scholarly journals A Disease-Modifying Approach for Advanced Hidradenitis Suppurativa (Regimen with Metformin, Liraglutide, Dapsone, and Finasteride): A Case Report

2017 ◽  
Vol 9 (2) ◽  
pp. 70-78 ◽  
Author(s):  
Birgit N. Khandalavala
Keyword(s):  
Hidradenitis Suppurativa ◽  
Liver Enzymes ◽  
Ethinyl Estradiol ◽  
Residual Disease ◽  
Antibiotic Use ◽  
Initial Weight Loss ◽  
The Past ◽  
Elevated Liver Enzymes ◽  
History Of ◽  
Abdominal Lesions

Hidradenitis suppurativa (HS) is a challenging skin disease with limited therapeutic options. Obesity and metabolic syndrome are being increasingly implicated and associated with younger ages and greater metabolic severity. A 19-year-old female with an 8-year history of progressively debilitating cicatricial HS disease presented with obesity, profound anemia, leukocytosis, increased platelet count, hypoalbuminemia, and elevated liver enzymes. A combination of metformin, liraglutide, levonorgestrel-ethinyl estradiol, dapsone, and finasteride was initiated. Acute antibiotic use for recurrences and flares could be slowly discontinued. Over the course of 3 years on this regimen, the liver enzymes normalized in 1 year, followed in2 years by complete resolution of the majority of the hematological and metabolic abnormalities. The sedimentation rate reduced from over 120 to 34 mm/h. She required 1 surgical intervention for perianal disease after 9 months on the regimen. Flares greatly diminished in intensity and duration, with none in the past 6 months. Right axillary lesions have completely healed with residual disease greatly reduced. Chiefly abdominal lesions are persistent. She was able to complete high school from home, start a job, and resume a normal life. Initial weight loss of 40 pounds was not maintained. The current regimen is being well tolerated and continued.

scholarly journals The Impact of Recent Antibiotic Usage on Oropharyngeal Neisseria spp. in MSM of Hanoi, Vietnam

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S105-S105
Author(s):  
Huan Dong ◽  
Hoa Thi Nguyen ◽  
Minh Binh Xuan Nguyen ◽  
Trung Vu Nguyen ◽  
Folasade May ◽  
...  
Keyword(s):  
Antimicrobial Susceptibility ◽  
Antibiotic Use ◽  
Antibiotic Usage ◽  
The Past ◽  
History Of ◽  
Neisseria Gonorrhea ◽  
Sex With Men ◽  
The Impact ◽  
Susceptibility Status ◽  
Commensal Neisseria

Abstract Background Neisseria gonorrhea (NG) has a long history of gaining resistance to nearly all antimicrobials used for treatment since the 1930s, which makes susceptibility to last-line cephalosporins of dire importance. Horizontal gene transmission is highly prevalent among the Neisseria genus, with genetic fragments from common commensal Neisseria having been found in resistant NG strains. Globally, NG disproportionately affects men-who-have-sex-with-men (MSM) and nearly all ceftriaxone-resistant cases have been reported from pharyngeal samples. Our study aims to assess the impact of antibiotic usage on the antimicrobial susceptibility of oropharyngeal Neisseria spp. Methods MSM from Hanoi, Vietnam, were surveyed regarding antibiotic usage. Pharyngeal swabs were collected and cultured on chocolate and modified-Thayer–Martin agar. Neisseria spp. were subcultured, identified using MALDI-TOF, and antimicrobial susceptibility determined by E-test using NG CLSI MIC breakpoints to ciprofloxacin (CIP), cefixime (CFM), ceftriaxone (CRO), and cefpodoxime (CPD). Results The 225 MSM surveyed were young (mean age 23.9 years, std 4.4). In the past 6 months: 41.6% participants used any antibiotics, among whom 62.4% did not have a prescription; 6.6% used CFM (16.4% more were unsure), among whom 55.6% did not have a prescription; and 4.5% received CRO. From 72 swabs, 102 Neisseria isolates were obtained; N. flavescens (n = 59), N. perflava (n = 14), N. macacae (n = 8), N. sublfava (n = 7), N. gonorrhoeae (n = 5), N. mucosa (n = 3), N. meningitides (n = 3), N. cinerea (n = 2), and N. lactamica (n = 1). 
“Reduced susceptibility” status for any Neisseria spp. was 35.3, 10, 8, and 30% to CIP, CFM, CRO, and CPD, respectively; 61.8% were “resistant” to CIP. MSM who took any antibiotics in the past 6 months were almost twice as likely to have Neisseria spp. with reduced susceptibility to cephalosporins (CFM, CRO, or CPD), RR 1.8 (95% CI 1.1–3.2; P = 0.026) compared with non-antibiotic users. Conclusion Many MSM in Hanoi used antibiotics recently, often without a prescription. Antibiotic use was associated with antimicrobial “reduced susceptibility” of commensal Neisseria spp. to cephalosporins, possibly potentiating resistance acquisition by NG. Disclosures All authors: No reported disclosures.

