scholarly journals 373. Immune Reconstitution Inflammatory Syndrome in Patients with HIV/AIDS and Histoplasmosis: A Case Series

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S195-S195 ◽  
Author(s):  
Afroditi Boulougoura ◽  
Elizabeth Laidlaw ◽  
Gregg Roby ◽  
Yolanda Mejia ◽  
Alice Pau ◽  
...  
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Immune Reconstitution Inflammatory Syndrome ◽  
Immune Reconstitution ◽  
Histoplasma Capsulatum ◽  
Case Reports ◽  
Case Series ◽  
The United States ◽  
Inflammatory Syndrome

Abstract Background Immune Reconstitution Inflammatory Syndrome (IRIS) in HIV infection is the unexpected clinical deterioration due to worsening (paradoxical) or uncovering (unmasking) of an infection or malignancy upon initiation of antiretroviral therapy (ART). Histoplasma capsulatum (H. capsulatum) is the most common endemic mycosis in patients with AIDS, usually manifesting as disseminated disease at CD4 counts < 150 cells/μl. In the ART era, histoplasmosis IRIS has been described in case reports, but there has been a limited description regarding clinical presentations and pathogenesis in the United States. Methods ART-naive HIV+ patients with a CD4+ T-cell count < 100 cells/µL enrolled in prospective studies at the National Institutes of Health (NIH) (NCT00286767, NCT02147405) were evaluated to identify those with histoplasmosis and followed after ART initiation to identify those who would eventually develop IRIS. Results From a total of 271 patients, we identified 9 patients with histoplasmosis. The median age, CD4+ count and HIV VL of these 9 patients was 36 years, 40 cells/mm3 and 193,184 copies/mL, respectively. Two patients developed IRIS only to histoplasmosis (1 unmasking and 1 paradoxical), 2 patients developed IRIS to both histoplasmosis and nontuberculous mycobacteria (NTM) and 3 patients developed IRIS to other infections (1 VZV, and 2 NTM). The manifestations of histoplasmosis IRIS in our cohort ranged from worsening lymphadenopathy to small bowel obstruction and worsening pulmonary symptoms. Conclusion Histoplasma-related IRIS can present with worsening lymphadenopathy, small bowel obstruction, and worsening pulmonary symptoms. The emergence of IRIS appears to be very common in people with HIV and disseminated histoplasmosis but the underlying trigger may be histoplasma, other co-infections or both. Disclosures All authors: No reported disclosures.

scholarly journals Small Bowel Obstruction by Broad Ligament Hernia: Three Case Reports, Management and Outcomes

2019 ◽  
Vol 32 (3) ◽  
pp. 240
Author(s):  
Manuela Graça Fernandes ◽  
Ana Rita Mateus Loureiro ◽  
Maria João Diogo Obrist ◽  
César Prudente
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Case Reports ◽  
Broad Ligament ◽  
Exploratory Laparotomy ◽  
Anatomical Location ◽  
Internal Hernias ◽  
Surgical History ◽  
Broad Ligament Defect

Internal hernias are a rare cause of bowel obstruction (1%) and can be caused by broad ligament defects in 4% to 7% of the cases. These defects may be congenital or acquired and are classified according to its anatomical location. This paper reports three cases of small bowel obstruction by broad ligament hernia. The patients, three women aged from 35 to 51 years old, were admitted to the emergency department with small bowel obstruction. An exploratory laparotomy was performed during which an internal hernia through a broad ligament defect was identified. In all cases the hernia content was reduced and the defect closed. One of the patients required a segmental enterectomy. All patients had a favorable outcome. This paper aims to raise awareness about the broad ligament hernia as a cause of bowel obstruction, namely in middle-aged women with no surgical history.

What is the Rate of Small Bowel Obstruction after Colectomy?

2008 ◽  
Vol 74 (10) ◽  
pp. 1001-1005 ◽  
Author(s):  
Janak A. Parikh ◽  
Clifford Y. Ko ◽  
Melinda A. Maggard ◽  
David S. Zingmond
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Group Versus ◽  
The Elderly ◽  
The United States ◽  
First Year ◽  
Surgery Group ◽  
History Of ◽  
Common Operation

