ABSTRACT
Acute tumour lysis syndrome (TLS) is a catastrophic complication of the treatment of certain neoplastic disorders. It most commonly occurs in association with hematologic malignancies and appears a few hours to a few days after initiation of specific chemotherapy, as the result from the release of intracellular components into the bloodstream due to abrupt malignant cell death. Acute spontaneous TLS is rare, and it has been described in leukemia and lymphoma and in some patients with solid tumors prior to institution of therapy. The syndrome is characterized by hyperuricemia, hyperphosphatemia, hypocalcemia, hyperkalemia, and acute oliguric or anuric renal failure due to uric acid precipitation within the tubules (acute uric acid nephropathy) and to calcium phosphate deposition in the renal parenchyma and vessels.We report a case of acute spontaneous TLS in a patient with Crohn s disease treated with immunosuppressive drugs, who developed a plasmocytoma, in which serum uric acid concentration attained exceptionally high levels (44 mg/dL). The patient underwent acute oliguric renal failure, which required treatment with hyperhydration, urine alkalinization, urate oxidase and hemodialysis, with a fatal evolution.In conclusion, the present case report has several peculiarities: that of being one of the rare examples of spontaneous TLS, that of showing an exceptionally severe hyperuricemia, probably the highest ever reported in the literature, and that of the possible increased risk of tumours in patients with Crohn s disease taking inmunosuppressives and/or TNF antagonists.
Subject(s)
Crohn Disease/drug therapy , Immunosuppressive Agents/adverse effects , Tumor Lysis Syndrome/etiology , Acute Disease , Humans , Male , Middle AgedABSTRACT
El síndrome de lisis tumoral (SLT) es una complicación catastrófica del tratamiento de ciertas enfermedades neoplásicas. Si bien es más frecuente en pacientes con neoplasias hematológicas malignas tras el inicio de la quimioterapia, puede presentarse excepcionalmente, tras la necrosis espontánea de algunos tumores, en ausencia de tratamiento citostático. Clínicamente cursa con hiperuricemia, hiperfosfatemia, hipocalcemia, hiperpotasemia y fallo renal agudo. Presentamos el caso de un paciente con enfermedad de Crohn en tratamiento inmunospresor, que desarrolló un síndrome de lisis tumoral espontáneo como debut de un plasmocitoma. Al ingreso, se objetivó un fracaso renal oligoanúrico que, a pesar de tratamiento precoz con hiperhidratación, alcalinización de la orina, urato-oxidasa y hemodiálisis, tuvo un desenlace fatal en 72 horas. Este caso reviste un interés particular por lo excepcional de la naturaleza "espontánea" del síndrome de lisis tumoral en ausencia de quimioterapia, por presentarse con una hiperuricemia extrema, probablemente la más alta de las recogidas en la literatura, y por la controversia actual de la terapia con inmunosupresores y/o biológicos en la enfermedad inflamatoria intestinal y su relación con el desarrollo de determinados tumores(AU)
Acute tumour lysis syndrome (TLS) is a catastrophic complication of the treatment of certain neoplastic disorders. It most commonly occurs in association with hematologic malignancies and appears a few hours to a few days after initiation of specific chemotherapy, as the result from the release of intracellular components into the bloodstream due to abrupt malignant cell death. Acute spontaneous TLS is rare, and it has been described in leukemia and lymphoma and in some patients with solid tumors prior to institution of therapy. The syndrome is characterized by hyperuricemia, hyperphosphatemia, hypocalcemia, hyperkalemia, and acute oliguric or anuric renal failure due to uric acid precipitation within the tubules (acute uric acid nephropathy) and to calcium phosphate deposition in the renal parenchyma and vessels. We report a case of acute spontaneous TLS in a patient with Crohn's disease treated with immunosuppressive drugs, who developed a plasmocytoma, in which serum uric acid concentration attained exceptionally high levels (44 mg/dL). The patient underwent acute oliguric renal failure, which required treatment with hyperhydration, urine alkalinization, urate oxidase and hemodialysis, with a fatal evolution. In conclusion, the present case report has several peculiarities: that of being one of the rare examples of spontaneous TLS, that of showing an exceptionally severe hyperuricemia, probably the highest ever reported in the literature, and that of the possible increased risk of tumours in patients with Crohn's disease taking inmunosuppressives and/or TNF antagonists(AU)
Subject(s)
Humans , Male , Middle Aged , Pancreatic Neoplasms/diagnosis , Sarcoma/diagnosis , Crohn Disease/complications , Crohn Disease/diagnosis , Immunosuppressive Agents/therapeutic use , Acute Kidney Injury/complications , Acute Kidney Injury/diagnosisSubject(s)
Anti-Bacterial Agents/therapeutic use , Helicobacter Infections/drug therapy , Helicobacter pylori , Adult , Age Factors , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/pharmacology , Child , Controlled Clinical Trials as Topic , Drug Resistance, Bacterial , Drug Therapy, Combination , Female , Helicobacter Infections/epidemiology , Helicobacter pylori/drug effects , Humans , Male , Prevalence , Prospective Studies , Spain/epidemiologyABSTRACT
No disponible
Subject(s)
Humans , Helicobacter pylori/pathogenicity , Helicobacter Infections/drug therapy , Anti-Bacterial Agents/pharmacokinetics , Drug Resistance, Microbial/immunology , Microbial Sensitivity Tests/trendsABSTRACT
Alterations in blood clotting are a frequent complication of serious heatstroke and may result in gastrointestinal bleeding. We report the case of a 26-year-old man who was admitted to our hospital with symptoms of hyperthermia associated with encephalopathy and disseminated intravascular coagulation (DIC) after prolonged exposure to sunlight. He presented hematemesis, after which he was diagnosed with having a bruising of the esophagus that took up the upper and lower thirds, there being no other lesions in the stomach or duodenum. After supportive treatment and following the resolution of the underlying pathology, the endoscopy-revealed injuries healed with a complete normalization of the esophageal mucosa. Esophageal submucosal bruising is an exceptional cause of hematemesis in serious heatstroke not previously described in the literature.
