ABSTRACT
An 89-year-old man with a history of coronary artery disease status post coronary artery bypass grafting and atrial fibrillation on aspirin and warfarin, presented to the emergency department with a symptom of haemoptysis. He reported a history of dysphagia for 3â months prior to presentation, but had yet to seek medical attention. On presentation, he was hypotensive and tachycardic with a haemoglobin of 6.6â g/dL and an International Normalised Ratio (INR) of 3.9. Esophagogastroduodenoscopy was performed and showed active bleeding from Zenker's diverticulum. The patient's INR was reversed with fresh frozen plasma and his anaemia was treated with packed red blood cells. The bleeding stopped after reversal of his INR. A barium swallow confirmed a 9â cm Zenker's diverticulum. The patient had a diverticulectomy and cricopharyngeal myotomy. Histology showed mild chronic inflammation of the mucosa, but no ulceration. The patient was discharged without any further bleeding episodes.
Subject(s)
Esophageal Diseases/diagnosis , Gastrointestinal Hemorrhage/diagnosis , Zenker Diverticulum/diagnosis , Aged, 80 and over , Endoscopy, Digestive System , Esophageal Diseases/etiology , Gastrointestinal Hemorrhage/etiology , Humans , Male , Zenker Diverticulum/complications , Zenker Diverticulum/surgeryABSTRACT
Granulomatous hepatitis has many causes. Drugs are an important etiologic factor. Several oral hypoglycemic agents are available for treatment of type II diabetes. Rosiglitazone, a thiazolidinedione, is a newer agent in this class. It has not been shown to be hepatotoxic in the premarketing trials. However, a few case reports have implicated it as a cause of acute hepatocellular injury. The authors report a case of granulomatous hepatitis associated with use of rosiglitazone. Liver function tests should be done regularly to monitor patients on this medication.