The rate of small bowel obstruction (SBO) after colectomy is unknown. Given the large number of colectomies performed in the United States, elucidating SBO rates, outcomes, and identifying predictors of readmission is important. Using the California Inpatient File, we identified all patients readmitted with a principle diagnosis of SBO at least once in the 3 years after colectomy (n = 4555). Patients admitted with a diagnosis of SBO in the 3 years before surgery were excluded. Overall, 10 per cent of patients were readmitted for SBO at least once after colectomy. Approximately 58 per cent were readmitted in the first year and 22 per cent of these patients required surgery. The most common operation performed was lysis of adhesions. Median length of stay was twice as long in the surgery group versus the no surgery group (12 vs 6 days). Overall mortality was higher in the nonsurgery group compared with the surgery group (33% vs 21%, P < 0.001) and highest in the elderly (44% vs 30%, P < 0.001). One in 10 patients without a history of SBO who undergoes a colectomy will be readmitted at least once in the subsequent 3 years for SBO, and there is a high mortality rate in this group, especially in the elderly.

scholarly journals Secular trends in small-bowel obstruction and adhesiolysis in the United States: 1988–2007

2012 ◽  
Vol 204 (3) ◽  
pp. 315-320 ◽  
Author(s):  
Frank I. Scott ◽  
Mark T. Osterman ◽  
Najjia N. Mahmoud ◽  
James D. Lewis
Keyword(s):  
United States ◽  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
The United States ◽  
Secular Trends

scholarly journals Immune Reconstitution Inflammatory Syndrome in Patients with AIDS and Disseminated Coccidioidomycosis: A Case Series and Review of the Literature

2017 ◽  
Vol 16 (6) ◽  
pp. 540-545 ◽  
Author(s):  
Anandit Mu ◽  
Thwe Thwe Shein ◽  
Priya Jayachandran ◽  
Simon Paul
Keyword(s):  
Antiretroviral Therapy ◽  
Immune Reconstitution Inflammatory Syndrome ◽  
Immune Reconstitution ◽  
Case Series ◽  
Kaposi Sarcoma ◽  
Optimal Timing ◽  
Review Of The Literature ◽  
Inflammatory Syndrome ◽  
Clinical Worsening ◽  
Substantial Morbidity

Coccidioidomycosis causes substantial morbidity and mortality in endemic areas, and dissemination is frequent in patients with impaired cellular immunity such as AIDS. Immune reconstitution inflammatory syndrome (IRIS) is paradoxical clinical worsening after initiation of antiretroviral therapy (ART) in a patient with HIV and a simultaneous opportunistic infection (OI). Immune reconstitution inflammatory syndrome has been well described for a host of mycobacterial, viral, and fungal OIs and malignancies such as Kaposi sarcoma. To date, only 3 cases of IRIS due to coccidioidomycosis have been reported in the literature. At our institution, we report 4 cases of IRIS in HIV-infected patients with disseminated coccidioidomycosis. Unfortunately, all 4 patients died of worsening coccidioidal infection after initiating ART. The optimal timing of ART in patients with AIDS and coccidioidomycosis remains to be elucidated.

scholarly journals Left hand extensor tenosynovitis due to <i>Histoplasma capsulatum</i> complicated by immune reconstitution inflammatory syndrome

2021 ◽  
Vol 6 (8) ◽  
pp. 355-361
Author(s):  
Talha Riaz ◽  
Mark Collins ◽  
Mark Enzler ◽  
Marco Rizzo ◽  
Audrey N. Schuetz ◽  
...  
Keyword(s):  
Antifungal Therapy ◽  
Immune Reconstitution Inflammatory Syndrome ◽  
Immune Reconstitution ◽  
Histoplasma Capsulatum ◽  
Surgical Debridement ◽  
Left Hand ◽  
Paradoxical Worsening ◽  
Inflammatory Syndrome

Abstract. We describe a case of left hand extensor tenosynovitis due to histoplasmosis in a patient with dermatomyositis on chronic immunosuppression. Treatment involved surgical debridement and antifungal therapy. The patient experienced paradoxical worsening of tenosynovial inflammation during de-augmentation of immunosuppression felt to be immune reconstitution inflammatory syndrome.

scholarly journals Small bowel obstruction secondary to diaphragmatic herniation following transabdominal cardiac ablation

2020 ◽  
Vol 102 (3) ◽  
pp. e57-e59
Author(s):  
E Sharma ◽  
C Bussa-Rao ◽  
A Sergot ◽  
K Ratnasigham ◽  
GP Thomas
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Diaphragmatic Hernia ◽  
Literature Search ◽  
Unusual Case ◽  
Case Series ◽  
Cardiac Ablation ◽  
Diaphragmatic Herniation

We report an unusual case of strangulated diaphragmatic hernia secondary to a pericardial ablation, which resulted in necrosis of the incarcerated small bowel. Through a literature search, we have found a limited number of similar cases introducing a case series for this rare but potentially fatal condition.

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