ABSTRACT
We describe the case of a 51-year-old man with recently diagnosed ulcerative colitis who developed fever and elevated liver enzymes as well as cholestasis a few weeks after starting treatment with mesalazine. As no obvious cause was found and fever persisted, liver biopsy was performed and revealed granulomatous hepatitis. The patient recovered completely after cessation of mesalazine, so that a drug-induced granulomatous hepatitis after exclusion of other differential diagnoses in an extensive work up was assumed. The present case demonstrates that even though drug-induced liver injury due to mesalazine is rare, it should be considered in unclear cases and lead to prompt discontinuation of mesalazine.
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Chemical and Drug Induced Liver Injury/etiology , Colitis, Ulcerative/drug therapy , Fever/diagnosis , Hepatitis/etiology , Liver/pathology , Mesalamine/adverse effects , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Biopsy , Chemical and Drug Induced Liver Injury/diagnosis , Cholestasis/etiology , Fever/etiology , Hepatitis/diagnosis , Humans , Male , Mesalamine/therapeutic use , Middle AgedABSTRACT
Defined by lasting more than four weeks - is a common but often challenging clinical scenario. It is important to be aware that diarrhoea means different things to different patients. The evaluation of chronic diarrhoea depends on taking an excellent history and careful physical examination as well as planning investigations thoughtfully. Functional diarrhea ist the most common cause of chronic diarrhea in the developed countries and motility disorders are more common than inflammatory, osmotic or secretory causes. In some cases categorizing patients by their stool characteristics can be helpful in directing further evaluation.
Subject(s)
Diarrhea/etiology , Algorithms , Chronic Disease , Diagnosis, Differential , Diarrhea/therapy , Humans , Medical History Taking , Risk FactorsABSTRACT
BACKGROUND: Cutaneous carbon dioxide tension (PcCO(2)) is a promising non-invasive surrogate measure of arterial partial pressure of carbon dioxide (PaCO(2)). OBJECTIVES: To compare values of PcCO(2) and oxygen saturation (SpO(2)) with arterial blood gas (ABG) analysis. METHODS: SpO(2) and PcCO(2) were measured with a v-Sign-sensor (Sentec AG, Therwil, Switzerland) and the values compared with simultaneously obtained SaO(2) and PaCO(2) obtained from ABG analysis (ABL 725, Radiometer, Copenhagen, Denmark) in 275 adult patients referred to the lung function laboratory. RESULTS: Median of the PcCO(2) was 4.7 kPa (interquartile range [IQR] 0.9 kPa). Median of the SpO(2) was 97% (IQR 3%). Bland-Altman analysis for comparison of PcCO(2) with PaCO(2) showed a bias of -0.1 kPa with a precision of +/- 0.9 kPa with 3.7% outlying values. Bland-Altman analysis for the comparison of SpO(2) and SaO(2) showed a bias of 20.1 % with a precision of +/- 3.5%. There were no complications. CONCLUSION: There is a good agreement between combined cutaneous capnography and oximetry values with ABG analysis. Due to the excellent safety profile and the short time to get a continuous measurement, this technique should be examined in settings where it can complement repeated ABG analysis when ventilatory disturbances are suspected or non-invasive monitoring of ventilation is needed.