scholarly journals Spontaneous subconjunctival and retinal hemorrhage in acute on chronic liver failure: A case report and brief review of the literature

2021 ◽  
Vol 1 (3) ◽  
Author(s):  
Himanshu Gupta ◽  
◽  
Prasanta Debnath ◽  
Akash Roy ◽  
◽  
...  
Keyword(s):  
Interventional Procedure ◽  
Liver Function Tests ◽  
International Normalized Ratio ◽  
Retinal Hemorrhage ◽  
Free Fluid ◽  
Palmar Erythema ◽  
Severe Alcoholic Hepatitis ◽  
History Of ◽  
Laboratory Investigations ◽  
Ocular Discharge

A 48-year-old male with a history of significant alcohol consumption (120 gm per day for six years) and a recent binge presented with jaundice for one month followed by abdominal distention for ten days. At presentation, he was normotensive (BP 110/70 mmHg), had tachycardia (HR 122/min), and maintained saturation at room air (Sp02 98%). Physical examination was remarkable for scleral icterus, palmar erythema, enlarged liver (span 14 cm), and free fluid in the abdomen. Laboratory investigations revealed anemia (Hemoglobin 10.1 gm%), leucocytosis (White blood cell count 17000/mm3), thrombocytopenia (Platelet count 90 X 103)/mm3), deranged liver function tests (Total bilirubin 9.5 gm/dl, Alanine Transaminase 52 U/L, Aspartate Transaminase (112 U/L), and coagulopathy (International normalized ratio 2.2, Prothrombin time 20 sec). A provisional diagnosis of Acute on Chronic Live Failure (ACLF) with severe alcoholic hepatitis as the precipitating event was made. The patient was started on standard therapy with nutritional supplementation, diuretics, laxatives. On day 4 of admission, the patient developed bilateral red-eye. There was no history of any diminution of vision, double diplopia, ocular discharge, orbital pain, antecedent trauma, cough, or any interventional procedure. Vision, pupillary reflexes, intraocular pressure as well as range of extraocular movements were normal.

scholarly journals Aeromonas hydrophilaSepsis Associated with Consumption of Raw Oysters

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Ivan Nikiforov ◽  
John Goldman ◽  
Pramil Cheriyath ◽  
Anix Vyas ◽  
Vinod Nookala
Keyword(s):  
Acute Pancreatitis ◽  
Aeromonas Hydrophila ◽  
Liver Function Tests ◽  
Free Fluid ◽  
Aquatic Environments ◽  
Blood Cell Count ◽  
Case Presentation ◽  
History Of ◽  
Elevated Liver Function Tests ◽  
Inflammatory Changes

Introduction. Aeromonas hydrophilais a gram negative bacillus that is native to aquatic environments that is increasingly reported in humans. This case is remarkable forA. hydrophilawith an initial presentation of acute pancreatitis.Case Presentation.A 61-year-old male presented to the emergency department with nausea, vomiting, and abdominal pain for two days. His past medical history was significant for alcohol abuse. Initial laboratory examination showed an elevated white blood cell count, elevated lipase, and elevated liver function tests (LFT). Computer tomography (CT) showed peripancreatic inflammatory changes and retroperitoneal free fluid, suggestive of acute pancreatitis. The patient was treated with intravenous (IV) fluids and IV meropenem. After two days, the patient developed sepsis and respiratory failure and was intubated. Blood cultures were positive forAeromonas hydrophilasensitive to ciprofloxacin which was added to his treatment. Additionally, it was discovered that this patient had recently vacationed in Florida where he consumed raw oysters. He was discharged home on the eighth day of the hospital admission.Conclusion.This is a rare case ofA. hydrophilasepsis in an elderly patient with acute pancreatitis and a history of consumption of raw oysters. This case suggests thatA. hydrophilacan cause disseminated infection in immunocompetent individuals.

