ABSTRACT
Mycobacterium kansasii is the second most frequent cause of non-tuberculous mycobacterial disease in the United States after Mycobacterium avium complex. While primarily it is a pulmonary disease, extrapulmonary manifestations are common. This case report describes a recent renal transplant recipient with disseminated M. kansasii infection presenting with hepatic abscesses, with discussion of clinical management issues and strategies, and a review of the literature.
Subject(s)
Kidney Transplantation/adverse effects , Liver Abscess/microbiology , Mycobacterium Infections, Nontuberculous/etiology , Mycobacterium kansasii , Anti-Bacterial Agents/therapeutic use , Humans , Liver Abscess/drug therapy , Liver Abscess/etiology , Male , Middle Aged , Mycobacterium Infections, Nontuberculous/drug therapyABSTRACT
Adenoviruses (AdV) are increasingly recognized as important viral pathogens in immunocompromised hosts. The clinical spectrum ranges from asymptomatic viremia to allograft dysfunction, and death. Most of the medical literature is on AdV infection in children and bone marrow transplant recipients. We report a case of AdV in an adult recipient in the first month after simultaneous kidney-pancreas transplant with thymoglobulin induction. This is a rare report of adenovirus infection after multiorgan transplant, and is unique in that it exhibited tissue invasive disease without any localizing signs or allograft dysfunction, while other cases in medical literature had invasive disease of the allograft with allograft dysfunction, failure, or death. In addition, this is the first report of a radiologic presentation of AdV nephritis.
Subject(s)
Adenoviridae/pathogenicity , Adenovirus Infections, Human/etiology , Kidney Transplantation/adverse effects , Pancreas Transplantation/adverse effects , Postoperative Complications , Adenovirus Infections, Human/diagnosis , Adenovirus Infections, Human/drug therapy , Humans , Male , Middle Aged , PrognosisABSTRACT
Breast cancer is the commonest cancer among women worldwide. Surgery plays an important role in its management. Axillary lymph node dissection has been the standard of care for staging, prognostication and control of axillary disease for almost a century. However, this time-tested paradigm is shifting gradually in the western world, because of the increasing use of screening mammography resulting in the detection of a large proportion of node-negative early breast cancers and a significant incidence of axillary lymph node dissection-related arm morbidity. Minimally invasive and less morbid procedures such as sentinel lymph node biopsy are being used more commonly in the West. However, the western experience cannot be directly extrapolated to the Indian scenario because of the differences in patient profile, treatment standards and expertise available. There is a need to critically analyse these issues before the Indian medical community advocates sentinel lymph node biopsy as a routine procedure for managing patients with breast cancer.
Subject(s)
Axilla/pathology , Breast Neoplasms/diagnosis , Lymph Nodes/pathology , Sentinel Lymph Node Biopsy , Axilla/surgery , Breast Neoplasms/pathology , Breast Neoplasms/surgery , Female , Humans , India , Lymph Nodes/surgery , Neoplasm Staging , PrognosisABSTRACT
Insulin-dependent diabetes mellitus is associated with renal failure, diabetic retinopathy, neuropathy and vasculopathy. We report the first successful simultaneous pancreas-kidney transplant in India in a young diabetic with renal failure. The dual transplant has cured his diabetes and renal failure and has had a beneficial effect on his neuropathy, retinopathy and quality of life. Obstacles to dual transplant in India include a lack of suitable recipients and a cadaver donor programme that is still in its infancy.
