Cannabis-induced recurrent acute pancreatitis.

Acute pancreatitis has a large number of causes. Major causes are alcohol and gallstones. Toxic causes, mainly represented by medication-induced pancreatitis account for less than 2% of the cases. Cannabis is an anecdotally reported cause of acute pancreatitis. Six cases have previously been reported. Herein we report a new case of cannabis-induced recurrent acute pancreatitis.

Socioeconomic deprivation does not influence the severity of Crohn's disease: Results of a prospective multicenter study.

BACKGROUND: Socioeconomic deprivation is associated with poor health. The aims of this study were to evaluate the influence of deprivation in the characteristics and comparisons of deprived and nondeprived Crohn's disease (CD) patients. METHODS: CD patients were prospectively recruited from September 2006 to June 2007 in 6 hospitals in the Paris area. To assess the level of deprivation we used the EPICES score (Evaluation of Precarity and Inequalities in Health Examination Centers; http://www.cetaf.asso.fr), a validated individual index of deprivation developed in France, a score >30 defining deprivation. We defined CD as severe when at least 1 of the conventionally predefined criteria of clinical severity was present. RESULTS: In all, 207 patients (128 women and 79 men, mean age 40 years) were included and had a median score of deprivation of 20.7 (0-100). Seventy-three (35%) were deprived. There were no statistical differences between deprived and nondeprived patients for the following parameters: 1) mean age: 39 +/- 14.6 versus 40.6 +/- 13.5, P = 0.4; 2) sex ratio (female/male): 87/47 (65%) versus 41/32 (56%), P = 0.2; 3) duration of disease (years) 9 +/- 8.8 versus 8.5 +/- 7.2, P = 0.7; 4) delay from onset of symptoms to diagnosis >1 year: 22/115 (19%) versus 13/63 (21%), P = 0.8; and 5) severity of disease 71% versus 70% (P = 0.9). Nondeprived patients had a lower rate of hospitalization (40 versus 56%, P = 0,04) and a higher rate of surgery (44 versus 22%, P = 0,004); the rate of surgery was only identified by logistic regression. CONCLUSIONS: In this study deprivation does not seem to influence the severity of CD. This can be explained by easy access to healthcare in France.

Sclerosing mesenteritis associated with giant-cell temporal arteritis.

A 72-year-old man presented with a history of progressive abdominal pain associated with simultaneous headache, constitutional syndrome, and weight loss. A CT scan demonstrated sclerosing mesenteritis (SM). A surgical biopsy of mesenteric tissue excluded malignancies and a temporal artery biopsy showed giant-cell arteritis, establishing the diagnosis of SM associated with giant-cell temporal arteritis (GCA). Both entities responded well to steroid therapy and relapsed simultaneously after steroid withdrawal. This association may be fortuitous, but it can also represent a unique clinical setting. We suggest ruling out GCA every time a SM is encountered in the appropriate clinical setting (i.e., in elderly patients with other symptoms and signs suggestive of GCA). A temporal artery biopsy may be systematically considered in these patients.

Pegylated interferon-induced eyelid and eyebrow trichomegaly during chronic hepatitis C.

One of the most common skin and hair growth disorders related to interferon therapy is alopecia. Hypertrichosis has also been reported as a rare side-effect of interferon therapy, especially in eyelashes. Herein is reported a case of eyelid and eyebrow trichomegaly in a patient treated with pegylated interferon and ribavirin for chronic hepatitis C associated with porphyria cutanea tarda.

Omeprazole-induced intractable cough.

OBJECTIVE: To report a case of chronic, persistent cough induced by omeprazole therapy. CASE SUMMARY: A 42-year-old white woman presented with chronic, persistent cough after omeprazole initiation for treatment of postoperative heartburn. The cough was permanent, dry, and exhausting and worsened at night. Omeprazole therapy was continued for 4 months because the persistent cough was thought to be related to gastroesophageal reflux disease (GERD). However, no cause of persistent, chronic cough was identified. After omeprazole discontinuation, the cough resolved. DISCUSSION: The most common causes of chronic cough in nonsmokers of all ages are postnasal drip syndrome, asthma, and GERD. However, persistent cough without bronchospasm or other pulmonary involvement may occur as a drug adverse effect. According to the US omeprazole package insert, cough is observed as an adverse reaction in 1.1% of patients, although this has not been mentioned in international drug information sources or medical literature. A MEDLINE search (1966-June 2003) using the terms cough, drug related, adverse effects, and omeprazole failed to find any data. In our patient, there was a temporal relationship between cough and medication use, suggesting a causal relationship. An objective causality assessment revealed that the adverse drug reaction was probable. The mechanism is unclear. CONCLUSIONS: Chronic, persistent cough may occur as an adverse effect of omeprazole therapy. Clinicians must be aware of this adverse effect to avoid useless and costly tests.