Profound diarrhoea and weight loss in an immunocompromised patient

2021 ◽  
Vol 14 (1) ◽  
pp. e236913
Author(s):  
George Ashton ◽  
Alan Shand ◽  
Ian Arnott ◽  
Shahida Din
Keyword(s):  
Weight Loss ◽  
Complete Resolution ◽  
Immunocompromised Patient ◽  
Acute Illness ◽  
Chronic Diarrhoea ◽  
Infectious Gastroenteritis ◽  
Immunosuppressed Patients ◽  
History Of ◽  
Stool Samples

A 75-year-old man was admitted with a 3-month history of worsening diarrhoea and weight loss. He was on long-term immunosuppression following cardiac transplantation. Investigations revealed herpes simplex oesophagitis and stool samples were positive for norovirus. Treatment with acyclovir and nitazoxanide resulted in a complete resolution of symptoms. Norovirus is a common cause of infectious gastroenteritis, but immunosuppressed patients may present with chronic diarrhoea rather than an acute illness. This case highlights the importance of a low clinical threshold for testing for norovirus infection in immunocompromised patients.

scholarly journals Changes in Maternal Weight 5–10 Years after a First Delivery

2012 ◽  
Vol 8 (5) ◽  
pp. 513-519 ◽  
Author(s):  
Sarah E Britz ◽  
Kelly C McDermott ◽  
Christopher B Pierce ◽  
Joan L Blomquist ◽  
Victoria L Handa
Keyword(s):  
Weight Loss ◽  
Black Women ◽  
Reproductive Factors ◽  
Education History ◽  
Healthy Weight ◽  
Maternal Weight ◽  
History Of ◽  
The Difference ◽  
Self Administered Questionnaire

Aim: The objective of this study was to identify maternal, obstetrical and reproductive factors associated with long-term changes in maternal weight after delivery. Materials & methods: Participants were enrolled in a longitudinal cohort study of maternal health 5–10 years after childbirth. Data were obtained from obstetrical records and a self-administered questionnaire. Weight at the time of first delivery (5–10 years prior) was obtained retrospectively and each woman's weight at the time of her first delivery was compared with her current weight. Results: Among 948 women, obesity was associated with race, parity, education, history of diabetes and history of cesarean at the time of first delivery. On average, the difference between weight at the time of first delivery and weight 5–10 years later was −11 kg (11 kg weight loss). In a multivariate model, black race and diabetes were associated with significantly less weight loss. Cesarean delivery, parity and breastfeeding were not associated with changes in maternal weight. Conclusion: Black women and those with a history of diabetes may be appropriate targets for interventions that promote a long-term healthy weight after childbirth.

scholarly journals Weight Loss Barriers and Dietary Quality of Intermittent and Continuous Dieters in Women with a History of Gestational Diabetes

2021 ◽  
Vol 18 (19) ◽  
pp. 10243
Author(s):  
Kristy L. Gray ◽  
Peter M. Clifton ◽  
Jennifer B. Keogh
Keyword(s):  
Weight Loss ◽  
Gestational Diabetes ◽  
Secondary Analysis ◽  
Theoretical Domains Framework ◽  
Energy Restriction ◽  
Dietary Quality ◽  
Behavioral Regulation ◽  
History Of ◽  
Regulation Strategies

