ABSTRACT
IgG4-related disease is a rare inflammatory disorder that may mimic many infectious, malignant, and autoimmune conditions. The biliary tract is frequently involved, but hepatic lesions are rarely seen. Diagnosis is often delayed due to the absence of specific clinical and radiological signs, and the lack of an accurate diagnostic marker. Differential diagnosis includes cholangiocarcinoma, primary sclerosing cholangitis and intrinsic or metastatic liver disease. Corticosteroids are the cornerstone of therapy but treatment has not been standardized and relapse is common. Based on two cases of IgG4-related hepatobiliary disease, we review the current literature on this pathological entity.
Subject(s)
Autoimmune Diseases/diagnosis , Autoimmune Diseases/drug therapy , Cholangitis/diagnosis , Cholangitis/drug therapy , Glucocorticoids/therapeutic use , Liver Diseases/diagnosis , Liver Diseases/drug therapy , Autoimmune Diseases/immunology , Cholangitis/immunology , Contrast Media , Diagnosis, Differential , Diagnostic Imaging , Humans , Immunoglobulin G/immunology , Liver Diseases/immunology , Liver Function Tests , Male , Middle AgedABSTRACT
Endoscopic injection of fibrin glue into a bleeding peptic ulcer is an effective and safe treatment modality. The present report describes a patient who developed rectal bleeding from an arteriovenous malformation after endoscopic injection of fibrin glue containing human thrombin into a gastric ulcer. Additional laboratory investigations revealed the presence of an inhibitor against coagulation factor V, which resulted in severe coagulopathy, triggering the bleeding. Acquired factor V inhibitors have frequently been reported with the use of bovine thrombin, but to our knowledge, they have never been documented in patients exposed to human thrombin. Endoscopists should be aware of this rare, but potentially serious, complication.
Subject(s)
Blood Coagulation Disorders/etiology , Factor V/antagonists & inhibitors , Hemostatics/adverse effects , Peptic Ulcer Hemorrhage/therapy , Thrombin/adverse effects , Aged , Aged, 80 and over , Blood Coagulation Disorders/therapy , Blood Coagulation Tests , Endoscopy, Gastrointestinal , Female , Fibrin Tissue Adhesive/adverse effects , Humans , Thrombin/immunologyABSTRACT
Kingella kingae is an aerobic gram-negative coccobacillus that has been associated predominantly with bone and joint infection but also with septicemia and endocarditis. Until now, only four cases of proven K. kingae meningitis have been reported. We describe a case of a K. kingae meningitis in a male adolescent who presented with a history of fever of unclear origin.