Subject(s)
Esophageal Diseases/etiology , Gastrointestinal Hemorrhage/etiology , Heat Stroke/complications , Hematoma/etiology , Adult , Humans , MaleABSTRACT
Las alteraciones de la coagulación son una complicación frecuenteen el golpe de calor grave, y pueden ser causa de hemorragiadigestiva. Presentamos el caso de un varón de 26 años quefue admitido en nuestro hospital por un cuadro de hipertermia,asociado con encefalopatía y coagulación intravascular diseminadatras exposición solar prolongada. Presentó hematemesis por laque fue diagnosticado de múltiples hematomas esofágicos queocupaban los tercios superior e inferior del órgano, en ausenciade otras lesiones en estómago y duodeno. Tras el tratamiento desoporte y la resolución de la patología subyacente, desaparecieronlas lesiones endoscópicas, normalizándose la mucosa esofágica
Alterations in blood clotting are a frequent complication ofserious heatstroke and may result in gastrointestinal bleeding.We report the case of a 26-year-old man who was admitted toour hospital with symptoms of hyperthermia associated with encephalopathyand disseminated intravascular coagulation (DIC)after prolonged exposure to sunlight. He presented hematemesis,after which he was diagnosed with having a bruising of theesophagus that took up the upper and lower thirds, there beingno other lesions in the stomach or duodenum. After supportivetreatment and following the resolution of the underlying pathology,the endoscopy-revealed injuries healed with a completenormalization of the esophageal mucosa. Esophageal submucosalbruising is an exceptional cause of hematemesis in seriousheatstroke not previously described in the literature
Subject(s)
Male , Adult , Humans , Esophageal Diseases/etiology , Gastrointestinal Hemorrhage/etiology , Hematoma/etiology , Heat Wave (Meteorology)ABSTRACT
OBJECTIVE: cavernous hemangioma of the rectosigmoid colon is a rare disease, with no more than 200 cases reported in the literature. The rectosigmoid is the most common site of this disease in the gastrointestinal tract. CASE REPORT: we report the case of a 31-year-old male with recurrent episodes of rectal bleeding, who was finally diagnosed of diffuse cavernous hemangioma of the rectum. The tumor, of 12 x 10 x 9 cm in size, occupied the rectum to the margin of the anal sphincter. A surgical procedure was ruled out because of the inability to carry out a safe anastomosis while preserving anal sphincters. DISCUSSION: rectal hemangiomas are less frequent vascular malformations. The clinical presentation of a cavernous hemangioma of the rectum is usually acute, recurrent or chronic rectal bleeding. Other symptoms stem from the possible compression or invasion of adjacent structures, such as lumbar or perianal pain, metrorrhage, hematuria, etc. This diagnosis is commonly made in younger patients. Colonoscopy is without doubt the diagnostic technique of choice, and it allows to establish the localization, morphology, and total extension of the lesion; its characteristic image is a red-purplish nodule with great vascular congestion. According to the opinion of most authors, biopsy is not advisable during colonoscopy, since imaging techniques are sufficient for an accurate diagnosis, and the risk of bleeding while manipulating this lesion is not negligible. Computed tomography and particularly magnetic resonance imaging, given their high precision to delimit the lesion and its relations to adjacent structures, are imaging studies that are mandatory before surgical treatment. Other techniques such as selective angiography, barium enema, gastrointestinal transit, and upper-tract endoscopy may be supplementary and help locate more lesions along the gastrointestinal tract. Failure to recognize the exact diagnosis and extent of diffuse cavernous hemangioma may lead to failed surgical treatment and severe complications. Complete surgical excision of the lesion with a sphincter-saving procedure is the primary mode of treatment: conservative proctectomy with coloanal anastomosis.
Subject(s)
Gastrointestinal Hemorrhage/etiology , Hemangioma, Cavernous/diagnosis , Rectal Neoplasms/diagnosis , Adult , Colonoscopy , Endosonography , Hemangioma, Cavernous/surgery , Humans , Magnetic Resonance Imaging , Male , Rectal Neoplasms/surgery , Tomography, X-Ray ComputedABSTRACT
Idiopathic thrombocytopenic purpura is an infrequent extraintestinal manifestation of inflammatory bowel disease. It is particularly rare in association with Crohn's disease. In these cases it presents certain peculiarities with respect to its normal clinical features, occurring more frequently when Crohn's disease is mainly colonic and usually appearing after the diagnosis of Crohn's disease has been made. Moreover, it usually complicates the clinical course of both diseases. We present a case of idiopathic thrombocytopenic purpura in a 14-year-old girl in whom the two diseases first presented simultaneously. The clinical course was poor and both diseases were refractory to habitual treatment.