scholarly journals Hepatitis por citomegalovirus: Presentación de dos casos

2013 ◽  
Vol 6 (2) ◽  
Author(s):  
Carlos Tori ◽  
Raúl Leon Barua ◽  
Carlos Roe
Keyword(s):  
Blood Test ◽  
Liver Enzymes ◽  
The Other ◽  
General Malaise ◽  
Igg Antibodies ◽  
Premature Babies ◽  
Normal Individuals ◽  
Elevated Liver Enzymes ◽  
History Of ◽  
Low Prevalence

Two cases of hepatitis by cytomegalovirus are described, one in a child and the other in a young adult, presenting with a history of fever, general malaise, hepatomegaly and no jaundice. Their blood test showed atypical lymphocytes, normal bilirubin, elevated liver enzymes, and IgG antibodies against cytomegalovirus. Their course was un was unremarkable except for asthenia which persisted in spite of clinical and laboratory improvement. This course was unremarkable except for asthenia which persisted in spite of clinical and laboratory improvement. This presentation is done because of the low prevalence or infrequent diagnosis of anicteric hepatitis due to cytomegalovirus in normal individuals. Most of the literature refers to congenital cases, premature babies, or patients with debilitating or immunocompromising diseases.

scholarly journals The Impact of Preeclampsia on Work-Related Psychosocial Aspects and Need for Recovery

2021 ◽  
Vol 6 (3) ◽  
pp. 1-7
Author(s):  
Muijsers HEC ◽  
Keyword(s):  
Cognitive Deficits ◽  
Liver Enzymes ◽  
Memory Function ◽  
Need For Recovery ◽  
Subjective Cognitive Impairment ◽  
Work Related ◽  
Elevated Liver Enzymes ◽  
History Of ◽  
The Impact ◽  
Syndrome Report

Women with a history of preeclampsia and/or Hemolysis Elevated Liver enzymes Low Platelets (HELLP) syndrome report impaired cognitive functioning, such as concentration problems and decreased memory function. The presence of subjective cognitive impairment, depressive symptoms and cognitive deficits may affect working abilities.

scholarly journals Three Fatal Cases of Squamous Cell Carcinoma Arising in Chronic Perineal Hidradenitis Suppurativa

2007 ◽  
Vol 89 (7) ◽  
pp. 709-712 ◽  
Author(s):  
Gael M Maclean ◽  
David J Coleman
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Hidradenitis Suppurativa ◽  
Squamous Carcinoma ◽  
Apocrine Glands ◽  
Medline Search ◽  
The Past ◽  
History Of ◽  
Malignant Condition

INTRODUCTION Hidradenitis suppurativa (HS) is a chronic, inflammatory and suppurative disorder of skin bearing apocrine glands. The most severe complication is squamous cell carcinoma (SCC) and we here present three cases, all of which proved fatal, and review the past 40 years of published cases. PATIENTS AND METHODS Three advanced cases of SCC arising in chronic HS have been referred for reconstructive surgery over the past 8 years. Another 28 cases published over the past 40 years were identified using a Medline search (search items in combination: hidradenitis, squamous, carcinoma). RESULTS The male:female ratio was 4:1, most (61%) were perineal or buttock. We found no reports of SCC arising in axillary disease. The symptomatic history of HS prior to SCC diagnosis ranged from 3–50 years with a mean of 25 years. Age at diagnosis of SCC ranged from 27–71 years, and 15 patients (48%) died within 2 years of SCC diagnosis. CONCLUSIONS We advocate that hidradenitis suppurativa arising in extra-axillary sites is a pre-malignant condition, and should not be treated conservatively; curative resection is the mainstay of management.