scholarly journals Recurrent noncirrhotic hyperammonemia causing acute metabolic encephalopathy in a patient with a continent ileocecal pouch: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
T. M. Skipina ◽  
S. Macbeth ◽  
E. L. Cummer ◽  
O. L. Wells ◽  
S. Kalathoor
Keyword(s):  
Emergency Department ◽  
Metabolic Acidosis ◽  
Mental Status ◽  
Rare Case ◽  
Liver Function Tests ◽  
Altered Mental Status ◽  
Potassium Citrate ◽  
Metabolic Encephalopathy ◽  
History Of ◽  
Normal Urine

Abstract Introduction Acute encephalopathy, while a common presentation in the emergency department, is typically caused by a variety of metabolic, vascular, infectious, structural, or psychiatric etiologies. Among metabolic causes, hyperammonemia is relatively common and typically occurs in the setting of cirrhosis or liver dysfunction. However, noncirrhotic hyperammonemia is a rare occurrence and poses unique challenges for clinicians. Case presentation Here we report a rare case of a 50-year-old Caucasian female with history of bladder cancer status post chemotherapy, radical cystectomy, and ileocecal diversion who presented to the emergency department with severe altered mental status, combativeness, and a 3-day history of decreased urine output. Her laboratory tests were notable for hyperammonemia up to 289 μmol/L, hypokalemia, and hyperchloremic nonanion gap metabolic acidosis; her liver function tests were normal. Urine cultures were positive for Enterococcus faecium. Computed tomography imaging showed an intact ileoceal urinary diversion with chronic ileolithiasis. Upon administration of appropriate antibiotics, lactulose, and potassium citrate, she experienced rapid resolution of her encephalopathy and a significant reduction in hyperammonemia. Her hyperchloremic metabolic acidosis persisted, but her hypokalemia had resolved. Conclusion This case is an example of one of the unique consequences of urinary diversions. Urothelial tissue is typically impermeable to urinary solutes. However, when bowel segments are used, abnormal absorption of solutes occurs, including exchange of urinary chloride for serum bicarbonate, leading to a persistent hyperchloremic nonanion gap metabolic acidosis. In addition, overproduction of ammonia from urea-producing organisms can lead to abnormal absorption into the blood and subsequent oversaturation of hepatic metabolic capacity with consequent hyperammonemic encephalopathy. Although this is a rare case, prompt identification and treatment of these metabolic abnormalities is critical to prevent severe central nervous system complications such as altered mental status, coma, and even death in patients with urinary diversions.

Persistently raised aspartate aminotransferase (AST) due to macro-AST in a rheumatology clinic

Diagnosis ◽  
2015 ◽  
Vol 2 (2) ◽  
pp. 137-140 ◽  
Author(s):  
Wycliffe Mbagaya ◽  
Joanne Foo ◽  
Ahai Luvai ◽  
Claire King ◽  
Sarah Mapplebeck ◽  
...  
Keyword(s):  
Liver Function ◽  
Aspartate Aminotransferase ◽  
Normal Liver ◽  
Abdominal Ultrasound ◽  
Liver Function Tests ◽  
Analytical Investigation ◽  
Normal Liver Function ◽  
Rheumatology Clinic ◽  
History Of ◽  
Liver Biopsies

AbstractMacrocomplexes between immunoglobins and aspartate aminotransferase (macro-AST) may result in persistently increased AST concentration. The presence of macro-AST in patients has been implicated in unnecessary investigations of abnormal liver function tests. We report the case of a 44-year-old female who presented to the rheumatology clinic with a 12-months’ history of constant widespread pain affecting her limbs and was found to have an elevated AST concentration. Further information from her GP revealed a 14-years’ history of elevated AST with otherwise normal liver function. Previous abdominal ultrasound and two liver biopsies carried out 2 years apart were normal. This prompted further analytical investigation by the biochemistry department which identified macro-AST as the cause. This case illustrates that persistently raised isolated AST concentration with no other abnormal indices may warrant macroenzyme analysis potentially avoiding unnecessary invasive investigations.

