RESUMO
Acute kidney injury is a common complication in patients with cancer. Obstructive uropathy is a rare complication of gastric cancer and occurs mainly during treatment. Moreover, obstructive uropathy is rarely complicated by acute renal injury and thus requires emergency treatment. We report a rare case of anuric acute kidney injury that was actually obstructive uropathy secondary to gastric adenocarcinoma. Based on this case and literature review, malignancy should be considered in any patient not known to have cancer who presents with acute kidney injury caused by obstructive uropathy. This presentation reflects an advanced stage of malignancy. Non-enhanced computed tomography is valuable and should be the initial imaging study for diagnosing the obstruction and its cause. Early diagnosis and relief of the obstruction are associated with better recovery of the renal function.
RESUMO
Thrombotic disease represents a rare manifestation of leprosy. In this study, we report the case of an external jugular vein thrombosis associated with tuberculoid leprosy in a 23-year-old male patient. The patient presented with a 3-month history of painful cord-like swelling on the left side of the neck and a nearly 3-week history of skin lesions on the left cheek and right leg. Physical examination revealed cord-like, tender swelling on the left lateral aspect of the neck overlying the sternocleidomastoid muscle, and a hypopigmented, hypoaesthetic 6×7 cm lesion with an irregular margin on the left cheek. A Doppler ultrasound examination of the jugular vein showed thrombosis of the left external jugular vein. Three-dimensional reconstruction of the computed tomography scan showed the enlarged and enhanced left external jugular vein, as well as 1 of its tributaries, and the thickened skin patch. A skin punch biopsy from the left cheek lesion revealed granulomatous inflammation with occasional peri-adnexal granulomas, consistent with the clinical impression of tuberculoid leprosy. A diagnosis of leprosy with external jugular vein thrombosis was established. Anticoagulation therapy was initiated, and the patient was referred to an infectious disease clinic for treatment with anti-leprosy medications. LEARNING POINTS: Thickened cord-like neck swelling in leprosy can be vein thrombosis rather than a thickened nerve.Leprosy should be considered if a skin lesion is associated with thrombosis.The common causes of upper extremity DVT.
RESUMO
BACKGROUND: We conducted a retrospective cohort study to evaluate the clinical manifestations, laboratory findings, complications and treatment of brucellosis in the State of Qatar. METHODS: The medical records of patients in Hamad Medical Corporation, Doha, Qatar were reviewed from January 2000 to December 2006. History, various socio-demographic features, clinical and biochemical parameters, therapeutic features, and complications were retrospectively collected from the patient database. RESULTS: Around three quarters of the study population were males. History of raw milk consumption and animal contact were seen in 41.7% and 12.5% respectively. The main presenting features of our cohort were fever, chills and sweating (93.1%, 62.5% and 58.3% respectively). Positive antibody titre (>1:160) was detected in 95.8% and positive blood culture was reported in 63.9% of the cohort. Splenomegaly was observed in 19.4%, hepatomegaly in 15.3% and lymphadenopathy in 9.7% of the cases. Approximately half of our patients were treated with a combination of doxycycline and streptomycine and nearly one quarter received doxycycline and rifampicine combination therapy. CONCLUSIONS: Brucellosis is an important public health problem worldwide. It is associated with significant morbidity and mortality. It may affect any organ system and can present with a variety of clinical features. Diagnosis of brucellosis requires serological tests with or without blood culture. Treatment with at least two antibiotics for six weeks or more appears to be effective.
RESUMO
Neurological symptoms are rare manifestations of Behcet's disease. In this paper, we report cerebral venous thrombosis as the initial presentation of Behcet's disease in a 40 yearold man. Our patient presented with a six-week history of headache, progressive loss of vision in the right eye and recurrent oral ulcers. Physical examination revealed oral ulcers and posterior synechia in the right eye with loss of light perception. Fundoscopic examination showed evidence of retinal vasculitis. Magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) of the brain showed superior sagittal, left transverse, and left sigmoid sinus venous thrombosis. A diagnosis of Behcet's disease was made based on clinical criteria. Treatment with methylpredinsolone, cyclophosphamide, and azathioprine as well as anticoagulation was done with significant clinical improvement.