Brain abscess due to Listeria monocytogenes after HELLP syndrome in a patient with antiphospholipid syndrome

Lupus ◽  
2016 ◽  
Vol 26 (9) ◽  
pp. 1002-1004 ◽  
Author(s):  
A Fervienza ◽  
M Bodro ◽  
P Castro ◽  
S Hernández ◽  
I Teixidó ◽  
...  
Keyword(s):  
Listeria Monocytogenes ◽  
Brain Abscess ◽  
Antiphospholipid Syndrome ◽  
Hellp Syndrome ◽  
Unusual Case ◽  
Liver Enzymes ◽  
Neurological Dysfunction ◽  
Mri Scan ◽  
Elevated Liver Enzymes ◽  
History Of

Objective To illustrate an unusual case of Listeria cerebral abscess. Material and methods A 32-year-old pregnant woman with thrombotic antiphospholipid syndrome (APS) received corticotherapy for two weeks due to hemolysis, elevated liver enzymes, low platelet (HELLP) syndrome. After delivery she presented with neurological symptoms and fever. Results The MRI scan confirmed the presence of a brain abscess, and Listeria monocytogenes was isolated in blood cultures. After eight weeks of antibiotic treatment, the patient presented no sequelae. Conclusion L. monocytogenes should be included in the differential diagnosis of patients with fever and neurological dysfunction, especially in those with a recent history of corticotherapy.

scholarly journals Postpartum Pseudoaneurysm After Cesarean Delivery

2018 ◽  
Vol 35 (2) ◽  
pp. 136-140 ◽  
Author(s):  
Dora DiGiacinto ◽  
Jennifer E. Bagley ◽  
Bradford Gildon ◽  
Gina Cantrell
Keyword(s):  
Cesarean Delivery ◽  
Uterine Artery ◽  
Liver Enzymes ◽  
Vascular Lesion ◽  
Artery Pseudoaneurysm ◽  
Elevated Liver Enzymes ◽  
Life Threatening ◽  
History Of ◽  
Low Platelet Count ◽  
Uterine Artery Pseudoaneurysm

Uterine artery pseudoaneurysm is an uncommon vascular lesion that can be life threatening. A ruptured uterine artery pseudoaneurysm can cause acute massive hemorrhaging, creating a true emergency for the postpartum patient. The etiology is more commonly seen with traumatic procedures such as cesarean delivery or curettage. This case report is of a patient with a history of HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome who presented with heavy bleeding after a cesarean delivery. Sonography was primarily used to diagnose the uterine artery pseudoaneurysm. Because of the massive hemorrhaging in this case, a hysterectomy was performed.

scholarly journals Nonalcoholic Fatty Liver Disease in Patients Investigated for Elevated Liver Enzymes

2003 ◽  
Vol 17 (1) ◽  
pp. 38-42 ◽  
Author(s):  
Krikor Kichian ◽  
Ross Mclean ◽  
Leah M Gramlich ◽  
Robert J Bailey ◽  
Vincent G Bain
Keyword(s):  
Liver Disease ◽  
Liver Biopsy ◽  
Fatty Liver ◽  
Nonalcoholic Fatty Liver Disease ◽  
Nonalcoholic Steatohepatitis ◽  
Fatty Liver Disease ◽  
Liver Enzymes ◽  
Nonalcoholic Fatty Liver ◽  
Elevated Liver Enzymes ◽  
History Of

Nonalcoholic fatty liver disease (NAFLD) is a common diagnosis among patients referred to gastroenterology and hepatology clinics for the evaluation of elevated liver enzymes. The diagnosis of NAFLD is supported by blood work to exclude other liver diseases, and by ultrasound evidence of fat in the liver in patients without a significant history of alcohol intake. The gold standard, however, is a liver biopsy to show the typical histological features of NAFLD, which are almost identical to those of alcohol-induced liver damage and can range from mild steatosis to cirrhosis. A variety of retrospective series have linked NAFLD to obesity, diabetes, hyperlipidemia, total parenteral nutrition, jejunoileal bypass surgery and certain medications. A subset of patients with NAFLD that had an initial presentation of elevated liver enzymes was studied. Two hundred and two patients were reviewed, of whom 49 met the inclusion criteria including a liver biopsy. Patients were excluded if insufficient data were available, if the patients had a significant history of ethanol intake or if they had other coexisting liver disease. These patients were seen between 1996 and 2000 in gastroenterology and hepatology clinics in two community hospitals and one regional liver transplant centre in Edmonton, Alberta. NAFLD was associated with a spectrum of changes in the liver ranging from mild steatosis to more significant steatosis with inflammation and fibrosis. Cases of NAFLD with steatosis and mixed inflammatory infiltration but lacking ballooning degeneration or fibrosis were prevalent in young (20 to 40 years of age) patients with no other significant medical history except for obesity. NAFLD with biopsies showing significant fibrosis and ballooning cell degeneration was associated with obesity, diabetes and older age. It was concluded that, in this predominantly outpatient setting, age over 40 years and diabetes at any age are risk factors for both nonalcoholic steatohepatitis and nonalcoholic steatohepatitis with cirrhosis. It is therefore recommended that patients with raised liver enzymes and suspected NAFLD be targeted for liver biopsy in their evaluation.

