Résumé
Acute pancreatitis is one of the most common complications of endoscopic retrograde cholangiopancreatography (ERCP). Prophylactic pancreatic stents are effective for reducing the risk for post-ERCP pancreatitis in high-risk patients. However, an unretrieved pancreatic stent, as a result of proximal migration, can cause pancreatitis. We experienced a case of recurrent acute pancreatitis associated with a pancreatic ductal leak and stricture due to proximal migration of a prophylactic stent in a patient with suspected acute gallstone pancreatitis. We endoscopically retrieved the proximally migrated stent and inserted a new pancreatic stent. Follow-up pancreatic imaging showed that the pancreatitis and pancreatic ductal leak/stricture had resolved.
Sujets)
Humains , Cholangiopancréatographie rétrograde endoscopique , Sténose pathologique , Études de suivi , Migration d'un corps étranger , Calculs biliaires , Conduits pancréatiques , Pancréatite , EndoprothèsesRésumé
As the clinical and radiological features of pulmonary paragonimiasis are similar to those of pulmonary tuberculosis and lung cancer, the diagnosis of pulmonary paragonimiasis is very difficult and a biopsy is needed for the diagnosis. Transbronchial needle aspiration (TBNA) using conventional bronchoscopy is frequently used for nodal sampling, but its diagnostic accuracy is questionable due to the blind approach for targeting lymph nodes. Endobronchial ultrasound-guided (EBUS)-TBNA has high diagnostic value due to the direct visualization of lymph nodes, and thereby improves nodal diagnosis accuracy. This paper reports the first patient we experienced with pulmonary paragonimiasis mimicking lung cancer diagnosed by EBUS-TBNA.
Sujets)
Humains , Biopsie , Cytoponction , Bronchoscopie , Poumon , Tumeurs du poumon , Noeuds lymphatiques , Aiguilles , Paragonimose , Tuberculose pulmonaireRésumé
Adrenal insufficiency during the treatment of pulmonary tuberculosis is a troublesome condition and can at times be lifethreatening if untreated. Rifampin is one of the most widely prescribed anti-tuberculosis agents. Furthermore, rifampin has been known to be capable of affecting the metabolism of various medications, including glucocorticoids. In this paper, a case of recurrent adrenal insufficiency induced by rifampin during the treatment of pulmonary tuberculosis is reported. The patient was a 63-year-old man who was diagnosed with Addison's disease 17 years earlier and had been undergoing glucocorticoid replacement therapy. Five months before, the patient manifested pulmonary tuberculosis and was immediately given anti-tuberculosis medication that included rifampin. After one week of medication, general weakness and hyponatremia occurred. Despite the increased dose of the glucocorticoid medication, the adrenal insufficiency recurred many times. Since the substitution of levofloxacin for rifampin, the episodes of adrenal insufficiency have not recurred so far.
Sujets)
Humains , Adulte d'âge moyen , Maladie d'Addison , Insuffisance surrénale , Glucocorticoïdes , Hyponatrémie , Ofloxacine , Rifampicine , Tuberculose pulmonaireRésumé
Seizure is one of the manifestations of nonketotic hyperglycemia (NKH). Partial motor seizures are observed in most cases and, occasionally, with epilepsia partialis continua. Generalized convulsive status epilepticus caused by NKH is rare. In this report, we present a case of a 68-year-old man who developed generalized convulsive status epilepticus as an initial manifestation of NKH.