ABSTRACT
BACKGROUND: Besides the hepatitis A and B viruses, the hepatitis E virus (HEV) is a major contributor to infectious hepatitis in developing countries. In the Netherlands, acute HEV infection is occurring with ever-increasing frequency, although it is not always immediately recognized. We present a Dutch patient who was diagnosed with hepatitis E after having returned from Spain. CASE DESCRIPTION: A 69-year-old male patient presented with symptoms of general malaise, nausea, abdominal pain and fatigue. A gastroenterologist identified hepatitis on the basis of laboratory testing and abdominal ultrasound. Additional investigations included serological blood tests, PCR (polymerase chain reaction) testing and a histopathological analysis of a liver biopsy. Finally, the diagnosis of acute HEV infection was established; the patient recovered without further treatment. CONCLUSION: HEV is endemic in the Western world and not merely an imported disease. Diagnostic testing for HEV should be incorporated into the standards of care for any patient suspected of having infectious hepatitis, with serological PCR-testing of HEV-RNA being an essential element.
Subject(s)
Hepatitis E virus/isolation & purification , Hepatitis E/diagnosis , Aged , Diagnosis, Differential , Hepatitis E/epidemiology , Hepatitis E virus/genetics , Humans , Male , Netherlands/epidemiology , Polymerase Chain Reaction , RNA, Viral/analysisSubject(s)
Catha/adverse effects , Central Nervous System Stimulants/adverse effects , Chemical and Drug Induced Liver Injury, Chronic/etiology , Liver/drug effects , Chemical and Drug Induced Liver Injury, Chronic/epidemiology , Emigrants and Immigrants , Humans , Liver/pathology , Mastication , Somalia/epidemiology , Substance-Related Disorders , United Kingdom/epidemiologyABSTRACT
Secondary achalasia or pseudoachalasia is mostly caused by gastric or oesophageal carcinoma. Here we report a case of pseudoachalasia caused by a pancreatic tumour invading the cardiac region. A 66-year-old man with a 2-month history of dysphagia and weight loss showed no abnormalities on upper gastrointestinal endoscopy and computed tomography scan, but had no swallow-induced relaxation on oesophageal manometry. Based on the patient's history and oesophageal manometry findings, further investigation was performed to exclude pseudoachalasia. Endoscopic ultrasonography showed abnormalities in the cardiac region, but large endoscopic biopsies showed no malignancy. A laparotomy was performed, which revealed a large, irresectable tumour originating from the pancreatic corpus region and expanding into the gastric cardia region. This case illustrates that a pancreatic tumour invading the cardiac region may present as pseudoachalasia.
