ABSTRACT
Although varicella-zoster virus (VZV) is known to affect the central nervous system in a protean manner, hemorrhagic VZV meningitis has not been well documented in the literature. Here, we correlate the clinical, cytologic, and radiologic findings in an immunocompromised patient presenting with subarachnoid hemorrhage associated with VZV meningitis. Clinical findings included multidermatomal zoster, myelitis, and neurapraxia. Magnetic resonance imaging findings included superficial siderosis and diffused linear and nodular leptomeningeal enhancement. Cerebrospinal fluid cytology revealed hemorrhage and lymphocytic pleocytosis. This case report adds hemorrhagic meningitis to the spectrum of complications associated with disseminated VZV infection.
ABSTRACT
AIM: To determine the prevalence, characteristics and clinical course of pancreatic cystic neoplasms (PCNs) in liver transplantation (LT) recipients. METHODS: We retrospectively studied consecutive patients who underwent LT between January 1998 to April 2016. Clinical and laboratory data were obtained from patient medical records. Imaging findings on computed tomography and magnetic resonance cholangiopancreatography were reviewed by two radiologists. RESULTS: During the study period, 872 patients underwent cadaveric LT. Pancreatic cysts were identified in 53/872 (6.1%) and 31/53 (58.5%) were PCNs [28 intraductal papillary mucinous neoplasm (IPMN), 2 mucinous cystic neoplasm (MCN), 1 serous cystadenoma]. Patients with PCNs exhibited less male predominance (55% vs 73%, P = 0.03) compared to patients without pancreatic cysts. Thirteen patients (42%) were diagnosed with PCN pre-LT while 18 patients (58%) developed PCN post-LT. The median size of PCNs was 13mm [interquartile range (IQR) 10-20 mm]. All IPMNs were side-branch type. Most PCNs were found in the head and body of pancreas (37% each), followed by the tail (25%). Five patients underwent further evaluation with endoscopic ultrasound. Progress imaging was performed on 81% of patients. PCNs remained stable in size and number in all but 2 patients. During a median follow up of 39 mo (IQR 26-58 mo), the 2 (6%) patients with MCN underwent pancreatectomy. No PCN patient developed pancreatic adenocarcinoma, while 5 died from illnesses unrelated to the PCN. Among patients without PCN, 1/841 (0.1%) developed pancreatic adenocarcinoma. CONCLUSION: The prevalence of PCNs in LT recipients was similar to the general population (3.6%, 31/872). Side-branch IPMNs do not appear to have accelerated malignant potential in post-LT patients, indicating the current surveillance guidelines are applicable to this group.
