ABSTRACT
A 51-year-old woman was admitted to the hospital with abdominal pain, jaundice, and transaminitis. The patient's laboratory results showed elevated liver enzymes, high antinuclear antibodies (ANA) titer, positive anti-smooth muscle antibody, and hypergammaglobulinemia. Given risk factors for HIV infection, an ADVIA Centaur® HIV Antigen/Antibody Combo assay was performed showing a reactive sample with a follow up HIV-1 nucleic acid test (NAT) proving to be negative. Following confirmation of autoimmune hepatitis type I via a liver biopsy, steroids were initiated and significant clinical improvement of symptoms as well as resolution in transaminitis were noted. Autoimmunity is the most likely causative factor in inducing a false positive reactive screening assay. It is important to recognize that cross-reactivity with autoimmune conditions and HIV specific proteins is a potential concern for false reactive samples.
ABSTRACT
A young man presented with several days of dyspnoea and delirium due to cocaine use which was confirmed by urine drug screening. Imaging studies confirmed the diagnosis of subcutaneous emphysema, pneumorrhachis and pneumomediastinum. He was managed successfully with conservative therapy.Although a rare clinical finding, cocaine-related pneumomediastinum, subcutaneous emphysema and pneumorrhachis should be recognised early on presentation. This will certainly help to effectively direct the use of healthcare resources and avoid subjecting the patient to unnecessary investigations.
Subject(s)
Cocaine-Related Disorders/complications , Mediastinal Emphysema/chemically induced , Pneumorrhachis/chemically induced , Subcutaneous Emphysema/chemically induced , Humans , Male , Young AdultSubject(s)
Cyanosis/diagnosis , Eisenmenger Complex/diagnosis , Heart Defects, Congenital/etiology , Hypertrophy, Left Ventricular , Adult , Eisenmenger Complex/diagnostic imaging , Heart Defects, Congenital/diagnosis , Humans , Male , Pulmonary Artery/abnormalities , Pulmonary Artery/diagnostic imagingABSTRACT
Foreign body granulomatosis is a rare complication of intravenous injection of pulverized oral prescription tablets. We present the case of an active duty male who was ultimately diagnosed with foreign body granulomatosis caused by the crushing and intravenous injection of acetaminophen with oxycodone (Percocet). The 24-year-old patient initially presented with multiple syncopal episodes, hemoptysis and hypoxia. The patient presentation and imaging findings involved in foreign body granulomatosis can mimic many pulmonary disorders and can be widely variable. Diagnosis is made following lung biopsy. The disease has irreversible effects and patients usually have a progressive decline in pulmonary function. Treatment is supportive although lung transplantation may be beneficial in patients with end-stage lung disease. Pulmonary foreign body granulomatosis should be considered in patients presenting with unexplained hypoxia and imaging consistent with diffuse micronodular disease.