scholarly journals Acute Iodine Toxicity from a Suspected Oral Methamphetamine Ingestion

2014 ◽  
Vol 7 ◽  
pp. CCRep.S20086 ◽  
Author(s):  
Marilyn N. Bulloch
Keyword(s):  
Case Report ◽  
Gastrointestinal Symptoms ◽  
Liver Function Tests ◽  
Oral Ingestion ◽  
Methamphetamine Abuse ◽  
Normal Limits ◽  
Naturally Occurring ◽  
History Of ◽  
Systemic Symptoms ◽  
Iodine Toxicity

Background Iodine is a naturally occurring element commercially available alone or in a multitude of products. Iodine crystals and iodine tincture are used in the production of methamphetamine. Although rarely fatal, iodine toxicity from oral ingestion can produce distressing gastrointestinal symptoms and systemic symptoms, such as hypotension and tachycardia, from subsequent hypovolemia. Objective The objective of this case report is to describe a case of iodine toxicity from suspected oral methamphetamine ingestion. Case Report A male in his early 20′s presented with gastrointestinal symptoms, chills, fever, tachycardia, and tachypnea after orally ingesting a substance suspected to be methamphetamine. The patient had elevated levels of serum creatinine, liver function tests, and bands on arrival, which returned to within normal limits by day 4 of admission. Based on the patient's narrow anion gap, halogen levels were ordered on day 3 and indicated iodine toxicity. This is thought to be the first documented case of iodine toxicity secondary to suspected oral methamphetamine abuse. Conclusion Considering that the incidence of methamphetamine abuse is expected to continue to rise, clinicians should be aware of potential iodine toxicity in a patient with a history of methamphetamine abuse.

Herpes Simplex Virus Infections

1996 ◽  
Vol 17 (12) ◽  
pp. 415-423
Author(s):  
Paula W. Annunziato
Keyword(s):  
Herpes Simplex Virus ◽  
Herpes Simplex ◽  
Hepatitis B Surface Antigen ◽  
Liver Function Tests ◽  
Virus Infections ◽  
Sexually Transmitted ◽  
The Third ◽  
Intravenous Acyclovir ◽  
History Of ◽  
Simplex Virus

Case Report A term female developed fever and tachypnea and had a transient episode of poor color and tone on the third day of life. She was delivered by cesarean section 5 hours after rupture of membranes to a 19-year-old, gravida 4, para 0 mother whose serology was negative for syphilis, human immunodeficiency virus (HIV), and hepatitis B surface antigen. The mother had no history of sexually transmitted diseases. Apgar scores were 8 at 1 minute and 9 at 10 minutes. When the infant was admitted to the nursery, scalp abrasions were noticed by the nurse. On the third day of life, a sepsis evaluation was initiated, and the infant received ampicillin and gentamicin intravenously: no bacterial infection was found. On the fifth day of life, vesicular lesions were noticed on her scalp. Bilateral interstitial infiltrates were present On chest radiograph and laboratory studies revealed mild elevations in liver function tests. There were no cerebrospinal fluid (CSF) abnormalities. She was started on intravenous acyclovir, and herpes simplex virus (HSV)-2 subsequently was isolated from both her pharynx and scalp lesions. After receiving intravenous acyclovir for 3 weeks, she was discharged with no evidence of residual sequelae. Four days after acyclovir was discontinued, new scalp vesicles appeared and the infant developed a temperature of 38.8°C (102°F).

