Hepatitis in Idiopathic Hypereosinophilic Syndrome: Report of an Unusual Case

2021 ◽  
Vol 5 (02) ◽  
Author(s):  
Mahbuba Sharmin ◽  
Amin Lutful Kabir ◽  
Md. Abdul Aziz ◽  
Sonia Shormin Miah ◽  
Umme Shahera ◽  
...  

World Health Organization defines a rare diagnosis Idiopathic hypereosinophilic syndrome (HES) as a persistent eosinophilia for 6 months and resulting in end-organ dysfunction. Most of the patients present with nonspecific symptoms, while others will present with symptoms of the affected organs, commonly those involving the heart, skin, or nervous system. Gastrointestinal or liver involvement is estimated to affect up to one-third of patients with HES, although patients with clinically significant disease are limited to case reports. This is the first report of a patient presenting with idiopathic HES related hepatitis and achalasia. Hypereosinophilic syndrome has been reported to be associated with hepatic dysfunction; liver histology is mainly characterized by a diffuse eosinophilic inflammatory infiltrate. A 49-yr-old woman, diagnosed as a case of idiopathic hypereosinophilic syndrome with bone marrow and pulmonary eosinophilic infiltrates associated with peripheral eosinophilia,high IgE level  developed features of chronic gatrornteritis, hepatitis, with a significant eosinophil component. She responded well to systemic glucocorticoid  and Imatinib therapy with normalization of liver function tests within a few weeks.

2011 ◽  
Vol 3 (2) ◽  
pp. 16 ◽  
Author(s):  
Peter R. Donald

Recent increases in the dosages of the essential antituberculosis agents isoniazid (INH), rifampicin and pyrazinamide for use in children recommended by World Health Organization have raised concerns regarding the risk of hepatotoxicity. Published data relating to the incidence and pathogenesis of antituberculosis drug-induced hepatotoxicity (ADIH), particularly in children, is reviewed. Amongst 12,708 children receiving chemoprophylaxis, mainly with INH, but also other combinations of INH, rifampicin and pyrazinamide only 1 case (0.06%) of jaundice was recorded and abnormal liver functions documented in 110 (8%) of the 1225 children studied. Excluding tuberculous meningitis (TBM) 8984 were children treated for tuberculosis disease and jaundice documented in 75 (0.83%) and abnormal liver function tests in 380 (9.9%) of the 3855 children evaluated. Amongst 717 children treated for TBM, however, jaundice occurred in 72 (10.8%) and abnormal LFT were recorded in 174 (52.9%) of those studied. Case reports document the occurrence of ADIH in at least 63 children. Signs and symptoms of ADIH were frequently ignored in the recorded cases. Conclusion: ADIH is less common in children than adults, but can occur in children at any dosage of INH, RMP or PZA, but its incidence is considerably lower than in adults. Children with disseminated forms of disease are at greater risk of ADIH.


2021 ◽  
Vol 11 (3) ◽  
pp. 301
Author(s):  
Fatima Ghandour ◽  
Alessio Squassina ◽  
Racha Karaky ◽  
Mona Diab-Assaf ◽  
Paola Fadda ◽  
...  

Brain tumors can present with various psychiatric symptoms, with or without neurological symptoms, an aspect that complicates the clinical picture. However, no systematic description of symptoms that should prompt a neurological investigation has been provided. This review aims to summarize available case reports describing patients with brain tumors showing psychiatric symptoms before brain tumor diagnosis, in order to provide a comprehensive description of these symptoms as well as their potential relationship with delay in the diagnosis. A systematic literature review on case reports of brain tumors and psychiatric symptoms from 1970 to 2020 was conducted on PubMed, Ovid, Psych Info, and MEDLINE. Exclusion criteria comprised tumors not included in the World Health Organization (WHO) Classification 4th edition and cases in which psychiatric symptoms were absent or followed the diagnosis. A total of 165 case reports were analyzed. In a subset of patients with brain tumors, psychiatric symptoms can be the only manifestation or precede focal neurological signs by months or even years. The appearance of focal or generalized neurological symptoms after, rather than along with, psychiatric symptoms was associated with a significant delay in the diagnosis in adults. A timely assessment of psychiatric symptoms might help to improve early diagnosis of brain tumors.


