ABSTRACT
The ingested foreign body is a very unusual etiology of liver abscess. This clinical scenario is infrequently reported in the literature. A 66-year-old male patient presented to the hospital because of abdominal pain along with 7 days of right upper quadrant pain and intermittent low-grade fever. He was living in an epidemiological area of Fasciola infection. Physical examination showed right hypochondria tenderness without guarding or rebounding. Laboratory results were significant for leukocytosis, predominant neutrophils, and increased inflammatory markers. The liver function tests were within normal limits. Abdominal ultrasonography and CT scan were consistent with a hepatic abscess spread from segment 4B to segment 3. The patient was preliminarily diagnosed with a parasitic hepatic abscess. After management with fluid infusion and antibiotics, the patient was discharged in stable condition. Two weeks later, on the follow-up visit, the patient reported intermittent low-grade fever had persisted. After consulting the CT scan, an abnormal high-attenuation linear structure was identified inside the liver lesion, which is suspected of being a foreign body. Laparoscopic surgery was performed, and a fishbone was removed from the abscess cavity. Perforation was not found in the stomach, duodenum, or in the bowel. One week later, their condition was fully resolved. Liver abscess due to a foreign body should be suspected when a patient has radiology findings suggestive of an abscess, but the clinical presentation does not indicate the common etiologies. Meticulous observation on abdominal CT scans or ultrasonography can help with diagnosis and guide treatment.
ABSTRACT
Coronary artery vasospasm (CVS), an uncommon cause of acute chest pain, can be provoked by vasoconstriction-induced medications. Misoprostol, a prostaglandin analog, is a safe medication to terminate a pregnancy. However, misoprostol can cause coronary artery vasospasm due to vasoconstrictor properties, leading to acute myocardial infarction with nonobstructive coronary arteries (MINOCA), especially in patients with a high risk for cardiovascular disease. We report a case of a 42-year-old female with a past medical history of hypertension who presented with ST-elevation myocardial infarction following the administration of a high-dose Misoprostol. The fact that coronary angiogram and intravascular ultrasound revealed normal coronary arteries suggested transient coronary vasospasm. CVS is a severe but rare cardiac adverse effect associated with high-dose misoprostol. This medication should be prescribed with caution and close monitoring, especially in those with pre-existing heart disease or cardiovascular risk factors. Our case raises awareness of severe cardiovascular complications that can be related to using misoprostol in high-risk patients.
