RESUMO
Vanishing bile duct syndrome (VBDS) in association with Hodgkin lymphoma (HL) is well described but not well understood. We report an unusual case of a 75-year-old patient presenting with biopsy-proven VBDS and immunodeficiency, without identifiable cause, which showed a waxing and waning course, culminating in the development of HL 18 months later. To our knowledge, this is the first adult case in which VBDS preceded the diagnosis of HL by such a long period.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Ductos Biliares Intra-Hepáticos/patologia , Colagogos e Coleréticos/administração & dosagem , Colestase/diagnóstico , Doença de Hodgkin/diagnóstico , Ácido Ursodesoxicólico/administração & dosagem , Idoso , Bleomicina/administração & dosagem , Colestase/tratamento farmacológico , Colestase/imunologia , Doxorrubicina/administração & dosagem , Doença de Hodgkin/tratamento farmacológico , Doença de Hodgkin/imunologia , Humanos , Hospedeiro Imunocomprometido , Masculino , Neutropenia , Síndrome , Resultado do TratamentoAssuntos
Hipertensão Portal/etiologia , Mastocitose Sistêmica/complicações , Mastocitose Sistêmica/diagnóstico , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Medula Óssea/patologia , Feminino , Humanos , Fígado/patologia , Mastocitose Sistêmica/genética , Mastocitose Sistêmica/patologia , Mutação , Tomografia por Emissão de Pósitrons , Proteínas Proto-Oncogênicas c-kit/genética , Tomografia Computadorizada por Raios XRESUMO
We describe the first case of a patient undergoing orthoptic liver transplantation for acquired generalized lipodystrophy-related nonalcoholic steatohepatitis who developed severe recurrence of nonalcoholic fatty liver disease in the first few months posttransplant but responded rapidly to the administration of exogenous leptin. The beneficial effects of therapy were supported by histology along with magnetic resonance spectroscopy studies, which demonstrated that leptin therapy greatly reduced fat deposition in the liver. Leptin therapy may have a role to play in preventing patients with lipodystrophy developing end-stage liver disease or in rescuing such patients who develop disease recurrence postliver transplantation.
Assuntos
Fígado Gorduroso/complicações , Leptina/farmacologia , Lipodistrofia/complicações , Transplante de Fígado/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Prevenção Secundária , Adulto , Fígado Gorduroso/patologia , Fígado Gorduroso/cirurgia , Feminino , Humanos , Lipodistrofia/patologia , Lipodistrofia/cirurgia , Espectroscopia de Ressonância Magnética , Hepatopatia Gordurosa não Alcoólica , Resultado do TratamentoRESUMO
OBJECTIVE: To determine risk factors for colonization with vancomycin-resistant enterococci (VRE) in a hospital outbreak. DESIGN: Outbreak investigation and case-control study. SETTING: A referral teaching hospital in Melbourne, Australia. PARTICIPANTS: Cases were inpatients colonized (with or without clinical disease) with VRE between July 26 and November 28, 1998; controls were hospitalized patients without VRE. METHODS: Five cases of VRE were identified between July 26 and November 8, 1998, by growth of VRE from various sites. Active case finding by cultures of rectal swabs from patients surveyed in wards was commenced on July 26, after the first isolate of VRE. RESULTS: There were 19 cases and 66 controls. All the VRE identified were vanB, and all were Enterococcus faecium. One molecular type predominated (18/19 cases). In a logistic-regression model, being on the same ward as a VRE case was the highest risk factor (odds ratio [OR], 82; 95% confidence interval [CI95], 5.7-1,176; P=.001). Having more than five antibiotics (OR, 11.9; CI95 1.1-129.6; P<.05), use of metronidazole (OR, 10.9; CI95, 1.7-69.8; P=.01), and being a medical patient (OR, 8.1; CI95, 1.4-47.6; P<.05) also were significant. Intensive care unit admission was associated with decreased risk (OR, 0.1; CI95, 0.01-0.8; P<.05). CONCLUSION: Our findings are consistent with an acute hospital outbreak. Monitoring and control of antibiotic use, particularly metronidazole, may reduce VRE in our hospital. Ongoing surveillance and staff education also are necessary.