ABSTRACT
A gallstone ileus is an unusual form of bowel obstruction. Colonic gallstone ileus is rare, difficult to diagnose, and still has a high mortality rate. We present a case of biliary ileus caused by an impacted gallstone, causing necrosis and perforation of the rectosigmoid junction. A Hartmann's procedure was performed to treat the perforation and the obstruction. Cholecystectomy and closure of the cholecysto-colonic fistula were delayed until restoration of the intestinal continuity.
Subject(s)
Gallstones/complications , Ileus/etiology , Intestinal Obstruction/etiology , Aged , Cholecystectomy , Diagnosis, Differential , Gallstones/diagnostic imaging , Gallstones/surgery , Humans , Ileus/diagnostic imaging , Ileus/surgery , Intestinal Obstruction/diagnostic imaging , Intestinal Obstruction/surgery , Male , Tomography, X-Ray ComputedABSTRACT
In four patients, two men and two women aged 73, 68, 84 and 72 years respectively, reversible cholestatic liver injury was seen 28-35 days after the start of treatment with amoxycillin-clavulanic acid (Augmentin). This rare complication of amoxycillin-clavulanic acid treatment is characterized by a relatively long latent period before the onset of symptoms or biochemical abnormalities, which makes early recognition difficult. The mechanism responsible for this idiosyncratic cholestasis is unknown.
Subject(s)
Cholestasis/chemically induced , Drug Therapy, Combination/adverse effects , Aged , Aged, 80 and over , Amoxicillin/adverse effects , Amoxicillin-Potassium Clavulanate Combination , Clavulanic Acids/adverse effects , Female , Humans , MaleABSTRACT
We report a case of acute encephalopathy in a patient with Crohn's disease who had taken sulfasalazine for 1 month. The development of toxic hepatitis and dermatitis prompted interruption of the drug. Four days later, neurologic symptoms became evident. These included acute monoparesis of the left arm, the development of stupor and coma, with endorotation of both arms, and a left Babinski sign. CT and MR imaging revealed multiple lesions in the white and gray brain matter, suggesting diffuse cerebral microangiitis. All cerebrospinal fluid examinations were negative. Methylprednisolone was given intravenously. Complete clinical normalization followed. Neurotoxicity secondary to sulfasalazine has seldom been reported in the literature. We found certain similarities with two previous case reports suggesting a hypersensitivity reaction to sulfasalazine or one of its metabolites. For ethical reasons, no rechallenge was performed.
Subject(s)
Brain Diseases/chemically induced , Crohn Disease/drug therapy , Drug Hypersensitivity/etiology , Sulfasalazine/adverse effects , Adult , Chemical and Drug Induced Liver Injury/etiology , Drug Eruptions/etiology , Humans , Male , Sulfasalazine/therapeutic useABSTRACT
We report a case of acute encephalopathy in a patient with Crohn's disease who had taken sulfasalazine for 1 month. The development of a toxic hepatitis and dermatitis prompted interruption of the drug. Four days later, neurological symptoms became evident. These included acute monoparesis of the left arm, the development of stupor and coma, with endorotation of both arms and a left Babinski sign. CT and magnetic resonance imaging revealed multiple lesions in the white and gray brain matter, suggesting diffuse cerebral microangiitis. All cerebrospinal fluid examinations were negative. Methylprednisolone was given intravenously. Complete clinical normalization followed. Neurotoxicity secondary to sulfasalazine has seldom been reported in the literature. We found certain similarities between this case and two previous case reports suggesting a hypersensitivity reaction to sulfasalazine or one of its metabolites. For ethical reasons, no rechallenge was performed.
Subject(s)
Brain Diseases/chemically induced , Crohn Disease/drug therapy , Sulfasalazine/adverse effects , Acute Disease , Adult , Brain/diagnostic imaging , Brain/pathology , Brain Diseases/diagnosis , Brain Diseases/diagnostic imaging , Chemical and Drug Induced Liver Injury/etiology , Coma/chemically induced , Drug Eruptions/etiology , Drug Hypersensitivity/etiology , Humans , Magnetic Resonance Imaging , Male , Tomography, X-Ray ComputedABSTRACT
A 19-year-old girl fell ill with a high temperature and cervical lymphadenopathy. The detection of heterophile antibodies as well as Epstein-Barr-virus-specific antibodies confirmed the diagnosis of infectious mononucleosis. In the course of the infection, the patient developed severe hemolytic anemia with her hemoglobin falling from 14 to 8 g/dl. High-dose corticosteroid therapy did not stop hemolysis; this could only be achieved by seven plasmapheresis sessions. Antibodies against triosephosphate isomerase (TPI) and the blood group marker 'i' were found in the patient's serum. Anti-i cold agglutinins were not active at 37 degrees C, whereas antibodies against TPI caused increased 51Cr release from marked patient's erythrocytes in vitro. Plasmapheresis removed the autoantibodies effectively and stopped the hemolysis. After 8 weeks, the patient gradually recovered.
Subject(s)
Adrenal Cortex Hormones/therapeutic use , Anemia, Hemolytic/immunology , Anemia, Hemolytic/therapy , Autoantibodies/blood , Infectious Mononucleosis/immunology , Plasmapheresis , Triose-Phosphate Isomerase/immunology , Adult , Chromium Radioisotopes/blood , Drug Resistance , Female , Humans , Immunoblotting , Immunoglobulin M/blood , Immunoglobulin kappa-Chains/bloodABSTRACT
The authors report a case of Familial Mediterranean Fever (FMF) in a Turkish patient. FMF is characterised by paroxysmal attacks of fever, peritonitis and/or pleuritis or arthritis. FMF is almost exclusively confined to populations of Mediterranean origin and it is often familial. The diagnosis is mainly clinical. Recently an enhanced dopamine beta-hydroxylase (DBH) activity was described as a diagnostic test. We confirmed this in our patient. FMF was successfully treated by chronic colchicine therapy: 1-2 mg daily, which reduced DBH activity to normal levels.
Subject(s)
Familial Mediterranean Fever/complications , Peritonitis/etiology , Adult , Colchicine/therapeutic use , Dopamine beta-Hydroxylase/blood , Familial Mediterranean Fever/blood , Familial Mediterranean Fever/drug therapy , Humans , Male , RecurrenceSubject(s)
Pulmonary Embolism/complications , Pulmonary Heart Disease/etiology , Anticoagulants/therapeutic use , Chronic Disease , Humans , Male , Middle Aged , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/drug therapy , Pulmonary Heart Disease/diagnostic imaging , Radiography , RecurrenceSubject(s)
Mesenchymoma/diagnosis , Stomach Neoplasms/diagnosis , Adolescent , Adult , Aged , Endoscopy , Female , Humans , Male , Middle AgedABSTRACT
A case is reported of a 32-year old man, in which relapsing pancreatitis was the presenting symptom of an underlying carcinoma of the body of the pancreas. The rare association of clinically manifest pancreatitis and pancreatic carcinoma is reviewed and a possible pathogenetic mechanism is proposed in this case. It is suggested that pancreatic carcinoma should be suspected in patients with relapsing so-called idiopathic pancreatitis.