2018 ◽  
Vol 24 (5) ◽  
pp. 576-594 ◽  
Author(s):  
Josivan da Silva Costa ◽  
Karina da Silva Lopes Costa ◽  
Josiane Viana Cruz ◽  
Ryan da Silva Ramos ◽  
Luciane Barros Silva ◽  
...  

About 132 thousand cases of melanoma (more severe type of skin cancer) were registered in 2014 according to the World Health Organization. This type of cancer significantly affects the quality of life of individuals. Caffeine has shown potential inhibitory effect against epithelial cancer. In this study, it was proposed to obtain new caffeine-based molecules with potential epithelial anticancer activity. For this, a training set of 21 molecules was used for pharmacophore perception procedures. Multiple linear regression analyses were used to propose mono-, bi-, tri-, and tetra-parametric models applied in the prediction of the activity. The generated pharmacophore was used to select 350 molecules available at the ZINCpharmer server, followed by reduction to 24 molecules, after selection using the Tanimoto index, yielding 10 molecules after final selection by predicted activity values > 1.5229. These ten molecules had better pharmacokinetic properties than the other ones used as reference and within the clinically significant limits. Only two molecules show minor hits of toxicity and were submitted to molecular docking procedures, showing BFE (binding free energy) values lower than the reference values. Statistical analyses indicated strong negative correlations between BFE and pharmacophoric properties (high influence on BFE lowering) and practically null correlation between BFE and BBB. The two most promising molecules can be indicated as candidates for further in vitro and in vivo analyzes.


2020 ◽  
Vol 37 (08) ◽  
pp. 829-836 ◽  
Author(s):  
Angela J. Stephens ◽  
John R. Barton ◽  
Nana-Ama Ankumah Bentum ◽  
Sean C. Blackwell ◽  
Baha M. Sibai

Novel coronavirus disease 2019 (COVID-19) is a respiratory tract infection that was first identified in China. Since its emergence in December 2019, the virus has rapidly spread, transcending geographic barriers. The World Health Organization and the Centers for Disease Control and Prevention have declared COVID-19 as a public health crisis. Data regarding COVID-19 in pregnancy is limited, consisting of case reports and small cohort studies. However, obstetric patients are not immune from the current COVID-19 pandemic, and obstetric care will inevitably be impacted by the current epidemic. As such, clinical protocols and practice on labor and delivery units must adapt to optimize the safety of patients and health care workers and to better conserve health care resources. In this commentary, we provide suggestions to meet these goals without impacting maternal or neonatal outcomes. Key Points • Novel coronavirus disease 2019 (COVID-19) is a pandemic.• COVID-19 impacts care of obstetric patients.• Health care should be adapted for the COVID-19 pandemic.


2021 ◽  
Vol 54 ◽  
Author(s):  
Abigail F. Melicor ◽  
Katrina Loren R. Rey ◽  
Leonila F. Dans

KEY FINDINGSAsymptomatic and pre-symptomatic transmission of SARS-CoV-2 may occur.• Manifestations of COVID-19 are highly varied and may include asymptomatic cases, who do not manifest with anysigns and symptoms despite testing positive for COVID-19 by viral nucleic acid tests. Pre-symptomatic cases areinfected individuals who are still in their incubation period, hence do not exhibit any symptoms yet but eventuallydevelop symptoms.• As of June 2020, only 586 (2.8%) of the 20,990 active cases in the Philippines were classified as asymptomatic,but it is unclear whether cases are pre-symptomatic or carriers (true asymptomatic).• Based on 36 observational studies (case reports, case series, cross-sectional and cohort studies) and 9 statisticalmodeling analysis, asymptomatic and pre-symptomatic transmission of SARS-CoV-2 may occur. However, 3studies reported no transmission from pre-symptomatic and asymptomatic cases.• Studies on viral load comparing symptomatic cases with pre-symptomatic and asymptomatic cases reportedcontradicting results. The duration of viral shedding was significantly longer for symptomatic patients comparedto asymptomatic patients but similar for asymptomatic and pre-symptomatic patients.• Therewas no difference in the transmission rates of symptomatic and asymptomatic cases. However,the estimatedinfectivity and probability of transmission was higherfor symptomatic cases compared to asymptomatic cases, butresults were imprecise due to a wide confidence interval.• The World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) recognize thepossibility of pre-symptomatic and asymptomatic transmission. According to WHO, current evidence suggestsasymptomatic cases are less likely to transmit the virus than symptomatic cases.