scholarly journals Recurrence and Severe Worsening of Hepatotoxicity After Reintroduction of Atorvastatin in Combination With Ezetimibe

2017 ◽  
Vol 10 ◽  
pp. 117954761773137 ◽  
Author(s):  
Silje Bergland Ellingsen ◽  
Elisabet Nordmo ◽  
Knut Tore Lappegård
Keyword(s):  
Liver Injury ◽  
Liver Enzymes ◽  
Current Data ◽  
Class Effect ◽  
Drug Induced ◽  
Good Tolerance ◽  
Drug Induced Liver Injury ◽  
Severe Hepatotoxicity ◽  
Elevated Liver Enzymes ◽  
History Of

Severe hepatotoxicity is a rare but well-known adverse reaction to statins. However, despite the widespread use of statins, only a few cases describing statin reexposure or switch to another statin after liver injury have been published. The literature on hepatotoxicity with ezetimibe alone or in combination with statins is also scarce. We report a case where a patient with a history of elevated liver enzymes while using atorvastatin, but prior and subsequent good tolerance to simvastatin and pravastatin, developed drug-induced liver injury on reexposure to a combination of atorvastatin and ezetimibe. The hepatotoxicity in our patient was most likely caused by reexposure to atorvastatin, although we cannot exclude ezetimibe as a contributing factor. This case highlights the risk of hepatotoxicity recurrence on rechallenge with the same statin. The tolerance to other statins in this case also strengthens the suspicion that statin-induced liver injury may not be a class effect, although the current data are too scarce to draw any definite conclusions.

scholarly journals Correlation between bright echogenic liver, elevated liver enzymes and liver histology

2012 ◽  
Vol 17 (1) ◽  
pp. 8-13
Author(s):  
Iqbal Murshed Kabir ◽  
Mahbub Alam ◽  
Mohammad Mahmuduzzaman ◽  
Abdullah Al Mamoon ◽  
Mostak Uddin Ahmed ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Hepatitis C ◽  
Alcohol Consumption ◽  
Hepatitis B ◽  
Liver Enzymes ◽  
Histological Findings ◽  
Hepatitis C Infection ◽  
Elevated Liver Enzymes ◽  
History Of

A total of 30 cases having bright echogenic liver on ultrasonography and raised ALT levels without Hepatitis B and Hepatitis C infection and without having history of alcohol consumption were referred to Gastroenterology department of BIRDEM Hospital and selected for liver biopsy in the study. The patient’s BMI and demographic profiles were recorded and necessary biochemical tests were carried out. After obtaining the histopathological reports, the correlation between different possible risk factors including biochemical findings and histological findings was sorted out. Based on BMI of Asian population, 73.4% of patients were over weight, 23.3% were obese and only 3.3% were with normal BMI. 90% patients presented with diabetes and 80% had some form of dyslipidaemia. 41% patients exhibited hypertriglycerdaemia, 21% had hypercholesterolaemia and both cholesterol and triglyceride were high in 34% patients. Histopathological study revealed that all 30 patients exhibited fatty change with macrovesicular type being the predominant. 43.3% patients had mild (<33%) steatosis and the rest 56.7% had moderate (33-66%) steatosis. In terms of staging of fibrosis in the liver, 83.3% exhibited stage-1 fibrosis and only 6.7% had stage-2 fibrosis. The rest 10% of the patients did not have any fibrosis. No correlation was established between hepatic enzyme levels (AST & ALT levels) and grading of steatosis & stage of fibrosis. Study of association between possible risk factors (Age, Sex, Diabetes Mellitus, Dyslipidaemia & BMI) and grading of steatosis and stage of fibrosis demonstrated that none of these risk factors was associated with those histological findings. Therefore it can be concluded that the patients presenting with bright echogenic liver on ultrasonography and elevated liver enzymes without having hepatitis B and hepatitis C infection and history of alcohol consumption are almost certainly to have Nonalcoholic fatty liver disease (NAFLD) specially if they are diabetic, dyslipidaemic and overweight or obese.The level of liver enzymes and the possible risk factors like age, sex, diabetes mellitus, dyslipidaemia and BMI do not seem to be good estimates of the severity of NAFLD. DOI: http://dx.doi.org/10.3329/jdnmch.v17i1.12184 J. Dhaka National Med. Coll. Hos. 2011; 17 (01): 8-13

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