Disturbo della condotta alimentare, ecchimosi e carenza di vitamina C

2021 ◽  
Vol 24 (9) ◽  
pp. 273-276
Author(s):  
Anna Attico ◽  
Alessandra Iacono ◽  
Loretta Biserna ◽  
Sara Brandolini ◽  
Federico Marchetti
Keyword(s):  
Eating Disorder ◽  
Vitamin C ◽  
Rare Disease ◽  
Eating Habits ◽  
Coagulation Disorders ◽  
Vitamin C Deficiency ◽  
History Of ◽  
Laboratory Investigations

The paper presents the case of a 16-year-old girl with a 6-month history of eating disorder, restrictive subtype and diffuse ecchymosis. Anamnestic history and laboratory investigations allowed excluding coagulation disorders and making the diagnosis of vitamin C deficiency. Vitamin C deficiency is a rare disease but still sporadically described in children with unusual eating habits.

DEMOGRAPHIC PROFILE OF ACUTE FEBRILE ENCEPHALOPATHY CASES IN PEDIATRIC AGE GROUP PATIENTS: A STUDY FROM WESTERN RAJASTHAN

2021 ◽  
pp. 72-73
Author(s):  
Laxmi Rathore ◽  
P. K. Khatri ◽  
Saroj K. Meena ◽  
Archana Bora ◽  
Suneel Bhooshan
Keyword(s):  
Lower Class ◽  
Mental States ◽  
Clinical Feature ◽  
Female Ratio ◽  
Pediatric Age Group ◽  
History Of ◽  
Laboratory Investigations ◽  
Demographic Distribution ◽  
Viral Etiologies ◽  
Male To Female

Acute Febrile Encephalopathy is a clinical term used to describe patients presenting with short febrile illnesses with altered mental states. Demographic distribution plays an essential role in the diagnosis of viral etiologies. One hundred ve suspected AFE cases were enrolled in the study. A detailed history by predesigned performa and laboratory investigations was obtained for data collection. Viral etiology was diagnosed in 32 (30.48%) cases. The male to female ratio was 1.39:1. Total 56.25% of positive cases were from the lower class, 28.13% from the middle class, and 15.63% from the upper class. 24 (75%) cases from rural, while only 8 (25%) of the urban population showed viral etiologies. In 19 (59.4%) cases were either history of incomplete vaccination or not vaccinated, 13 (40.6%) cases had a history of complete immunization among positive cases. The predominant clinical feature was fever (100%) followed by seizures 66(62.86%), vomiting 37(35.24%), headache 14(13.33%), paresis in 16(15.24%) and altered sensorium in 29(27.62%), respectively. To conclude, the etiologic panorama of AFE varies with several factors such as time and demographical location, age, and immunization status. There is an urgent need to conduct more studies to prole the viral etiologies according to their prevalence in geographical areas so the treatment can be tailored accordingly and prophylaxis treatment or immunization can be boosted in the population at risk of getting the disease.

Cefazolin and rifampin: A coagulopathy-inducing combination

2021 ◽  
Author(s):  
Natalia E Castillo Almeida ◽  
Ryan W Stevens ◽  
Pooja Gurram ◽  
Christina G Rivera ◽  
Gina A Suh
Keyword(s):  
Adverse Drug Reaction ◽  
Drug Reaction ◽  
Assessment Tool ◽  
International Normalized Ratio ◽  
Medication Therapy ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Implant Retention ◽  
History Of

Abstract Purpose To identify risk factors that may predispose patients to rifampin- and cefazolin-induced coagulopathy. Summary An 86-year-old man with a history of rheumatoid arthritis on chronic prednisone and stage 3 chronic kidney disease, notably not on warfarin, presented to the hospital with a 10-day history of right hip pain, swelling, and drainage after a recent right total-hip arthroplasty. The patient underwent a combination of surgical intervention and medication therapy with rifampin and ceftriaxone. After discharge and at postoperative day 9, ceftriaxone was changed to cefazolin due to increasing alkaline phosphatase levels. Four weeks after the initial debridement, antibiotics, and implant retention, the patient underwent a second irrigation and debridement due to persistent infection. Cefazolin and rifampin therapy was extended. Three days later, the patient presented to the emergency room with significant bleeding at the surgical site and a profoundly elevated prothrombin time and international normalized ratio (INR). No potential contributors were identified. The Naranjo adverse drug reaction probability scale identified cefazolin and rifampin as the probable cause of elevated INR. The Liverpool adverse drug reaction avoidability assessment tool classified this adverse event as “definitely avoidable.” Conclusion Rifampin-containing regimens are often recommended to treat staphylococcal prosthetic joint infections when the implant is retained. In methicillin-susceptible staphylococcal infections, cefazolin is routinely employed as the β-lactam backbone of definitive antimicrobial regimens. Although rifampin- and cefazolin-induced hypoprothrombinemia seems to be rare, adverse consequences of its occurrence may be prevented with appropriate monitoring.

