ABSTRACT
Introduction: Visceral leishmaniasis is endemic in Somalia and in East Africa at large. Clinically, patients present with recurrent fever, weight loss, hepatosplenomegaly and pancytopenia. Sometimes, patients in low resource countries with no properly functioning primary healthcare facilities may present with complications. Case presentation: Here, we report a case of 19 years old male patient who presented with impaired renal function. After diagnosing with VL and starting Sodium Stibogluconate, patient developed acute pancreatitis, that compelled us to shift to liposomal amphotericin B, which he responded well and finally was discharged within a good condition. Clinical discussion: Early diagnosis and proper treatment is necessary to restore the renal function. Conclusion: This case report elaborates some of the clinical presentations of VL, complications of treatment and encouraging physicians in endemic areas to keep VL into their list of differential diagnosis in patients with fever and hepatosplenomegaly.
ABSTRACT
Background: It is extremely rare for hypercalcemia to appear as the first symptom of hepatocellular carcinoma. Instead, it occurs primarily as a paraneoplastic manifestation after the disease is already diagnosed. Methods: In this report, we describe a 55-year-old woman who presented with symptoms of acute severe hypercalcemia and was negative for hepatitis B surface antigen and hepatitis C virus antibodies. Results: Laboratory tests confirmed hypercalcemia (serum calcium 16.2 mg/dL) with intact parathyroid hormone (2 pg/mL). Alpha-fetoprotein serum level was 3031.14 ng/mL. Abdominal ultrasonography and computed tomography revealed a big vascularized mass of 7 × 5.5cm in diameter, occupying most of the right lobe of the liver. Conclusion: Based on these findings, hepatocellular carcinoma may present late in disease progression with isolated hypercalcemia; therefore, HCC should be considered in the differential diagnosis in a hypercalcemic patient.