Weight-loss after gestational diabetes (GDM) lowers the risk of type-2 diabetes (T2DM). Intermittent energy restriction (IER) produces comparable weight-loss to continuous energy restriction (CER), but long-term adherence remains difficult in this population. This exploratory secondary analysis of a 12-month trial comparing IER to CER following GDM examined weight-loss and dietary quality associated with barriers to weight-loss or T2DM risk perception as assessed in a Likert scale questionnaire at baseline. The participants had a median (IQR) BMI of 32.6 (9.4) kg/m2 and 3 (4) years postpartum (n = 121). Forty-five percent (n = 54) of the participants thought they were at a high risk of developing T2DM. Greater affordability of healthy food was related with greater weight-loss at 3 months (p = 0.044, n = 85). At 12 months, there was no significant relationship between weight-loss and the barriers to weight-loss (p > 0.05). CER had superior improvement in dietary quality at 12 months (CER 11 ± 10, IER 6 ± 5.6, n = 42, p = 0.05). Under the Theoretical Domains Framework, the barriers were predominantly related to behavioral regulation (n = 83, 69%; n = 76, 63%) and environmental context and resources (n = 67, 56%). Interventions for diabetes prevention in this population should include behavioral regulation strategies, consider the family home environment, and ensure that the risk of T2DM is conveyed. Women choosing IER may benefit from education to improve their dietary quality.

scholarly journals Indolent T-cell lymphoproliferative disorder of the gastrointestinal tract managed conservatively with corticosteroids

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Tyler McKechnie ◽  
Haroon Yousuf ◽  
Stephen Somerton
Keyword(s):  
Computed Tomography ◽  
Weight Loss ◽  
Abdominal Pain ◽  
Gastrointestinal Tract ◽  
T Cell ◽  
Complete Resolution ◽  
Lymphoproliferative Disorder ◽  
Duodenal Biopsy ◽  
High Dose ◽  
History Of

An 82-year-old female presented with a 4-week history of abdominal pain, weight loss, diarrhea, and nausea. A complete infectious workup was negative. Her computed tomography (CT) scan showed no pathologic changes and her esophagogastroduodenoscopy (EGD) showed erosive damage in the duodenum. Her duodenal biopsy showed inflammation with a marked increase in intra-epithelial lymphocytes and her immunohistochemistry was consistent with indolent T-cell lymphoproliferative disorder of the gastrointestinal tract. She was started on high dose steroids three months after the onset of her symptoms. She gradually improved with complete resolution of erosive changes on her repeat EGD.

scholarly journals Bilateral adrenal histoplasmosis in an immunocompetent man

2007 ◽  
Vol 40 (2) ◽  
pp. 230-233 ◽  
Author(s):  
Carlos Frederico Lopes Benevides ◽  
Ronilson Oliveira Durães ◽  
Bianca Aquino ◽  
Leonardo de Lucca Schiavon ◽  
Janaína Luz Narciso-Schiavon ◽  
...  
Keyword(s):  
Weight Loss ◽  
Adrenal Gland ◽  
Adrenal Mass ◽  
Pulmonary Infection ◽  
Fungal Disease ◽  
Disseminated Histoplasmosis ◽  
Immunosuppressed Patients ◽  
History Of ◽  
Unilateral Involvement

Histoplasmosis is a fungal disease that is endemic in Brazil. It may present as chronic pulmonary infection or in disseminated form. Disseminated histoplasmosis frequently affects the adrenal gland; however, unilateral involvement in immunosuppressed patients is the usual presentation. We report a case of an elderly immunocompetent male with history of weight loss, fever and bilateral adrenal mass who was successfully treated with itraconazole.

scholarly journals Experience (Mostly Negative) with the Use of Sympathomimetic Agents for Weight Loss

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Mario A. Inchiosa
Keyword(s):  
Weight Loss ◽  
Cardiac Arrhythmias ◽  
Indirect Effects ◽  
Adrenergic Receptors ◽  
Direct Effects ◽  
Cardiovascular Toxicity ◽  
Sympathomimetic Drug ◽  
History Of ◽  
Treatment Of Obesity

Sympathomimetic agents have a poor history of long-term success in the treatment of obesity. From earlier experiences with amphetamine and its analogs, to more recent drugs with direct effects on adrenergic receptors or indirect effects from release of catecholamines or inhibition of reuptake, cardiovascular toxicity (strokes and cardiac arrhythmias) has been the major concern. These concerns also extended to food supplements containing ephedra alkaloids and may require consideration for current supplements containing the sympathomimetic drug, synephrine.

