11/130. Pylephlebitis after appendicitis in a child. Septic phlebitis of the portal vein, or pylephlebitis, is a rare but potentially severe complication of abdominal sepsis. The authors present a case of pylephlebitis after perforated retrocecal appendicitis in a child and discuss the etiology, presentation, diagnosis, and treatment of this disorder in the modern era. ( info) |
12/130. An unusual presentation of enterocolic lymphocytic phlebitis. Enterocolic lymphocytic phlebitis (ELP) is a recently described disease characterized by phlebitis in the wall and mesentery of the colon and small bowel. Unlike other systemic or localized vasculitic diseases that can have similar gastrointestinal manifestations, there is no involvement of the arterial system or evidence of systemic vasculitis. The lymphocytic phlebitis affects not only the grossly involved intestinal segment but also the apparently healthy bowel. The diagnosis of ELP is histologic, and other systemic vasculitis must be ruled out. Surgical resection of the bowel not only provides the diagnostic tissue but also leads to resolution of the symptoms. In the literature, ELP has most commonly been reported to present as an acute abdomen. We describe a case of ELP presenting as a large abdominal mass, without evidence of an acute abdomen. This mass was actually diffusely thickened colonic serosa, caused by extensive organizing fat necrosis and marked edema of the serosa and bowel wall. ( info) |
13/130. Severe and fatal reactions to rheomacrodex. Primary idiosyncrasia against dextran does really exist and is to be taken into account. It may even be more frequent than is usually accepted because in many cases an other cause than the infusion may be obvious. The shock develops at the first milliliters of the infusion. When dextran is to be administered for the first time, a doctor is to be present and all equipment for resuscitation must be available. For any reaction occurring during the infusion, the dextran must be withdrawn. ( info) |
14/130. Granulomatous phlebitis of small hepatic vein. Several cases of granulomatous phlebitis of small hepatic veins are reported in the literature, though the etiology remains unclear. We experienced a similar case of granulomatous phlebitis involving terminal hepatic venules and this case will be reported in comparison with two previous cases presenting in our laboratory. A 39-year-old-female had a long course of medical treatment for epilepsy. She suffered from acute liver injury after prolonged fever for more than 1 week. leukocytosis (11,100/ micro L) without eosinophilia, and inflammatory reactions such as c-reactive protein (21.0 mg/dL) were pointed out. She suffered from transient disseminated intravascular coagulation, but these abnormalities recovered with antibiotic and steroid therapy. liver biopsy revealed granulomatous lesions mainly involving terminal hepatic venules. The possibility of tuberculosis was excluded by a negative Thiel-Nielsen stain and a negative molecular study for bacterial deoxyribonucleic acid of Mycobacteria species. Extrahepatic involvements were not clear clinically. This case and the previous two cases shared granulomatous phlebitis of the intrahepatic small hepatic veins, as well as clinical features suggestive of bacterial infection. Clinicians should be aware of such a rare clinicopathological entity. ( info) |
15/130. pichia ohmeri fungemia associated with phlebitis: successful treatment with amphotericin b. We report a case of fungemia caused by the yeast-form fungus pichia ohmeriin a 59-year-old hospitalized patient. P. ohmeri was found in all of the patient's blood cultures collected on days 52, 57, 59, and 64 of his hospital stay. Intermittent fever developed on the 52nd hospital day and persisted for about 10 days. The patient had previously received intensive antimicrobial therapy for a ventriculoperitoneal shunt infection and subsequent nosocomial pneumonia. Although a central venous catheter was not used in the patient, he suffered from tender swelling of the right leg due to peripheral phlebitis at the site of insertion of a peripheral venous catheter (which had already been removed at the onset of fever), the same site from which P. ohmeri was isolated. The fungemia and phlebitis cleared following 14-day amphotericin b therapy. This case shows that P. ohmeri can be a nosocomial bloodstream pathogen associated with phlebitis. ( info) |
16/130. thrombosis and infection: a case of transient anti-cardiolipin antibody associated with pylephlebitis. Infections with bacteroides species have been noted to occur in association with cases of thrombophlebitis. This association has led to the speculation that the microorganisms themselves may contribute to the pathogenesis of thrombus formation through elaborated enzymes, including heparinases, or by interactions between the clotting cascade and the unique structure of the bacteroides lipopolysaccharide. Anti-phospholipid antibodies have been linked with hypercoagulable states and thrombus formation. Although a number of infections have been associated with the transient production of anti-cardiolipin antibodies, the effect the antibodies may have in contributing to thrombus formation is not well understood. The occurrence of bacteroides species infection with transient anti-cardiolipin antibody has not been previously reported. ( info) |
17/130. Papillophlebitis and arteriolar occlusion in a pregnant woman. Among the pathologic findings affecting the eye during pregnancy, microvascular abnormalities affecting both choroidal and retinal circulation have been reported in cases of complicated pregnancy. We report a case of papillophlebitis and arteriolar occlusion in a pregnant woman without any complications throughout her pregnancy. The patient was placed on glucocorticoids and her vision, visual fields and funduscopic appearance improved almost to normal. Despite the improvement with treatment, the contributing role of glucocorticoids in this case could not be fully determined. Papillophlebitis and arteriolar occlusion should be included among gestational-related vasculopathies. ( info) |
| Acute frosted retinal periphlebitis is an inflammatory condition of unknown origin characterized by marked perivenular infiltration in otherwise healthy patients. We encountered seven patients with acquired immunodeficiency syndrome who exhibited visual loss associated with an unusual diffuse retinal periphlebitis very similar in appearance to acute frosted retinal periphlebitis. Each patient developed a thick inflammatory infiltrate surrounding the retinal venules, creating a frosted appearance. Two cases were bilateral. All patients had areas of more typical cytomegalovirus retinitis in their involved eye(s). Five of six patients treated with ganciclovir sodium showed improvement not only of the cytomegalovirus retinitis but also of the periphlebitis. Although we do not have histopathologic evidence that cytomegalovirus was the cause of these cases of periphlebitis, we believe that periphlebitis may be a previously unrecognized finding of cytomegalovirus retinitis in patients with acquired immunodeficiency syndrome. So far, there is no evidence implicating cytomegalovirus as the cause of acute frosted retinal periphlebitis in healthy patients. ( info) |
19/130. Acute frosted retinal periphlebitis associated with cytomegalovirus retinitis. The clinical picture of an acute frosted periphlebitis has been reported in a limited number of otherwise healthy patients, and in one case of human immunodeficiency virus (hiv) infection. The disease is usually bilateral and highly sensitive to steroids. The case of a 26-year-old, hiv-seropositive woman who developed unilateral diffuse perivenous sheathing in the course of recurrent cytomegalovirus retinitis is reported. The appearance of the retinovasculitis was identical to that described as an acute frosted periphlebitis, and the disease proved to be highly sensitive to a combined treatment of steroids and ganciclovir. The clinical findings in this case support the possibility that the appearance of an acute frosted periphlebitis can occur in response to several different stimuli, including cytomegalovirus. ( info) |
| Two patients with definite MS and no significant visual loss are presented, because of the marked bilateral sheathing of retinal veins, and diffuse pigmentary changes in the first patient, and the previously unreported paravenous pigmentation with bone corpuscular configuration in the second patient. The lesions in the second patient are similar to paravenous retinitis pigmentosa. We assume that the RPE lesions may be secondary to perivasculitis, which is not uncommonly seen in MS patients. ( info) |