13 research outputs found
Propylthiouracil-Induced Acute Liver Failure: Role of Liver Transplantation
Propylthiouracil- (PTU-) induced hepatotoxicity is rare but potentially lethal with a spectrum of liver injury ranging from asymptomatic elevation of transaminases to fulminant hepatic failure and death. We describe two cases of acute hepatic failure due to PTU that required liver transplantation. Differences in the clinical presentation, histological characteristics, and posttransplant management are described as well as alternative therapeutic options. Frequent monitoring for PTU-induced hepatic dysfunction is strongly advised because timely discontinuation of this drug and implementation of noninvasive therapeutic interventions may prevent progression to liver failure or even death
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Cirrhosis: Predictive factors and postoperative evolution in patients undergoing bariatric surgery
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Strongyloides Colitis as a Harmful Mimicker of Inflammatory Bowel Disease
Autoinfection caused by
Strongyloides stercoralis
frequently becomes a life-long disease unless it is effectively treated. There is overlapping histomorphology between
Strongyloides
colitis and inflammatory bowel disease; a low index of suspicion can lead to misdiagnosis and fatal consequences. We present a case of
Strongyloides
colitis mimicking the clinical and pathologic features of inflammatory bowel disease. A 64-year-old female presented to the emergency department with a four-day history of abdominal pain, diarrhea, and hematochezia. Colonoscopy revealed diffuse inflammation suggestive of inflammatory bowel disease, which led to initiation of 5-aminosalicylic acid and intravenous methylprednisolone. Biopsies of the colon revealed increased lymphoplasmacytic infiltrate of the lamina propria with eosinophilic microabscesses and presence of larvae, consistent with
Strongyloides stercoralis
. Immunosuppressive medication was halted. The patient ultimately died a few days later. This case emphasizes the importance of identifying the overlapping clinical and pathologic features of
Strongyloides
colitis and inflammatory bowel disease. A high index of suspicion and recognition of particular histological findings, including eosinophilic microabscesses, aid in the correct diagnosis. Definitive diagnosis is crucial as each disease carries distinct therapeutic implications and outcome
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Liver Damage due to Hypervitaminosis
Dietary supplements are unregulated medications that can lead to serious liver injury. Despite this, many people take vitamin supplements believing they are safe because they do not require prescriptions. We are reporting a case of an African American man who took large doses of vitamin supplements leading to noncirrhotic portal hypertension. The case highlights the importance of detailed history taking to diagnose and treat patients properly
A Rare Case of Hepatitis C-Associated Cryoglobulinemic Duodenal Vasculitis
Intestinal involvement of cryoglobulinemia is an uncommon manifestation and marker of severe vasculitis. We describe the case of a woman admitted to our service for management of acute renal failure and progressive gastrointestinal symptoms after initiating hepatitis C virus treatment with ribavirin and sofosbuvir 4 weeks prior. With an undetectable hepatitis C viral load and persistent symptoms despite hepatitis C virus therapy cessation, an upper endoscopy revealed duodenal sloughing, erythema, and bleeding, sparking suspicion for recurrence of cryoglobulinemic vasculitis
The sixth nationwide epidemiological survey of chronic pancreatitis in Japan: What about tobacco?
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QuantiFERON-TB gold plus in liver transplant candidates: single-center experience
Background/Objectives: Latent tuberculosis infection (LTBI) screening prior to orthotopic liver transplant (OLT) is essential. The data on QuantiFERON-TB -Gold Plus (QFT-Plus) in OLT candidates is scarce. Methods: QFT-Plus results performed prior to transplant among OLT recipients transplanted between 4/2019 and 8/2020 were evaluated. Previous QFT-Gold In-Tube (QFT-GIT) results were obtained, if available, to evaluate for discordant results. The infectious diseases (ID) team plan for those with positive or indeterminate QFT-Plus was obtained. Results: We assessed 170 OLT recipients. QFT-Plus was performed in 124(73%) patients [8(6%) were positive, 20(16%) indeterminate and 96(77%) negative]. Nine (45%) of the QFT-Plus-indeterminate patients converted to negative. Twenty-one (17%) of the patients that were tested with QFT-Plus were previously tested with QFT-GIT [4(21%) of them had discordant results]. There were no differences in the survival and biopsy-proven rejection at 6 months post-transplant between QFT-Plus-positive and QFT-Plus-negative patients. ID team recommended isoniazid 300mg daily for 9 months for 7(88%) and 9(45%) patients with positive and indeterminate QFT-Plus, respectively. Conclusions: QFT-Plus appears to be appropriate for LTBI diagnosis in OLT candidates. In our cohort, indeterminate QFT-Plus is common and QFT-Plus conversion from indeterminate to negative is frequent. In the presence of risk factors, it might be wise to treat patients with indeterminate QFT-Plus
Simultaneous Liver Kidney Transplant in Elderly Patients With Chronic Kidney Disease: Is There an Appropriate Upper Age Cutoff?
The aging of liver transplant (LT) recipients, the weighting of the model for end-stage liver disease score, and the increased prevalence of nonalcoholic steatohepatitis has led to an increased number of older LT recipients with pre-LT chronic kidney disease (CKD). There are limited data on the impact of increased recipient age on post-simultaneous liver-kidney (SLK) transplant outcomes among patients with CKD, leading some centers to employ subjective age cutoffs for potential SLK recipients.
We evaluated United Network for Organ Sharing data of adult SLK recipients from February 27, 2002, to December 31, 2018, restricted to recipients with ≥90 days of waiting time and CKD (estimated glomerular filtration rate persistently <60 mL/min/1.73 m2 for ≥90 d using the modification of diet in renal disease-4 equation). We fit mixed-effects Cox regression models (center as random effect) to evaluate the association of recipient age and patient survival.
Among 3146 SLK recipients with CKD, nearly two-thirds were 50-64 years of age, while 465 (14.8%) and 93 (3.0%) were 65-69 years and ≥70 years, respectively. Compared with nondiabetic SLK recipients aged 50-59 years, SLK recipients ≥70 years of age without diabetes (hazard ratio, 1.97; 95% CI, 1.20-3.23; P = 0.007) and with diabetes (hazard ratio, 1.90; 95% CI, 1.16-3.09; P = 0.01) had higher mortality compared with the reference group. In absolute terms, SLK recipients ≥70 years of age had 25% lower patient survival at 5 years compared to recipients aged 40-49 years.
Although careful selection is required of any SLK recipient, especially those with increased comorbidities, there are no objective data to justify a specific age cutoff <70 years among potential SLK recipients with CKD