[Extra-hepatic manifestations associated with Hepatitis and virus infection].

Hepatitis E virus (HEV) is a significant public health problem that affects almost 20 million individuals annually and cause acute liver injury in 3,5 million. Hepatitis E virus can cause acute, fulminant and chronic hepatitis and has been associated with a range of extrahepatic manifestation. The spectrum of these manifestation is still emerging. Acute pancreatitis and neurological, renal, hematologic, and muscoloskeletal manifestations have been described. Renal injury include membranoproliferative glomerulonephritis with or without cryoglobulinemia, membranous glomerulonephritis and tubular necrosis. The etiopathogenesis of extrahepatic manifestation is only supposed. It could be caused by a direct tossic effect of HEV or by an autoimmune process. We report a case of a 46 years old man who presented with acute hepatitis E. He was diagnosed to have acute severe renal failure and severe pancreatitis due to hepatitis E. Few cases have been reported in the literature concerning patients suffering from hepatitis E and severe extraepatic manifestations with a benign course and complete recovery.

[Therapy of glucocorticoid induced osteoporosis]. / Terapia dell'osteoporosi da glucocorticoidi.

Glucocorticoid-induced osteoporosis (GIO) is a major cause of secondary osteoporosis that starts early after the beginning of therapy even for low drug doses. Glucocorticoids are used for the treatment of immunologic nephropathies and in the setting of kidney transplant. In clinical practice, a number of algorithms are available; they allow us to estimate the long-term risk of major osteoporotic fracture; but none of them is specific for GIO. To date, the therapeutic approach comprises both general measures aimed at correcting calcium and vitamin D intake, and drugs (bisphosphonates, teriparatide, hormone replacement therapy, denosumab) that ameliorate bone mineral density and patient outcomes.

[Severe neutropenia during treatment with amoxicillin/clavulanic acid in a patient on regular hemodialysis treatment]. / Severa neutropenia durante trattamento con amoxicillina/acido clavulanico in un paziente in trattamento emodialitico regolare.

Beta-lactams are one of the most widely used antibiotics in respiratory diseases, both in adults and in the pediatric population. Their widespread use is also linked to the elevated tolerability and low risk of side effects that are generally not severe. We present here the case of a patient on regular haemodialysis pertaining to our Center who, after a seven-day treatment period with amoxicillin/clavulanic acid antibiotic therapy (medication originator), developed a framework of severe neutropenia (neutrophils till 10/mmc) resulting in hospitalization and the beginning of a specific diagnostic and therapeutic work-up. Our case is characterised, differently from other reports in the literature, for the onset of neutropenia after a short course of antibiotics, with a drug already used in the past without any side effects. During hospitalization, use of immunostimulant therapy led to the rapid recovery of a normal white blood cell count and resolution of severe neutropenia.