Résumé
We present a case report of brain death caused by Salmonella enterica serovar Enteritidis bacteremia. A 53-year-old diabetic male was admitted to our hospital with stupor mentality and fever. No evidence of meningitis was found upon cerebrospinal fluid analysis, but diffuse brain edema was shown by magnetic resonance imaging. S. Enteritidis phage type 7 was isolated from blood cultures. We diagnosed the patient with encephalopathy associated with S. Enteritidis bacteremia and treated him by intravenous administration of ceftriaxone and dexamethasone. Fifteen days after admission, the patient was diagnosed with brain death and became a cadaveric donor. Although encephalopathy associated with S. Enteritidis bacteremia is rare, it should be considered as a serious and potentially lethal complication.
Sujets)
Humains , Mâle , Adulte d'âge moyen , Administration par voie intraveineuse , Bactériémie , Bactériophages , Encéphale , Mort cérébrale , Oedème cérébral , Cadavre , Ceftriaxone , Dexaméthasone , Fièvre , Imagerie par résonance magnétique , Méningite , Salmonella , Salmonella enterica , Salmonella enteritidis , État de stupeur , Donneurs de tissusRésumé
We present a case report of brain death caused by Salmonella enterica serovar Enteritidis bacteremia. A 53-year-old diabetic male was admitted to our hospital with stupor mentality and fever. No evidence of meningitis was found upon cerebrospinal fluid analysis, but diffuse brain edema was shown by magnetic resonance imaging. S. Enteritidis phage type 7 was isolated from blood cultures. We diagnosed the patient with encephalopathy associated with S. Enteritidis bacteremia and treated him by intravenous administration of ceftriaxone and dexamethasone. Fifteen days after admission, the patient was diagnosed with brain death and became a cadaveric donor. Although encephalopathy associated with S. Enteritidis bacteremia is rare, it should be considered as a serious and potentially lethal complication.
Sujets)
Humains , Mâle , Adulte d'âge moyen , Administration par voie intraveineuse , Bactériémie , Bactériophages , Encéphale , Mort cérébrale , Oedème cérébral , Cadavre , Ceftriaxone , Dexaméthasone , Fièvre , Imagerie par résonance magnétique , Méningite , Salmonella , Salmonella enterica , Salmonella enteritidis , État de stupeur , Donneurs de tissusRésumé
Bisphosphonate generally seems to be safe, but hypocalcemia may occasionally develop in the course of bisphosphonate treatment. Hypocalcemia induced by bisphosphonate is usually mild and asymptomatic, but unrecognized or poorly treated hypocalcemia can lead to life-threatening state. A 78-year-old woman who had a history of hip arthroplasty and intravenous zoledronate treatment for femur neck fracture was presented to emergency department with altered mental status. It turned out that her symptom was due to severe hypocalcemia which was caused by intravenous zoledronate treatment. She also had renal dysfunction. She was treated by intravenous calcium gluconate and calcitriol administration. This case supports the need for evaluation of renal dysfunction, vitamin D deficiency and parathyroid gland dysfunction before bisphosphonate treatment and accurate monitoring of plasma calcium and creatinine levels. In addition, vitamin D and calcium supply during treatment with bisphosphonate is mandatory.
Sujets)
Sujet âgé , Femelle , Humains , Arthroplastie , Calcitriol , Calcium , Gluconate de calcium , Créatinine , Diphosphonates , Urgences , Fractures du col fémoral , Gluconates , Hanche , Hypocalcémie , Imidazoles , Ostéoporose , Glandes parathyroïdes , Plasma sanguin , Vitamine D , Carence en vitamine DRésumé
Primary malignant lymphoma of the stomach comprises 1 to 7% of all gastric malignancies and is mostly B-cell type. Anaplastic large cell lymphoma (ALCL) of the stomach is very rare and regarded to have a poor prognosis. A 66-year-old man complained of dyspepsia for 3 days. A esophagogastroduodenoscopic examination revealed a flat, depressed ulcer at the distal antrum. Biopsy of the lesion showed diffuse infiltration of large pleomorphic lymphoid cells that were positive for CD3 and CD30 and negative for cytokeratin and anaplastic lymphoma kinase (ALK). We diagnosed the patient with ALK-negative primary gastric ALCL with multiple lymphadenopathies, and he received systemic chemotherapy. CHOP-like regimens followed by consolidation therapy have been widely used for ALK-negative ALCL. However, the patient maintained complete remission for 36 months with only induction chemotherapy. This case suggests that heavy treatment for ALK-negative ALCL is not required for all patients.
Sujets)
Sujet âgé , Humains , Lymphocytes B , Biopsie , Dyspepsie , Chimiothérapie d'induction , Kératines , Lymphocytes , Lymphomes , Lymphome à grandes cellules anaplasiques , Phosphotransferases , Pronostic , Récepteurs à activité tyrosine kinase , Estomac , UlcèreRésumé
We report a case of tubulointerstitial nephritis and uveitis (TINU) syndrome in an old age female. A 66-year-old woman presented with nonspecific systemic symptoms and severe renal dysfunction. Renal biopsy showed acute interstitial nephritis and ophthalmologic examination revealed bilateral panuveitis. Evaluations for connective tissue diseases and infectious diseases were negative. She was treated with total eight sessions of hemodialysis, oral steroids and topical steroids. Renal function had improved significantly and remained stable at follow-up, although it did not fully recovered yet. TINU syndrome should be considered in cases of unexplained tubulointerstitial nephritis, especially in the presence of ocular symptom.