An unusual cause of acute anemia in an immunosuppressed patient

Gastrointestinal mucormycosis is an uncommon, invasive, opportunistic fungal infection with a high mortality rate, seen more commonly in immunocompromised patients. This lethal infection has a wide range of presentations, from colonization of peptic ulcers to infiltrative disease and eventually vascular invasion. Here we present a case of upper gastrointestinal bleeding in an immunocompromised patient, which was proved to be secondary to gastric involvement by mucormycosis

Enalapril induced reversible acute renal failure detected by 99mTc-DMSA renal scan in a patient with bilateral renal artery stenosis: a case report

The authors report and discuss a case of bilateral renal artery stenosis in a hypertensive 9 year-old girl that was first suspected with 99mTechnetium-dimercaptosuccinic acid renal scintigraphy. The scintigraphy showed signs of acute renal failure while the patient was on enalapril for controlling her hypertension. Bilateral renal artery stenosis was confirmed with computed tomography angiography. Hypertension resolved after bilateral renal artery angioplasty

Safety of anti-TNF agents in patients with compensated cirrhosis: a case-control study

Background: There is limited data on the use of anti-TNF agents in patients with concomitant cirrhosis. The aim of this study is to assess the safety of anti-TNF agents in patients with compensated cirrhosis who used these medications for the treatment of an underlying rheumatologic condition or IBD. Methods: Multicenter, retrospective, matched, case-control study. A one to three case-control match was performed. Adults who received anti-TNF therapy were matched to three adults with cirrhosis who did not receive anti-TNF therapy. Patients were matched for etiology of cirrhosis, MELD-Na and age. Primary outcome was the development of hepatic decompensation. Secondary outcomes included development of infectious complications, hepatocellular carcinoma (HCC), extra-hepatic malignancy, and mortality. Results: Eighty patients with cirrhosis who received anti-TNF agents were matched with 240 controls. Median age was 57.2 years. Median MELD-Na for the anti-TNF cohort was seven and median MELD-Na for the controls was eight. The most common etiology of cirrhosis was NAFLD. Anti-TNF therapy did not increase risk of decompensation (HR: 0.91, 95% CI: 0.64–1.30, p = 0.61) nor influence the time to development of a decompensating event. Anti-TNF therapy did not increase the risk of hepatic mortality or need for liver transplantation (HR: 1.18, 95% CI: 0.55–2.53, p = 0.67). Anti-TNF therapy was not associated with an increased risk of serious infection (HR: 1.21, 95% CI: 0.68–2.17, p = 0.52), HCC (OR: 0.45, 95% CI: 0.13–1.57, p = 0.21), or extra-hepatic malignancy (OR: 0.82, 95% CI: 0.29–2.30, p = 0.71). Conclusions: Anti-TNF agents in patients with compensated cirrhosis does not influence the risk of decompensation, serious infections, transplant free survival, or malignancy

Unusual MRI appearance of a well differentiated hepatocellular carcinoma, mimicking a cavernous hemangioma: A case report

The typical imaging findings in hepatocellular carcinoma (HCC) are arterial hyperenhancement with washout on portal venous and/or equilibrium phases. Larger HCCs can have atypical imaging findings including fibrous capsule or mosaic appearance. We describe an unusual biopsy proven HCC in a cirrhotic liver with imaging features mimicking cavernous hemangioma which also demonstrated some atypical features such as thick capsule. In addition to knowing the typical imaging findings of HCC, it is important to be familiar with its atypical imaging findings especially in larger lesions. Keywords: Hepatocellular carcinoma, Cavernous hemangioma, MRI, Atypica