Plasma Exchange for Refractory Pruritus Due to Drug-Induced Chronic Cholestasis Following Azithromycin Misuse in COVID-19 Infection.

Azithromycin can result in severe cholestatic liver disease. We describe two cases of intractable pruritus secondary to drug-induced cholestatic liver injury, unresponsive to symptomatic medical therapy, necessitating and responding well to therapeutic plasma exchange (TPE). The first is a case of a 60-year-old male known to have stable chronic lymphocytic leukemia (CLL) and benign prostatic hyperplasia, and the second is a 46-year-old female known to have primary biliary cirrhosis (PBC) who presented at six weeks and two weeks, respectively, post-mild-COVID-19 pneumonia. Their drug histories were positive for over-the-counter (OCT) azithromycin use during the COVID-19 pneumonia period. They presented with a two-week history of severe itching, associated with sleep deprivation and impaired quality of life. Liver function tests revealed a cholestatic pattern of liver injury. Pruritus remained refractory to multiple lines of treatment including bile acid sequestrants and antihistamines. Rapid and long-lasting relief of the patient's symptoms was observed after three sessions of TPE. Our cases highlight medically recalcitrant cholestatic pruritus as an adverse effect of antibiotic misuse during the recent COVID-19 pandemic. Sustained symptomatic improvements were seen after TPE.

Plasma Exchange for the Treatment of Severe Hypertriglyceridemic Pancreatitis With Diabetic Ketoacidosis: A Case Report From Sub-Saharan Africa.

The triad of acute pancreatitis, diabetic ketoacidosis, and hyperlipidemia is exceedingly rare. Case reports describing this uncommon triad have successfully been managed with insulin infusions only. Herein, we highlight the challenges in making this diagnosis and present Sub-Saharan Africa's first experience with therapeutic plasma exchange in the management of hypertriglyceridemic pancreatitis associated with diabetic ketoacidosis, which was initially refractory to insulin infusion alone.

Colonic polyps: a rare clinical manifestation of schistosomiasis (a case report).

Schistosomiasis is caused by parasitic blood flukes. It is one of the neglected tropical diseases (NTDs) and has variable manifestations depending on the species involved. Eggs and not adult worms are mostly responsible for the resultant pathologies commonly involving the small intestines. Colon polyps resulting from schistosomiasis represent a rare entity despite the endemicity of Schistosoma mansoni in the tropical regions. Praziquantel is the mainstay of treatment. Case presentation is of a 28 year old male with complaints of bloating, mild abdominal pain and loose stools over two weeks.On examination, the patient´s abdomen was soft on palpation with a liver span of 8 cm and a non-palpable spleen. Preliminary tests included stool microscopy which was negative for ova and cysts, negative for stool H. pylori antigen. Colonoscopy revealed a polyp at the caecum and pan-colonic erosions. Microscopy of the polyp showed numerous schistosome ova. The indolent picture of this particular patient makes it a unique case as the likelihood of the diagnosis not being schistosomiasis is greater than other differential diagnoses. The take-home message is that a high index of suspicion is needed in the diagnosis of colonic polyps resulting from schistosomiasis as it presents with non-specific manifestations and inconclusive laboratory and endoscopic findings.

Idiopathic Retroperitoneal Fibrosis: An East African Diagnostic Challenge.

Retroperitoneal fibrosis (RPF) is a rare disease with variable etiology characterized by chronic inflammation and fibrosis of tissue surrounding the abdominal aorta and iliac arteries. The majority of cases of RPF remain idiopathic and mostly reported in men. Glucocorticoids remain key in the treatment of RPF. Little has been reported on RPF in sub-Saharan Africa.