2020 ◽  
Vol 11 ◽  
pp. 209
Author(s):  
Turki Elarjani ◽  
Meshari Alhuthayl ◽  
Maher Hassounah

Background: Cutaneous meningioma is a very uncommon pathologic entity that can be divided into primary and secondary types. Secondary cutaneous meningioma arises from an intracranial meningioma through metastasis, seeding during surgery, or direct bone invasion. There are limited published case reports correlating the development of cutaneous meningioma to high-grade convexity meningioma. Case Description: A 63-year-old man underwent total resection of a right frontal convexity meningioma, World Health Organization Grade I in 2001. He presented in 2016 with a small frontal cutaneous mass over the craniotomy site. Computed tomography showed extracranial and intracranial components of the meningioma. The patient declined surgical intervention and lost to follow. One and half years later, he underwent resection of the growing ulcerating cutaneous component in an outside hospital. The pathological diagnosis was Grade 3 meningioma. Six months later, he presented to us with a massive cutaneous meningioma and large intracranial component. Surgical resection and multidisciplinary management were planned. The patient was very hesitant to have surgery but settled for receiving radiation. Seven months after radiation, he presented with a decreased level of consciousness and skin necrosis with maggot infestation. His code status was changed to “do not attempt resuscitation,” and he died 3 days later in December 2019. Conclusion: Large intracranial meningiomas with massive transosseous extension to the scalp pose a significant challenge to the treating team. Proper planning and a multidisciplinary approach are essential. However, prognosis remains generally poor.


Author(s):  
Das Moumalini ◽  
Banerjee Abhishek ◽  
Singh Dharvind Kumar ◽  
Karar Chandan Kumar ◽  
. Abhinandan

Introduction: COVID-19 disease is caused by SARS-CoV-2 virus and it was declared pandemic by World Health Organization (WHO) on March 11,2020. The coronavirus infection has an affinity for ACE2 receptors and by attaching to them, the virus enters the host cells. Along with many body organs like lungs, kidney, liver, upper respiratory tract, nervous system, skeletal muscles, ACE2 concentration is also found in abundance in epithelial cells of tongue and salivary glands. Materials and Methods: Recent studies, researches, documents and case reports published in the world medical literature in the year 2020-2021 were searched and documented in our study. The search engines used were PUBMED, google scholar, WEB OF SCIENCE etc. Results: Dysgeusia, xerostomia, sore throat, aphthous and herpetiform ulcers, candidiasis, enanthema, Kawasaki like lesions were the most common among various oral manifestations. Others includes plaque like changes, gingival inflammation, necrotizing gingivitis, erythema -multiforme, angina-bullosa like lesions, Melkersson-Rosenthal Syndrome, Oral mucormycosis etc.The sites of infection mainly include tongue, gingiva, hard and soft palate, buccal and labial mucosa etc. Conclusion: The etiopathogenesis of such lesions cannot be directly corelated with COVID-19 and factors such as stress, immunosuppression, co-infections, secondary lesions, opportunistic infections, systemic diseases, poor oral hygiene etc. must be considered. Management of stress is an important factor. In this review article various oral lesions are discussed in COVID-19 infection states in detail. The importance of earliest diagnosis of oral lesions is to be kept in mind to prevent further complications.


e-CliniC ◽  
2016 ◽  
Vol 4 (1) ◽  
Author(s):  
Inez Clarasanti ◽  
Marthen C.P. Wongkar ◽  
Bradley J. Waleleng

