RESUMO
Cytomegalovirus (CMV) infections are usually diagnosed in immunocompromised patients. A 74-year-old male without any significant medical history visited our center because of abdominal pain and diarrhea which began about a month ago. Abdominal computed tomography revealed segmental enhanced bowel wall thickening on jejunum and single-balloon enteroscopy showed multiple geographic shaped ulcerations covered with exudates on proximal jejunum. Biopsy samples taken during endoscopic examination demonstrated necrotic fibrinopurulent tissue debris and benign ulcer. Nested-PCR analysis of CMV DNA from jejunal tissue was positive. The patient was finally diagnosed with CMV jejunitis and was treated by intravenous ganciclovir for 14 days after which, abdominal pain and diarrhea improved. Our case shows that CMV jejunitis can occur in an immunocompetent adult as multiple jejunal ulcers which can be diagnosed using a single-balloon enteroscope.
Assuntos
Idoso , Humanos , Masculino , Antivirais/uso terapêutico , Citomegalovirus/genética , Infecções por Citomegalovirus/complicações , DNA Viral/análise , Endoscopia Gastrointestinal , Enterite/diagnóstico , Ganciclovir/uso terapêutico , Injeções Intravenosas , Doenças do Jejuno/diagnóstico , Reação em Cadeia da Polimerase , Tomografia Computadorizada por Raios XRESUMO
Hepatic tuberculosis is usually associated with active pulmonary or miliary tuberculosis. The occurrence of an isolated hepatic mass-forming tuberculosis with no evidence of tuberculosis elsewhere is rare. We report a case of a 31-year-old male with a solitary hepatic granuloma mimicking a mass-forming intrahepatic cholangiocarcinoma. Ultrasonography, computed tomography, magnetic resonance imaging, and positron emission tomography of the abdomen showed a malignant tumor-like lesion. We then conducted endoscopic ultrasonography (EUS) and EUS-guided fine-needle aspiration (EUS-FNA) for confirmation of the hepatic hilar mass, which was found to be a hepatic tuberculosis granuloma as the final diagnosis.
Assuntos
Adulto , Humanos , Masculino , Abdome , Biópsia por Agulha Fina , Colangiocarcinoma , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Endossonografia , Granuloma , Neoplasias Hepáticas , Imageamento por Ressonância Magnética , Tomografia por Emissão de Pósitrons , Tuberculose , Tuberculose Hepática , Tuberculose MiliarRESUMO
Hepatic tuberculosis is usually associated with active pulmonary or miliary tuberculosis. The occurrence of an isolated hepatic mass-forming tuberculosis with no evidence of tuberculosis elsewhere is rare. We report a case of a 31-year-old male with a solitary hepatic granuloma mimicking a mass-forming intrahepatic cholangiocarcinoma. Ultrasonography, computed tomography, magnetic resonance imaging, and positron emission tomography of the abdomen showed a malignant tumor-like lesion. We then conducted endoscopic ultrasonography (EUS) and EUS-guided fine-needle aspiration (EUS-FNA) for confirmation of the hepatic hilar mass, which was found to be a hepatic tuberculosis granuloma as the final diagnosis.
Assuntos
Adulto , Humanos , Masculino , Abdome , Biópsia por Agulha Fina , Colangiocarcinoma , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Endossonografia , Granuloma , Neoplasias Hepáticas , Imageamento por Ressonância Magnética , Tomografia por Emissão de Pósitrons , Tuberculose , Tuberculose Hepática , Tuberculose MiliarRESUMO
There have been several reported cases of acute lymphoblastic leukemia with severe lactic acidosis in adults. In these cases, kidney and liver enlargement that was caused by leukemic infiltration frequently accompanied the acute lymphoblastic leukemia and severe lactic acidosis. Chemotherapy is the only treatment that can rapidly correct the lactic acidosis and normalize the liver and kidney enlargement. We report here on a case of acute lymphoblastic leukemia that was accompanied with severe lactic acidosis and kidney enlargement.
