ABSTRACT
Thrombotic thrombocytopenic purpura (TTP) consists of the pentad of thrombocytopenia, hemolytic anemia, fever, neurologic abnormalities, and renal disease. We present a case report of acute TTP following a bout of ischemic colitis. This report reminds the clinician that ischemic colitis can be an atypical presentation of TTP. The prompt recognition and treatment of this disease process resulted in a good prognosis for our patient.
ABSTRACT
Laparoscopic cholecystectomy is now the gold standard for the treatment of symptomatic cholelithiasis. Portal venous thrombosis after laparoscopic cholecystectomy is rare. We report a case of thrombosis of the portal venous system after laparoscopic cholecystectomy in a patient with a latent prothrombin gene mutation. An abdominal computed tomography and magnetic resonance angiogram of the abdomen revealed portal, superior mesenteric, and splenic vein thrombosis. Testing for coagulation disorders showed a heterozygous form of factor II (prothrombin) G20210A mutation. Because of its rarity, information regarding this complication is limited.
Subject(s)
Cholecystectomy, Laparoscopic , Portal Vein , Prothrombin/genetics , Splenic Vein , Venous Thrombosis/genetics , Female , Humans , Magnetic Resonance Angiography , Middle Aged , MutationSubject(s)
Anti-Infective Agents, Local/toxicity , Colitis/chemically induced , Constipation/drug therapy , Dioctyl Sulfosuccinic Acid/toxicity , Enema/adverse effects , Gastrointestinal Hemorrhage/chemically induced , Hydrogen Peroxide/toxicity , Phosphates/toxicity , Surface-Active Agents/toxicity , Anti-Infective Agents, Local/administration & dosage , Biopsy , Colitis/diagnosis , Colitis/pathology , Colonoscopy , Dioctyl Sulfosuccinic Acid/administration & dosage , Gastrointestinal Hemorrhage/diagnosis , Humans , Hydrogen Peroxide/administration & dosage , Intestinal Mucosa/drug effects , Intestinal Mucosa/pathology , Male , Middle Aged , Phosphates/administration & dosage , Reactive Oxygen Species/metabolism , Surface-Active Agents/administration & dosage , Ulcer/chemically induced , Ulcer/diagnosis , Ulcer/pathologySubject(s)
Abdominal Injuries/complications , Common Bile Duct Diseases/therapy , Liver/injuries , Sphincterotomy, Endoscopic , Adult , Cholangiopancreatography, Endoscopic Retrograde , Common Bile Duct Diseases/etiology , Constriction, Pathologic , Endoscopy, Digestive System , Humans , Male , Stents , Wounds, Nonpenetrating/complicationsSubject(s)
Tuberculosis, Hepatic/diagnosis , Humans , Male , Middle Aged , Tuberculosis, Hepatic/drug therapyABSTRACT
Mild hypokalemia is common and encountered in a multitude of diseases, but severe hypokalemia leading to rhabdomyolysis is relatively rare. The watery diarrhea, hypokalemia, achlorhydria (WDHA) syndrome caused by vasoactive intestinal polypeptide (VIP)-producing tumors, is an extremely rare cause of hypokalemic rhabdomyolysis and the literature is limited to one case report. We report a second case of an adult who presented with rhabdomyolysis due to severe hypokalemia. Further evaluation revealed that he had a VIP-producing pancreatic neuroendocrine tumor (NET), which was the cause of his hypokalemic rhabdomyolysis. Although rare in occurrence, a high index of suspicion is of paramount importance for establishing the correct diagnosis and treatment.
Subject(s)
Hypokalemia/complications , Pancreatic Neoplasms/diagnosis , Rhabdomyolysis/etiology , Vipoma/diagnosis , Achlorhydria/etiology , Adult , Diarrhea/etiology , Humans , Hypokalemia/etiology , Male , Pancreatic Neoplasms/complications , Pancreatic Neoplasms/pathology , Syndrome , Vasoactive Intestinal Peptide/blood , Vipoma/complications , Vipoma/pathologyABSTRACT
Histoplasmosis is endemic to the midwestern and east central states in the United States near the Mississippi and the Ohio River valleys. Ninety-nine percent of patients exposed to histoplasmosis develop only subclinical infection. Liver involvement as a part of disseminated histoplasmosis is well known; however, isolated hepatic histoplasmosis without any other stigmata of dissemination is extremely rare and the literature is limited to only two case reports. We present a rare case of isolated granulomatous hepatitis due to histoplasmosis in a 35-year-old female with dermatomyositis receiving low-dose prednisone and methotrexate. There was no evidence of fungal dissemination elsewhere. High clinical suspicion is critical for early diagnosis and treatment.
Subject(s)
Hepatitis/diagnosis , Histoplasmosis/diagnosis , Adult , Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Female , Granuloma/diagnosis , Granuloma/pathology , Hepatitis/etiology , Hepatitis/pathology , Histoplasmosis/drug therapy , Histoplasmosis/pathology , Humans , Liver/pathologyABSTRACT
BACKGROUND: Clostridium difficile-associated diarrhea (CDAD) is a common cause of mortality and morbidity in hospitalized patients. Some case reports have implicated renal failure as a risk factor for CDAD. The aim of this study was to assess whether chronic renal insufficiency is a risk factor for CDAD and whether it increases mortality and morbidity. METHOD: We reviewed charts of 385 patients with diarrhea for CDAD, chronic renal insufficiency, mortality, and recurrence of CDAD. RESULTS: Seventy-seven patients had infection due to C difficile. There was no difference in the chronic renal insufficiency, mortality, and other comorbid conditions between patients who had C difficile infection and those who did not. The patients with CDAD and chronic renal insufficiency had significantly higher mortality and recurrence of CDAD than patients without chronic renal insufficiency. CONCLUSIONS: Chronic renal insufficiency is not a risk factor for CDAD, but its presence with CDAD increases mortality and recurrence of CDAD.
