16 research outputs found
Management of an extrasphincteric fistula in an HIV-positive patient by using fibrin glue: a case report with tips and tricks
<p>Abstract</p> <p>Background</p> <p>Individuals with impaired immunity are at higher risk of perianal diseases. Concerning complex anal fistulas impaired healing and complication rates are also higher. Definitive treatment of a fistula aims controlling the purulent discharge and prevents its recurrence. It depends mainly on the trajectory of the fistula and the underlying disease.</p> <p>We present a case of a HIV-positive patient with a complex extrasphincteric anal fistula who was treated successfully with fibrin glue application. We further, discuss tips and tricks when applying fibrin glue as plugging material in complex anal fistulas.</p> <p>Case presentation</p> <p>A sixty-one-year-old HIV-positive male referred to us for warts and extrasphincteric fistula. Because of the patients' immunological status, we opted against surgery and recommended fibrin glue plugging. The patient was discharged the same day. A follow-up examination was performed 5 days after the initial fibrin glue application showing that the fistula canal was obstructed. Three months and a year post-intervention the fistula tract remains closed.</p> <p>Conclusion</p> <p>The best treatment for a disease gives at least the same result with the other treatments with minimised risk for the life of the patient and minimal application effort. Conservative closure of fistula with fibrin plugging is simple, safe and with less morbidity than surgery. Our patient was successfully treated without endangering his life despite his precarious medical state. Not everybody believes in the effectiveness of fibrin glue application, however we consider this solution in cases of complex fistulas at least as primary procedure in special populations such as the immunosupressed.</p
Acute Generalized Exanthematous Pustulosis Induced by Amoxicillin/Clavulanic Acid: Report of a Case Presenting With Generalized Lymphadenopathy
Drug-induced acute generalized exanthematous pustulosis is a rare
pustular skin reaction, most commonly triggered by antibiotics. Although
its diagnosis is based primarily on the presence of specific clinical
and histopathologic features, additional in vivo (patch testing) or in
vitro testing may be required, especially in atypical cases, to more
accurately determine the causative agent. The authors report a
histologically confirmed case of acute generalized exanthematous
pustulosis that was induced by amoxicillin/clavulanic acid, as
documented by subsequent patch testing, and presented with generalized
painful lymphadenopathy, mimicking an acute infectious process. This is
a very rare and diagnostically challenging clinical presentation of
acute generalized exanthematous pustulosis, which has been reported, to
the best of our knowledge, only once previously