Assuntos
Adulto , Humanos , Acidose Láctica , Rim , Infiltração Leucêmica , Fígado , Leucemia-Linfoma Linfoblástico de Células PrecursorasRESUMO
A 40-year-old woman presented with hemoptysis and thoracocervicofacial purpura that occurred after a generalized tonic-clonic seizure. Diffuse alveolar hemorrhage is reported relatively rarely in neurogenic pulmonary edema (NPE), which is a life-threatening postictal complication. This clinical setting causes difficulty in the diagnosis, when an accurate diagnosis and proper management are required. Thoracocervicofacial purpura has been described as an unusual setting for an epileptic seizure. Here, we report the first case of postictal diffuse alveolar hemorrhage with thoracocervicofacial purpura.
Assuntos
Adulto , Feminino , Humanos , Epilepsia , Hemoptise , Hemorragia , Edema Pulmonar , Púrpura , ConvulsõesRESUMO
Scrotal edema may develop during continuous ambulatory peritoneal dialysis (CAPD). The two etiologic mechanisms are peritoneo-scrotal communication through a patent processus vaginalis or extravasation of dialysate through a defect of abdominal wall. We report two cases of scrotal edema due to inguinal hernia by peritoneo-scrotal communication during CAPD. The etiology of scrotal edema was confirmed by peritoneal scintigraphy and/or computed tomography. Scrotal edema due to inguinal hernia was completely resolved by a surgical repair of hernia and did not recur despite of resumption of peritoneal dialysis.
Assuntos
Humanos , Parede Abdominal , Edema , Hérnia , Hérnia Inguinal , Diálise Peritoneal , Diálise Peritoneal Ambulatorial Contínua , Hidrocele TesticularRESUMO
We experienced a case of tuberculosis presented simultaneously with pseudoaneurysm of the aorta and ARDS. A 63-year-old man was admitted with complaints of fever and right upper quadrant abdominal pain for a week. Chest X-ray on admission showed a normal finding. Sub-diaphragmatic abscess on abdomen CT scan was suspected and serosanguinous fluid was aspirated from the abscess pocket. On day 2, he was getting more dyspneic and chest X-ray revealed extensive bilateral infiltration. Aspirated fluid revealed AFB. Later, follow-up abdomen CT scan revealed a leakage of dye from the aneurysmal sac of the descending aorta which was previously diagnosed as sub-diaphragmatic abscess. An aortic stent was placed, covering the opening into the aneurysm. The sputum also showed positive AFB. The patient was successfully weaned from the ventilator, and discharged with anti-tuberculous medication on day 42. Follow-up abdomen CT scan 6 months later showed that the aneurymal sac was completely disappeared.
Assuntos
Humanos , Pessoa de Meia-Idade , Abdome , Dor Abdominal , Abscesso , Aneurisma , Falso Aneurisma , Aorta , Aorta Torácica , Febre , Seguimentos , Síndrome do Desconforto Respiratório , Escarro , Stents , Tórax , Tuberculose , Ventiladores MecânicosRESUMO
Systemic sclerosis is an autoimmune disease, characterized by inflammation, microangiopathy and fibrosis in the skin and various intestinal organs. Gastrointestinal involvement is one of the major causes of serious morbidity, and next to the skin, the gastrointestinal tract is the most commonly involved organ. While esophageal involvement is most common gastrointestinal manifestation, the involvement of the small intestine and colon is less common but may lead to life-threatening complications like chronic pesudoobstruction or pneumatosis cystoids intestinalis. Here, we describe a case of progressive systemic sclerosis associated with intestinal pseudoobstruction. 28 year-old male presented abdominal pain and vomiting and he was diagnosed as having intestinal pseudoobstruction. His symptoms were well managed using the combination of octreotide, a long-acting somatostatin analogue, and erythromycin.