Abstract: Pulmonary tuberculosis is a chronic infection and still a major worldwide health problem. Data from World Health Organization in 2013 showed that Indonesia was the fifth country with the highest prevalence of TB in the world. Treatment of TB in Indonesia is using the antituberculosis medication guide. One of the side effects of treatment is hepatotoxicity. Liver function tests commonly used are the transaminase enzymes (SGOT and SGPT). Levels of SGOT and SGPT will increase in case of damage or inflammation of the liver tissue. The results showed that after administration of the antituberculosis medication 26% of patients had high levels of transaminase enzymes meanwhile 74% of patients had normal levels of transaminase enzymes.Keywords: Pulmonal Tuberculosis, OAT, hepatotoxicity, transaminase enzymes, SGOT, SGPT Abstrak: Tuberkulosis paru adalah infeksi kronik yang sampai saat ini masih menjadi masalah kesehatan dunia yang utama. Data WHO tahun 2013 menunjukkan bahwa Indonesia menempati negara kelima dengan prevalensi TB tertinggi di dunia. Pengobatan TB di Indonesia menggunakan panduan obat antituberkuolosis (OAT) dan salah satu efek samping pengobatan ialah hepatotoksisitas. Tes fungsi hati yang umum digunakan ialah pemeriksaan enzim transaminase yakni kadar SGOT dan SGPT yang akan menunjukkan peningkatan jika terjadi kerusakan atau radang pada jaringan hati. Hasil penelitian memperlihatkan terdapat 26% pasien TB dengan kadar enzim transaminase yang tinggi setelah pemberian OAT, dan 74% pasien TB yang memiliki kadar enzim transaminase yang normal setelah pemberian OAT.Kata kunci: tuberkulosis paru, OAT, hepatotoksisitas, enzim transaminase, SGOT, SGPT


2021 ◽  
Vol 49 (10) ◽  
pp. 030006052110499
Author(s):  
Kuei-Lin Yeh ◽  
Szu-Hsien Wu ◽  
Shing-Sheng Wu

Osteoporosis is a rising concern in the aging population and should be considered before performing spinal surgery for older patients. Nonfusion surgery using interlaminar or interspinous devices is gradually gaining acceptance because adjacent segment disease seldom occurs postoperatively; however, other complications may occur. This report discusses the surgical outcomes of two women with osteoporosis treated by laminectomy and interlaminar device (IntraSPINE®) placement. Both patients had experienced low back pain for several years and had developed vertebral compression fractures. Several conservative treatments, including rehabilitation and local injections, were ineffective. Their bone mineral density levels were −3.0 and −2.8, indicating severe osteoporosis according to the definition established by the World Health Organization. They chose to undergo nonfusion surgery with IntraSPINE® interlaminar device placement. Their pain significantly decreased postoperatively, and their visual analog scale scores decreased from 8 to 2 and 3. Their extremity numbness and back pain resolved within 3 months. Both patients were satisfied with the surgical outcomes. No complications had occurred by 1 year postoperatively. These cases indicate that osteoporosis may not be an absolute contraindication for nonfusion spinal surgery. This report suggests a possible alternative surgical treatment for patients with osteoporosis that is refractory to conservative treatments.


Author(s):  
Calixto Machado ◽  
Joel Victor Gutierrez

SARS-CoV-2 (CoV-2) is a coronavirus which is causing the actual COVID-19 pandemic. The disease caused by 2019 new coronavirus (2019-nCoV) was named coronavirus disease-19 (COVID-19) by the World Health Organization in February 2020. Primary non-specific reported symptoms of 2019-nCoV infection at the prodromal phase are malaise, fever, and dry cough. The most commonly reported signs and symptoms are fever (98%), cough (76%), dyspnea (55%), and myalgia or fatigue (44%). Nonetheless, recent reports suggest an association between COVID-19 and altered olfactory and taste functions, although smell seems to be more affected than taste. These associations of smell and taste dysfunctions and CoV-2 are consistent with case reports describing a patient with SARS with long term anosmia after recovery from respiratory distress, with the observation that olfactory function is commonly altered after infection with endemic coronaviruses, and with data demonstrating that intentional experimental infection of humans with CoV-299 raises the thresholds at which odors can be detected. Post-viral anosmia and is one of the leading causes of loss of sense of smell in adults, accounting for up to 40% cases of anosmia. Viruses that give rise to the common cold are well known to cause post-infectious loss, and over 200 different viruses are known to cause upper respiratory tract infections. I reviewed the possible mechanisms of smell and taste loss in COVID-19. I concluded that since the existence of such a relationship is likely, it is highly recommended that those patients who experience complications such as smell and/or taste loss, even as unique symptoms, should be considered as potential SARS-CoV-2 virus carriers.


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