Fulminant varicella hepatitis: a rare but lethal cause of abdominal pain

2021 ◽  
Vol 14 (9) ◽  
pp. e244081
Author(s):  
Christopher Fang ◽  
Junice Wong ◽  
Wei Wen Ang
Keyword(s):  
Abdominal Pain ◽  
Hepatitis A ◽  
Case Reports ◽  
Antibody Testing ◽  
Salient Points ◽  
Vesicular Rash ◽  
History Of ◽  
Laboratory Investigations ◽  
The Common ◽  
Upper Abdominal

An 81-year-old woman with no history of immunocompromise presented with 2 days of upper abdominal pain associated with nausea. On arrival, her physical examination was unremarkable apart from mild epigastric and right hypochondriac tenderness, and laboratory investigations were unremarkable apart from mild thrombocytopenia and transaminitis. A CT scan performed on the day of admission revealed a tiny 0.3 cm stone in the common bile duct, with no upstream dilatation. On day 2 of admission, she developed a vesicular rash and with acutely worsening transaminitis. She deteriorated rapidly and demised from complications of acute liver failure within the next 24 hours. The diagnosis of varicella was confirmed with antibody testing. Fulminant varicella hepatitis is an extremely rare and lethal condition with only a handful of reported cases in the current literature. We aim to share our clinical experience and summarise the salient points from existing case reports.

Ecstasy: An Important Cause of Acute Liver Failure

2006 ◽  
Vol 5 (3) ◽  
pp. 93-95
Author(s):  
Ajay Kiran Muddu ◽  
◽  
Mark Wright ◽  
Nick Sheron ◽  
◽  
...  
Keyword(s):  
Liver Disease ◽  
Single Mother ◽  
Liver Function Tests ◽  
Herbal Remedies ◽  
Significant Past Medical History ◽  
Dark Urine ◽  
Counter Medication ◽  
Autoimmune Conditions ◽  
History Of ◽  
Excessive Alcohol

A twenty year old female was referred to hospital by her GP, after he received the results of blood tests taken earlier in the day. She had presented to him complaining of malaise, nausea and anorexia over a 3 day period. On the day of referral she had also become jaundiced with dark urine, but normal stool colour. There was no abdominal pain. She had no significant past medical history with no history of jaundice, liver disease or autoimmune conditions, and no apparent risk factors for blood-borne hepatitis infection. There was no relevant family history. She was taking no prescribed medication, had not taken any over the counter medication or herbal remedies. She denied excessive alcohol use or use of intravenous drugs in the past, although she was not specifically questioned on the use of other recreational drugs. She was a single mother and admitted to being under considerable stress recently. On examination she appeared well, apart from marked jaundice. There were no signs of hepatic encephalopathy or chronic liver disease. Abdominal examination revealed mild left upper quadrant tenderness, but no significant hepatomegaly. Liver function tests (LFTs) taken by her GP are shown in Table 1, revealing marked elevation of the Alanine Transaminase (ALT) (Table 1), with a relatively preserved albumin. Unfortunately her International Normalised Ratio (INR) had not been measured. An Ultrasound of the abdomen demonstrated a normal size liver with normal contour and texture with no other abnormality.

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