1/145. Two separate episodes of hemophagocytic syndrome at a two-year interval in an apparently immunocompetent male.We describe two separate episodes of hemophagocytic syndrome (HPS) at an interval of two years in a seemingly immunocompetent male. This case suggests the possible existence of an inherent predisposition to HPS, in which otherwise negligible self-limited viral infection may trigger HPS. Laboratory data for a 16-year-old boy admitted with persistent high grade fever and severe thrombocytopenia disclosed coagulation abnormality, liver damage, and hypercytokinemia. A bone marrow aspiration revealed a proliferation of histiocytes with fresh hemophagocytosis. We diagnosed that he was suffering from HPS. Responding to steroid pulse therapy, he recovered completely and was discharged. After two years of healthy life, he became febrile again and was readmitted. The fever was refractory to antibiotics and was associated with a sudden drop in platelet count. Laboratory data and the bone marrow picture were consistent with those of HPS. He was again successfully treated with steroid. After the second episode, he has been healthy for more than two years.- - - - - - - - - - ranking = 1keywords = liver (Clic here for more details about this article) |
2/145. Case of sepsis caused by bifidobacterium longum.We report a case of sepsis caused by bifidobacterium longum in a 19-year-old male who had developed high fever, jaundice, and hepatomegaly after acupuncture therapy with small gold needles. Anaerobic, non-spore-forming, gram-positive bacilli were isolated from his blood and finally identified as B. longum. He recovered completely after treatment with ticarcillin and metronidazole. To our knowledge, this is the first report of incidental sepsis caused by B. longum.- - - - - - - - - - ranking = 9.5520415193061keywords = hepatomegaly (Clic here for more details about this article) |
3/145. Virtual consult--pregnant woman with sickle-cell disease.A young woman in her 20s with a lifelong history of sickle-cell disease presents with sickle-cell crisis while in active labor. After delivery of the neonate via cesarean section, her fever spikes to nearly 106 F (41.1 C) and stays there. Clinicians are invited to comment on this case in a discussion moderated by Joseph Pastorek, MD, FACOG.- - - - - - - - - - ranking = 1keywords = liver (Clic here for more details about this article) |
4/145. Value of 111indium leukocyte scanning in febrile organ transplant patients.Immunosuppressed febrile organ transplant patients present a diagnostic and therapeutic dilemma since symptomatology is often altered by immunosuppression, which also masks the location of infection. Fifty 111indium leukocyte ( 111In WBC) scans were performed to determine their usefulness in the organ transplant patient. The results were compared with computerized tomography (CT) and gallium 67-citrate (Ga) scanning. Eleven patients received both 111In WBC and Ga scans; 22 received both 111In WBC and CT scans. Ten 111In WBC scans had subtraction of 99m Tc sulfur or albumin colloid for liver evaluation and four 111In WBC scans had subtraction of 99m Tc DMSA for kidney evaluation. The overall sensitivity and specificity for 111In WBC scans was 90% and 90%, respectively. lung uptake was sensitive (89%) and specific (97%) for pulmonary infections, including bacterial, fungal and cytomegalovirus pneumonias. Renal graft uptake occurred in 15 cases (41%), all except 2 being due to rejection, pyelonephritis, urinary tract infections, or cytomegalovirus infections. pyelonephritis and renal abscesses were diagnosed in 3 cases with 99m Tc DMSA subtraction. Perihepatic abscesses (2), and infected liver cysts (4) were diagnosed with 99m Tc sulfur or albumin colloid subtraction. There were five false-negative CT scans and three false-negative Ga scans. Therefore, when compared with 111In: sensitivity = 88% vs 64% (CT), specificity = 80% vs 86% (CT); and sensitivity = 111In 90% vs 67% (Ga), specificity = 100% for both 111In WBC and Ga scans.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 2keywords = liver (Clic here for more details about this article) |
5/145. Inflammatory pseudotumor of the diaphragm.A 5-year-old-boy presented with a right pleural effusion and fever. A tumorous mass was located between the right lung and the liver. The boy underwent a right thoracotomy with excision of the tumor and the adherent parts of the right hemidiaphragm. histology and immunohistochemistry showed an inflammatory pseudotumor of the diaphragm. This is the first reported case of an inflammatory pseudotumor in this location. A brief review of the heterogeneous theories about the pathogenesis and the different therapeutic regimens for this rare neoplastic entity are discussed.- - - - - - - - - - ranking = 1keywords = liver (Clic here for more details about this article) |
6/145. Toxic epidermal necrolysis and graft vs. host disease: a clinical spectrum but a diagnostic dilemma.We describe a 53-year-old man who developed partial and full thickness skin loss associated with pyrexia, diarrhoea, liver, renal and bone marrow failure, during treatment for an aggressive B cell lymphoblastic lymphoma. The clinical features and histology were compatible with both toxic epidermal necrolysis and graft vs. host disease, causing a diagnostic and therapeutic dilemma. We discuss the possibility that methotrexate was the causative drug, with review of its cutaneous side-effects. Histologically our patient demonstrated the sparse dermal infiltrate with full thickness epidermal necrosis typical of toxic epidermal necrolysis and graft vs. host disease. We discuss this finding with respect to the pathogenesis of toxic epidermal necrolysis.- - - - - - - - - - ranking = 1keywords = liver (Clic here for more details about this article) |