scholarly journals Klossiella equiInfection in an Immunosuppressed Horse: Evidence of Long-Term Infection

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Lora R. Ballweber ◽  
Deanna Dailey ◽  
Gabriele Landolt
Keyword(s):  
Weight Loss ◽  
Pituitary Gland ◽  
Developmental Stages ◽  
Pars Intermedia ◽  
Nasal Discharge ◽  
Coccidian Parasite ◽  
Quarter Horse ◽  
History Of ◽  
Initial Improvement

A 13-year-old quarter horse gelding presented with a history of hematuria of approximately 1-year duration, anemia, weight loss over the previous six months, and bilateral nasal discharge of 2-week duration. It was determined that hematuria was most likely caused by the coccidian parasiteKlossiella equi. Additional case workup suggested a diagnosis of pituitary pars intermedia dysfunction. Confirmatory testing was declined by the owners and the horse was discharged on medical therapy. Despite initial improvement after discharge, the horse developed unresolving sinusitis approximately 1 year later and was euthanized. Necropsy confirmed the presence of an adenoma of the pars intermedia of the pituitary gland, supporting the initial diagnosis. Additional findings included multiple developmental stages ofK. equipresent in the kidneys. This finding demonstrates infections withK. equican be chronic in nature and supports the association of increased severity of klossiellosis and impaired immune function.

One More Time: Redo Paraesophageal Hernia Repair Results in Safe, Durable Outcomes Compared with Primary Repairs

2018 ◽  
Vol 84 (7) ◽  
pp. 1138-1145 ◽  
Author(s):  
Angela M. Kao ◽  
Javier Otero ◽  
Kathryn A. Schlosser ◽  
Julia E. Marx ◽  
Tanushree Prasad ◽  
...  
Keyword(s):  
Weight Loss ◽  
Paraesophageal Hernia ◽  
Postoperative Morbidity ◽  
Operative Time ◽  
Hernia Recurrence ◽  
Prior History ◽  
Paraesophageal Hernia Repair ◽  
Conversion Rates ◽  
History Of

The incidence and causes of failed paraesophageal hernia repairs (PEHR) remain poorly understood. Our study aimed to evaluate long-term clinical outcomes after reoperative fundoplication as compared with initial PEHR. A prospectively maintained institutional hernia-specific database was queried for PEHR between 2008 and 2017. Patients with prior history of PEHR were categorized as “redo” paraesophageal hernia (RPEH). Primary outcomes included postoperative morbidity, mortality, symptom resolution, and hernia recurrence. A total of 402 patients underwent minimally invasive PEHR (Initial PEH = 305, RPEH = 97). Redo PEHR had more prevalent preoperative nausea/vomiting (50.6% vs 34.1%, P < 0.007) and weight loss (24.1% vs 13.5%, P < 0.02). RPEH had had longer mean operative time (256.4 ± 91.2 vs 190.3 ± 59.9 minutes, P < 0.0001) and higher rate of conversion to open (10.3% vs 0.67%, P < 0.0001); however, no difference was noted in postoperative complications, hernia recurrence, or mortality between cohorts. Laparoscopic revision of prior PEHR in symptomatic patients can be safely performed with favorable outcomes compared with initial PEHR. Despite redo procedures seeming to be more technically demanding (as noted by longer operative time and higher conversion rates), outcomes are similar and overall resolution of symptoms is achieved in most patients.

scholarly journals Olmesartan-induced enteropathy

2018 ◽  
pp. bcr-2018-224411 ◽  
Author(s):  
Nirmal K Onteddu ◽  
Venkata Siva Krishna Kumar Pulivarthi ◽  
Mihira Ginnavaram ◽  
Ramalinga Kedika
Keyword(s):  
Weight Loss ◽  
Primary Care Physicians ◽  
Hospital Admissions ◽  
Clinical Symptoms ◽  
Villous Atrophy ◽  
Signs And Symptoms ◽  
Chronic Diarrhoea ◽  
Caucasian Woman ◽  
Frequent Adverse Event ◽  
History Of

