Toxicidad hepática recurrente secundaria a metilprednisolona intravenosa / No disponible

Las reacciones adversas hepáticas relacionadas con la administraciónde fármacos (hepatotoxicidad) son cuadros relativamentefrecuentes que presentan una amplia variabilidad clínica e histológica.La identificación precoz de estos cuadros es fundamental enla práctica clínica debido a su potencial gravedad. En la mayoríade los casos la suspensión del fármaco desencadenante es suficientepara la resolución del cuadro clínico.A pesar de que los esteroides son utilizados en una amplia variedadde situaciones clínicas, la notificación de cuadros de hepatotoxicidadsecundaria a esteroides intravenosos es excepcional.Presentamos el caso clínico de una mujer diagnosticada de esclerosismúltiple, que recibió metilprednisolona a altas dosis enforma de “pulsos” intravenosos como tratamiento de las reagudizacionesde su enfermedad y presentó 3 brotes recurrentes de hepatitisde predominio hepatocelular con un patrón clínico, analíticoe histológico compatible con toxicidad hepática agudasecundaria a metilprednisolona intravenosa. En el tercer episodiose realizó una biopsia hepática que demostró un patrón de hepatitisaguda con necrosis líticas confluentes, histología no descritapreviamente en pacientes tratados con esteroides intravenosos

Adverse drug reactions (hepatotoxicity) are a frequent cause ofacute liver injury with a wide clinical and histological spectrum. Anearly recognition of drug-related liver disease has been consideredessential in clinical practice due to potential risks. In most casesexposure discontinuation improves the clinical picture.Steroids are used in a variety of clinical settings. However, intravenoussteroids have rarely been associated with hepatotoxicity.We report the case of a middle-aged woman with multiple sclerosiswho received a bolus of methylprednisolone on threeoccasions for the management of relapsing disease, with the developmentof repeated episodes of elevated liver enzymes aftercorticoid administration. In the third episode a liver biopsy wasperformed, which showed acute hepatitis with bridging necrosis;such histological picture has not been described before in patientstreated with intravenous steroids

[Recurrent acute liver toxicity from intravenous methylprednisolone]. / Toxicidad hepática recurrente secundaria a metilprednisolona intravenosa.

Adverse drug reactions (hepatotoxicity) are a frequent cause of acute liver injury with a wide clinical and histological spectrum. An early recognition of drug-related liver disease has been considered essential in clinical practice due to potential risks. In most cases exposure discontinuation improves the clinical picture.Steroids are used in a variety of clinical settings. However, intravenous steroids have rarely been associated with hepatotoxicity. We report the case of a middle-aged woman with multiple sclerosis who received a bolus of methylprednisolone on three occasions for the management of relapsing disease, with the development of repeated episodes of elevated liver enzymes after corticoid administration. In the third episode a liver biopsy was performed, which showed acute hepatitis with bridging necrosis; such histological picture has not been described before in patients treated with intravenous steroids.

Encefalopatía hepática secundaria a la existencia de un shunt portosistémico tratada satisfactoriamente mediante radiología intervencionista / Hepatic encephalopathy secondary to porto-systemic shunt satisfactorily treated with interventionist radiology

La encefalopatía hepática es un estado reversible de alteraciónen la función cognitiva, que puede ocurrir en pacientes con enfermedadhepática aguda o crónica o shunts porto-sistémicos, en elque puede aparecer cualquiera de los signos neurológicos o psiquiátricosconocidos. Las sustancias nitrogenadas procedentes dela digestión intestinal alcanzan el cerebro sin la depuración que suponesu paso por el hígado, debido a las derivaciones porto-sistémicas,y dan lugar a los signos característicos de la encefalopatíahepática. A continuación presentamos dos casos clínicos de pacientescon shunt porto-sistémicos, diagnosticados de encefalopatíahepática crónica recurrente refractaria al tratamiento médicoconvencional, tratados satisfactoriamente con embolización de dichoshunt mediante técnicas de radiología intervencionista

