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Case reports
A Toothpick a day, keeps the doctor away?Price: €10,00 |
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| A Toothpick is a dreaded offender when ingested, as it is risky
to cause impaction, obstruction or perforation of the gut. When
ingestion of a toothpick leads to one of these complications, it
clinically mimics an acute abdomen. Often the patient doesn’t
recall the ingestion, leading to misdiagnosis as inflammatory
bowel disease, appendicitis/diverticulitis, etc. We describe the case
of a 50-year old woman presenting to the emergency department
with right lower abdominal pain. CT-scan showed an obstruction
without clear underlying cause. The hypothesis of obstruction
due to intestinal adhesions without strangulation was assumed
and non-operative management lead to recovery and dismissal of
the patient. However, she presented 3 weeks later with identical
complaints, this time showing a terminal ileitis on CT-scan.
Surprisingly, a toothpick perforating the terminal ileum was found
during endoscopy and could by removed. A clinician should think
of foreign body ingestion when patients present with an acute
abdomen with no clear underlying pathology. [Product Details...] |
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Etanercept-induced granulomatous hepatitis as a rare cause of abnormal liver testsPrice: €10,00 |
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| The authors report the case of a 76 year-old man with rheumatoid
arthritis treated with prednisolone and etanercept. The patient was
seen for persistent changes in liver tests lasting for six months,
with a mixed pattern. The patient denied intake of new drugs or
dietary/herbal supplements. Imaging studies showed mild steatosis.
Additional study for chronic liver diseases only revealed positivity
for anti-nuclear antibodies. Liver biopsy revealed noncaseating
granulomas in some portal tracts. Consequent etiologic study for
granulomatous diseases showed negative or normal results. So
it was decided to suspend etanercept, with a subsequent gradual
improvement on analytical parameters that normalized three
months later. To date, only one case of granulomatous liver disease
associated with an anti-TNF agent was described in the literature.
This case also raises the question whether the development of
granulomatous processes associated with anti-TNF agents has
been underdiagnosed due to the presence of other concomitant
immunosuppressant therapies. [Product Details...] |
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Statins and Clarithromycin : a dangerous combination. Case report and review of the literaturePrice: €10,00 |
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| Statins account for the most prescribed drugs around
the world. The number of patients treated by statins is
estimated at 17% of the population older than 20 years and
more (1). Similarly, Helicobacter pylori (HP) infection
is also very frequent worldwide and estimated to occur
at least one over the life in one third of the population
in western countries (2). The treatment recommended
for HP by the Toronto consensus contains the use of
clarithromycin (3). Consequently, the possibility that
a patient receives concomitantly clarithromycin and a
statin is very high. [Product Details...] |
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Whipple’s disease in a man of North African descent : case report and brief review of the literaturePrice: €10,00 |
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| A 62-year-old man of North African descent presented with
weight loss in the past year and diarrhea for three weeks. His
medical history included erosive rheumatoid arthritis, treated
with methotrexate and adalimumab. Histological examination
of a duodenal biopsy showed foamy macrophages in the lamina
propria, with PAS-positive cytoplasmatic inclusions. These findings
are compatible with Whipple’s disease, a rare chronic infectious
disease caused by Tropheryma whipplei, an opportunistic
bacterium. It is typically seen in middle-aged Caucasian men
and the immunocompromised host. The classical presentation of
Whipple’s disease consists of intermittent migratory arthralgia,
followed by intestinal symptoms which typically occur six to
seven years later. The clinical image can be very variable, and
this complicates the diagnostic process. PAS-staining and PCR
are the diagnostic cornerstones. In our case, treatment consisted
of a prolonged cure of antibiotics: intravenous ceftriaxone for two
weeks, followed by an oral maintenance therapy of doxycycline
and hydroxychloroquine for at least one year. A therapeutic
dilemma arose as continued anti-TNF blockade was necessary to
maintain remission of the rheumatoid arthritis. Lifelong follow-up
is necessary because relapse is possible. [Product Details...] |
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Acta gastroenterologica is abstracted/indexed in Current Contents, Excerpta Medica, Index medicus, ISI.
Published by © Universa Press, Wetteren, Belgium. All rights reserved.
Published by © Universa Press, Wetteren, Belgium. All rights reserved.