7/145. Hepatic capillariasis in children: report of 3 cases in brazil.capillaria hepatica is a helminth that may cause an extremely rare condition of parasitic hepatitis. Only 29 cases have been published, 2 of them in brazil. We report here 3 cases of children in brazil with massive hepatic capillariasis who presented the characteristic triad of this type of infection, i.e., persistent fever, hepatomegaly, and eosinophilia. The diagnosis was made by liver biopsy. All children responded well after treatment with thiabendazole (case 1), albendazole (case 3), and albendazole in combination with a corticoid (case 2). Case 1 has been followed-up for 24 years, an event not previously reported in the literature.- - - - - - - - - - ranking = 10.552041519306keywords = hepatomegaly, liver (Clic here for more details about this article) |
8/145. Intra amniotic candidiasis. Case report and meta-analysis of 54 cases.We present a case of mid pregnancy loss with retained intrauterine contraceptive device associated with fetal candida infection. review of English literature identified 53 additional cases of fetal candidal infection, with 17 associated with an IUCD in situ. The presence of an IUCD was associated with delivery at a statistically significant earlier gestational age when compared to cases not associated with an IUCD (23.3 /- 4.9 vs 31.6 /- 7.0, p < 0.001). Seventy-seven percent of fetal candidal infections associated with an IUCD were systemic (heart, brain, liver, gastrointestinal, lung) compared to 33% of cases not associated with an IUCD. In contrast to bacterial intraamniotic infections there was a low incidence of maternal febrile morbidity. An hypothesis as to the pathogenesis of Candidal infections in the presence and absence of an IUCD is offered as well as a paradigm for the management of the gravid patient with an IUCD in situ.- - - - - - - - - - ranking = 2keywords = liver (Clic here for more details about this article) |
9/145. Puerperal and intrapartum group A streptococcal infection.OBJECTIVE: To determine the demographic and clinical variables characteristic of non-epidemic intrapartum or puerperal group A streptococcal (GAS) infection. methods: The records of 47 patients diagnosed with intrapartum or puerperal GAS infection over a 6 1/2 year period at Hadassah-University Hospital-Mt. Scopus, Jerusalem were reviewed. Data regarding 25,811 women, the general population of women that delivered during that period, were obtained from their computerized medical records. Frequency distributions, t-test, chi-square, and Spearman's Rank Correlation were used, as appropriate, to analyze and compare demographic and clinical variables associated with development of GAS infection, its clinical course and subsequent development of septic shock. RESULTS: Mean age of mothers with GAS infection was higher than that of our general pregnant population (30.4 versus 27.4 years, P = 0.0019), and a higher proportion of GAS infected patients (30% versus 12%, P < 0.005) experienced PROM. Thirty-one (66%) women had fever as their sole presenting symptom, eight (17%) had fever and abdominal pain, seven (15%) had fever and abnormal vaginal bleeding, and one patient (2%) presented with a rash. Three patients (6%) developed a septic shock. Two of these patients presented with symptoms more than 14 days after delivery. CONCLUSIONS: We describe the characteristics of non-epidemic intrapartum or puerperal GAS infection. Data from our study and review of the literature suggest that some patients who develop septic shock may present later in the puerperium than patients with an uncomplicated GAS infection.- - - - - - - - - - ranking = 2keywords = liver (Clic here for more details about this article) |
10/145. colitis may be part of the antiepileptic drug hypersensitivity syndrome.PURPOSE: To show that colitis may be part of the antiepileptic hypersensitivity syndrome. methods: Description of two case histories. RESULTS: The first patient was a 47-year-old man who developed fever, lymphadenopathy, influenza-like symptoms, facial edema, skin rash and diarrhea after 3 weeks of carbamazepine (CBZ) treatment. laparotomy because of severe abdominal pain 2 weeks later showed severe colitis with perforations. The second patient was a 41-year-old woman who developed fever, diarrhea, and skin rash 4 weeks after start of CBZ treatment. A colon biopsy confirmed colitis. Stool examinations did not show pathogenic microorganisms, and there was no evidence of Crohn's disease or ulcerative colitis. Both patients had elevated liver enzymes, peripheral eosinophilia, and eosinophils in the infiltrate of the colon. CONCLUSIONS: In view of the close temporal relation between start of CBZ intake and development of colitis, the presence of fever, lymphadenopathy, and rash, and improvement after discontinuation of CBZ, we conclude that the two patients developed an AED hypersensitivity syndrome. Our case histories demonstrate that severe colitis may be part of this syndrome.- - - - - - - - - - ranking = 1keywords = liver (Clic here for more details about this article) |
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