Olmesartan-induced enteropathy (OIE) typically presents with a constellation of signs and symptoms including chronic diarrhoea, weight loss and villous atrophy on biopsy. We describe a 68-year-old Caucasian woman with a history of hypothyroidism and hypertension who presented to our hospital with recurrent episodes of acute intermittent diarrhoea, nausea, vomiting, renal failure and 15 lbs weight loss. After an extensive workup, she was diagnosed with possible OIE. Cessation of the offending drug resulted in improvement of clinical symptoms and also hospital admissions for severe diarrhoea reinforcing the diagnosis of OIE. Among the adverse effects of drug therapy, diarrhoea is a relatively frequent adverse event accounting for about 7%. This report serves as an addition to existing literature and to increase the awareness of olmesartan-induced sprue-like enteropathy among the primary care physicians and gastroenterologists.

Chronic Laryngotracheal Granulomatous Disease Secondary to Sporothrix schenckii in an Immunocompromised Patient

2022 ◽  
pp. 000348942110730
Author(s):  
Hannah Kenny ◽  
Michael Dougherty ◽  
Ian Churnin ◽  
Stephen Early ◽  
Akriti Gupta ◽  
...  
Keyword(s):  
Immunocompromised Patient ◽  
Sporothrix Schenckii ◽  
Fungal Culture ◽  
Granulomatous Disease ◽  
Rare Presentation ◽  
Tissue Samples ◽  
History Of ◽  
Itraconazole Treatment ◽  
Inflammatory Changes

Objective: To describe a rare presentation of laryngotracheal granulomatous disease secondary to sporotrichosis. Methods: The authors report a case of laryngeal sporotrichosis in an immunocompromised patient, with accompanying endoscopic images and pathology. Results/case: A 72-year-old immunocompromised female with a history of rose-handling presented with a year of hoarseness and breathy voice. Flexible nasolaryngoscopy showed diffuse nodularity; biopsy of the lesions demonstrated granulomatous inflammatory changes, and fungal culture grew Sporothrix schenkii. Long-term itraconazole treatment was initiated, with improvement in dysphonia and few residual granulomas on follow-up examination. Conclusion: When evaluating granulomatous disease of the airway, a broad differential including infectious or inflammatory etiologies should be considered, especially in immunocompromised patients. Adequate tissue samples should be collected to facilitate special staining. The current recommendations for laryngeal sporotrichosis include treatment with a prolonged course of itraconazole.

Dysosmia and drug tolerance with use of venlafaxine

2021 ◽  
Vol 14 (4) ◽  
pp. e240547
Author(s):  
Celeste Rousseau ◽  
John Malaty
Keyword(s):  
Weight Loss ◽  
Depressive Symptoms ◽  
Complete Resolution ◽  
Financial Constraints ◽  
Hot Flashes ◽  
Oral Intake ◽  
Major Depressive ◽  
History Of ◽  
Continued Use

A 57-year-old woman presented with a 1-year history of major depressive disorder. She was started on venlafaxine XR 75 mg orally daily and a few days later developed severe dysosmia to foods she used to enjoy. She never had previous problems with smell or taste. At her 1-month follow-up, her depressive symptoms had improved, but she reported persistent dysosmia and was found to have associated weight loss due to decreased oral intake. She was advised to switch medications, but due to financial constraints she continued taking the same dose. At follow-up 48 days later, she reported complete resolution of her dysosmia and was eating normally again, but she had persistence of some depressive symptoms so her dose was gradually increased to venlafaxine XR 225 mg orally daily until her depressive symptoms and postmenopausal hot flashes were well controlled. There were no changes with continued use over the following 8 years.

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