Gastrointestinal CMV Disease and Tuberculosis in an AIDS Patient: Synergistic Interaction between Opportunistic Coinfections

The AIDS pandemic has made diseases such as tuberculosis, CMV disease, and other opportunistic infections more prevalent; these diseases may even be found to be associated among themselves, and the natural history of each disease may present in an unusual manner. We report the case of a 41-year-old man with HIV (CD4 of 144 cells/dL) and HCV with hematochezia due to tuberculosis in the ileocecal valve and descending colon and CMV tissue invasive disease in the esophagus and descending colon. Coinfection among tuberculosis and cytomegalovirus in the gastrointestinal tract was described only once in a patient with a recent diagnosis of HIV that affected the distal ileum and ascending colon. We will discuss the peculiarities of the case and the behavior of the immune system in the face of simultaneous opportunistic infections. This is a challenging scenario that has scarce publications and is of great clinical importance.

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Burkitt’s lymphoma presenting as acute appendicitis: a case report

Abstract

Appendiceal lymphomas are exceedingly rare, constituting around 0.015% of all gastrointestinal lymphoma cases. Burkitt's lymphoma is the second most prevalent pathology, diagnosed in 25.9% of patients. We report a case of a 36-year-old male admitted with acute abdominal pain with 2 days of evolution, localized in the right lower quadrant associated with hyporexia, but no fever. On examination he presented abdominal tenderness on the right iliac fossa. A diagnosis of acute appendicitis was made clinically. At the post-operative follow up, 2 weeks later, he presented a low back pain of high intensity, associated with swelling of the abdomen, night sweats, daily fevers and weight loss. The histopathological exam of the appendix revealed diffuse and transmural lymphoid proliferation. Immunohistochemistry suggested high grade B-cell lymphoma indicative of Burkitt's lymphoma. This patient was staged as a IVxB lymphoma and was submitted into polychemotherapy with a complete clinical response in 8 months.

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Cecal ameboma mimicking obstructing colonic carcinoma

Abstract

Ameboma is a mass of granulation tissue with peripheral fibrosis and a core of inflammation related to amebic chronic infection. The initial presentations of colonic ameboma usually include obstruction and low gastrointestinal bleeding. It may mimic colon carcinoma or other granulomatous inflammatory conditions of the colon in both the clinical presentation and the endoscopic appearance. Here, we report a case of a 45-year-old male with a presentation of abdominal pain and constipation, as well as clinical, radiological and endoscopic presentation resembling colonic carcinoma, that was managed operatively with right hemicolectomy and post-operative histopathologic finding of cecal ameboma.

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Irreversible electroporation in borderline resectable pancreatic adenocarcinoma for margin accentuation

Abstract

Achieving clear microscopic resection margins following pancreaticoduodenectomy (PD) is challenging particularly in borderline resectable pancreatic carcinoma (BRPC). Positive resection margins has been identified as a major independent prognostic factor. Irreversible electroporation (IRE) has emerged as a promising non-thermal ablative method that could be used in the treatment of pancreatic cancer as an adjunct to chemotherapy and surgery. This case report describes the successful simultaneous intraoperative IRE and PD in a patient with BRPC, achieving clear microscopic resection margins. Technical aspects and histology showing the effect of IRE are presented. The role of IRE in the treatment of pancreatic adenocarcinoma should be further evaluated in prospective studies.

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Spontaneous adrenal hemorrhage. Report of two cases and review of pathogenesis, diagnosis and management

Abstract

Adrenal hemorrhage represents a relatively rare condition, usually associated with meningococcal septicemia. It is an underestimated cause of acute decompensation, multiorgan failure and death, usually diagnosed post-mortem. Depending on its etiology adrenal hemorrhage is categorized as traumatic and non-traumatic. The technical advancement of imaging modalities, has made diagnosis and management more efficient. Assessment of hemodynamic stability, exclusion of a hormonal active adrenal tumor and assessment for adrenal insuffi¬ciency, are of cardinal importance. Angiographic embolization has contributed significantly in better outcomes as emergency laparotomy is associated with high morbidity and mortality rates. Hereby we present two cases of spontaneous adrenal hemorrhage associated with extensive retroperitoneal bleeding and hemodynamic instability. Both underwent angiography with one requiring embolization with favorable outcome. Investigation for exclusion of underlying adrenal tumor, adrenal insufficiency and follow-up imaging are presented in detail for both cases.

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A Rare Presentation of Clozapine-Induced DRESS Syndrome

Drug reaction with eosinophilia and systemic symptoms (DRESS syndrome) is an uncommon side effect of certain medications. It causes a skin reaction, with eosinophilia and other organ involvement. This case describes a presentation of a 32-year-old female with a past medical history significant for schizophrenia and bipolar disorder who presented for a rash. She had been started on clozapine 10 days prior to admission. After extensive workup she was found to have DRESS syndrome secondary to clozapine use. This is the second reported case in the literature of clozapine-induced DRESS syndrome. This case is unique because it is the first case to present with the common manifestations of DRESS syndrome including eosinophilia, rash, lymphadenopathy, and organ involvement after clozapine use.

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Odontogenic Cutaneous Fistula: A Cause of Persistent Cervical Discharge

Odontogenic cutaneous fistulas often lead to intense levels of patient discomfort and suffering. Due to its rarity and the absence of dental symptoms, a considerable number of patients are usually misdiagnosed which results in inappropriate management. This case report presents a 16-year-old patient with a 2-year history of a nonhealing, persistently discharging lesion in the left submandibular region of the neck. The patient underwent exploration of the left submandibular region, and a fistulous tract directed superomedially to the ipsilateral lower molar teeth was excised. A subsequent panoramic orthopantomogram performed one week postoperatively demonstrated radiolucency is the distal root of tooth 37. A final diagnosis of odontogenic cutaneous fistula was made, and the patient was referred to the Maxillofacial Department for treatment of the offending tooth.

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