Hepatits A induced diabetes mellitus, acute renal failure and liver failure

A 12-year-old otherwise healthy boy presented with hyperacute hepatic failure [encephalopathy, occurred within seven days of disease onset; total and direct bilirubin of 94 umol/l and 73 umol/I respectively; aspartate aminotransferase [AST] of 8,367 u/l; alanine aminotransferase [ALT] of 11,164 u/I; prolonged prothrombin time 29.1 sec [INR 3.03] and activated partial thromboplastin time of 48.2 sec [ratiol.6]], non-oliguric acute renal failure [creatinine of 591 umol/L and blood urea nitrogen of 21.0 mmol/L], transient leukopenia, transient thrombocytopenia, with new onset diabetes mellitus [on admission the patient had blood glucose of 23.9 mmol/L]. On admission, this patient had reactive 1gM antibody for acute hepatitis A with non-reactive results for hepatitis B surface antigen, hepatitis B core antibodies, and hepatitis C antibodies, The acute renal failure and hepatitis resolved in 17 days and 30 days from admission, respectively; but the patient continues to have diabetes mellitus 6 months [time of follow up] after the hepatitis A infection while the leukopenia and thrombocytopenia resolved in 3 and 6 days from admission respectively. This case illustrates unusual presentation of acute hepatitis A infection induced with acute liver failure, non-oliguric acute renal failure, and, diabetes mellitus as sequele of this infection

Double pylorus: as a cause of upper gastrointestinal bleeding

Double pylorus is a rare abnormality, and it occurs most commonly secondary of chronic peptic ulcer disease. It is usually treated conservatively and anti - ulcer therapy. However, refractory cases may require surgery. The most common causes of upper gastrointestinal tract bleeding are peptic ulcer disease, esophageal varices, Mallory-Weiss syndrome, and tumors. Hemangiomas and bleeding from biliary tract contribute a few cases. For double pylorus which is already a rare condition to present with upper gastrointestinal bleeding is very unusual