Hepatic encephalopathy is a reversible state of altered cognitionthat may occur in patients with acute or chronic liver diseaseor porto-systemic shunt, and in which known neurological or psychiatricsigns may develop. Nitrogenated substances from intestinaldigestion reach the brain without being cleared by their passagethrough the liver due to the presence of porto-systemicshunt. We report two cases of patients with porto-systemic shuntdiagnosed with recurrent chronic hepatic encephalopathy refractoryto conventional medical treatment. They were satisfactorilytreated with shunt embolization using interventionist radiologytechniques

[Hepatic encephalopathy secondary to porto-systemic shunt satisfactorily treated with interventionist radiology]. / Encefalopatía hepática secundaria a la existencia de un shunt portosistémico tratada satisfactoriamente mediante radiología intervencionista.

Hepatic encephalopathy is a reversible state of altered cognition that may occur in patients with acute or chronic liver disease or porto-systemic shunt, and in which known neurological or psychiatric signs may develop. Nitrogenated substances from intestinal digestion reach the brain without being cleared by their passage through the liver due to the presence of porto-systemic shunt. We report two cases of patients with porto-systemic shunt diagnosed with recurrent chronic hepatic encephalopathy refractory to conventional medical treatment. They were satisfactorily treated with shunt embolization using interventionist radiology techniques.

[Idiopathic chronic pancreatitis (with diffuse stenosis of Wirsung's duct) in ulcerative colitis]. / Pancreatitis crónica idiopática (con estenosis difusa del Wirsung) en la colitis ulcerosa.

We describe a case of chronic idiopathic pancreatitis associated with ulcerative colitis. Pancreatitis is a rare extra-intestinal manifestations of inflammatory bowel disease. Chronic idiopathic pancreatitis associated with ulcerative colitis are usually painless, without calcification, with stricture of the main pancreatic duct and with severe exocrine pancreatic insufficiency.

[Acute hepatitis E in Spain]. / Hepatitis aguda E en España.

Hepatitis E virus (HEV) is the worldwide leading cause of non-A non-B enterically transmitted hepatitis, and affects most commonly the population in developing countries. Cases outside this area, are nearly always imported, although apparent local acquisition has been occasionally reported. We assisted three patients with acute HEV hepatitis, confirmed by the presence of serum anti-HEV IgM. One of them did not report travelling outside of Spain in the previous years. HEV has to be included in the differential diagnosis of acute non-A non-B non-C hepatitis, even in cases in which an exposure in endemic areas cannot be recalled.

Bronchobiliary fistula secondary to biliary lithiasis. Treatment by endoscopic sphincterotomy.

Bronchobiliary fistula is a rare condition, defined by the presence of a passage between the biliary tract and the bronchial tree. Many conditions can give rise to the development of such a communication. Biliary lithiasis is one of those and is perhaps the one most amenable to endoscopic management. We describe a case of bronchobiliary fistula secondary to the development of choledocholithiasis in a cholecystectomized patient. The clinical suspicion was raised by the presence of bilioptosis (bile-stained sputum), and the diagnosis established by endoscopic retrograde cholangiopancreatography. The patient was submitted to endoscopic sphincterotomy and stone extraction, achieving frank clinical alleviation. This case gives us the chance to review bronchobiliary fistulas secondary to biliary lithiasis, placing particular emphasis on the opportunities of endoscopic management.

Invasive pulmonary aspergillosis: a rare presentation of non-Hodgkin's lymphoma.

We describe a patient with rapidly progressive pneumonia and a high level of serum lactate dehydrogenase, in whom postmortem study revealed the presence of a diffuse, small and large-cell multicentric non-Hodgkin's lymphoma, together with an invasive pulmonary aspergillosis. Aspergillosis is rare as a presenting feature of a lymphoproliferative disease; only one previous case has been reported to the best of our knowledge. Invasive aspergillosis and lymphoma should be considered in patients presenting with pneumonia and high level of lactate dehydrogenase.