or by both. Shunting of blood away from the mucosa may contribute to ischemia of the colon, but the mechanism of ischemia is not known. Ischemic colitis precipitated by colonoscopy has rarely been reported. Potentially air insufflation or mechanical effect during colonoscopic examination can cause ischemic colitis as a colonic wall factor. Recently, we experienced a case of ischemic colitic, which had been developed several hours after colonoscopic polypectomy. So we report this case with brief review of literature.
Asunto(s)
Colitis Isquémica , Colon , Colonoscopía , Insuflación , Isquemia , Membrana MucosaRESUMEN
Situs inversus is a rare condition with genetic predisposition and is characterized by transposition of both heart and intra-abdominal viscera to the opposite side of the body. Cholangiocarcinoma in this condition has rarely been reported. We present a case of adenocarcinoma of the common hepatic duct proximal to the cystic duct in a 68-year-old male with total situs inversus. The patient presented with complaints of abdominal pain, intermittent fever and chilling sensation without jaundice. Magnetic resonance cholangiopancreatography prior to surgery demonstrated segmental narrowing of the common hepatic duct proximal to the cystic duct and two stones in the proximal portion of the narrowed segment. Open laparotomy was performed to remove the lesion. Cholangiocarcinoma was confirmed pathologically. Magnetic resonance cholangiopancreatography was the only pre-operative diagnostic method which had suggested malignancy in this case.