ABSTRACT
Two women, aged 78 and 85 years, presented with watery diarrhoea and fever after a course of antibiotic therapy. Pseudo-membranous colitis was diagnosed, which was adequately treated. In both patients the C. difficile colitis relapsed, which was successfully treated with a pulse and tapering scheme of vancomycin. C. difficile infection is a frequent cause of antibiotic-associated diarrhoea. Clinical presentation can vary in severity. Cytotoxin testing, immunoassay and endoscopy are important tools in diagnosing C. difficile colitis. Like the first infection, the first relapse must be treated with metronidazole or vancomycin. To treat a second relapse, a pulse and tapering dose of vancomycin has been recommended. Nevertheless, multiple recurrences may occur, which are difficult to treat.
Subject(s)
Anti-Bacterial Agents/adverse effects , Anti-Bacterial Agents/therapeutic use , Clostridioides difficile/drug effects , Enterocolitis, Pseudomembranous/drug therapy , Vancomycin/therapeutic use , Aged , Aged, 80 and over , Anti-Bacterial Agents/administration & dosage , Cytotoxins/analysis , Enterocolitis, Pseudomembranous/epidemiology , Female , Humans , Recurrence , Vancomycin/administration & dosageABSTRACT
A 35-year-old man presented with a brief history of haemorrhagic diarrhoea. He had moved to The Netherlands 24 years before and had been in Surinam 12 years ago for the last time. Physical examination and routine laboratory tests revealed no abnormalities. Colonoscopy showed a striking congestion of the small blood vessels; histological examination of a sigmoid biopsy revealed Schistosoma eggs and microbiological investigation of the feces revealed ova of Schistosoma mansoni. The schistosomiasis was thus diagnosed more than 10 years after the last possible exposure to schistosomal cercariae. The patient was treated with a single dose of praziquantel.
Subject(s)
Diarrhea/parasitology , Gastrointestinal Hemorrhage/parasitology , Schistosoma mansoni/isolation & purification , Schistosomiasis mansoni/diagnosis , Adult , Animals , Anthelmintics/therapeutic use , Chronic Disease , Colon, Sigmoid/parasitology , Colonoscopy , Feces/parasitology , Humans , Male , Parasite Egg Count , Praziquantel/therapeutic use , Schistosomiasis mansoni/drug therapy , Suriname , Treatment OutcomeABSTRACT
BACKGROUND: Bladder instillations with Bacillus Calmette-Guerin (BCG) are commonly used as immunotherapy for bladder carcinoma. Sometimes patients experience serious systemic side effects, such as sepsis or pneumonitis. Granulomatous hepatitis is a rare serious side effect, which has been considered a hypersensitivity reaction to BCG. PATIENT: The first case of granulomatous hepatitis after BCG bladder instillation in which mycobacteria were identified by staining techniques and mycobacterial DNA was detected in liver tissue using the polymerase chain reaction is reported. CONCLUSION: The granulomatous hepatitis was caused by BCG infection of the liver after haematogenous dissemination of BCG, rather than hypersensitivity.
Subject(s)
BCG Vaccine/adverse effects , Granuloma/microbiology , Hepatitis/microbiology , Mycobacterium Infections/complications , Mycobacterium bovis/isolation & purification , Administration, Intravesical , Aged , BCG Vaccine/administration & dosage , Carcinoma, Transitional Cell/therapy , Humans , Liver , Male , Polymerase Chain Reaction , Urinary Bladder Neoplasms/therapyABSTRACT
Rhabdomyolysis is characterized by local or generalized skeletal muscle necrosis. It is caused by many clinical conditions and drug or alcohol abuse. Clinical symptoms are muscle pain and muscle weakness. Laboratory investigations show a rise in serum creatine phosphokinase and electrolyte disturbances. The most serious complication is acute renal failure. We present a patient with rhabdomyolysis and renal failure associated with a recent Influenza A virus infection.
