Recurrent Acute Pancreatitis Probably Induced by Rosuvastatin Therapy: A Case Report

Context. Approximately 1.4–2% of all cases of acute pancreatitis are drug related in general population. The literature on statin-induced pancreatitis consists primarily of anecdotal case reports. We report a case of possible rosuvastatin-induced pancreatitis. Case Report. A 67-year-old female presented with progressively worsening abdominal pain and vomiting for 7 days. Home medications included rosuvastatin and clonidine. CT scan of abdomen, with intravenous contrast, showed findings consistent with acute pancreatitis. She responded to conservative management. Rosuvastatin was resumed at the time of discharge from the hospital, and she presented two months later with recurrence of acute pancreatitis. Further workup ruled out all likely causes of acute pancreatitis. Rosuvastatin was stopped completely when she was discharged the second time, and she did not have any further episodes of acute pancreatitis. She was completely asymptomatic throughout the 18-month follow-up period. Conclusion. This paper reinforces the possible association of rosuvastatin, a novel statin, with acute pancreatitis, even though the exact underlying mechanism of statin-induced pancreatitis remains unknown

Recurrent Mitral Valve Endocarditis Caused by Streptococcus pneumoniae in a Splenectomized Host

A 72-year-old male with a remote history of splenectomy and two previous episodes of pneumococcal endocarditis of mitral valve presented with high-grade fever and confusion for 3 days. Nine months priorly, patient underwent mitral valve repair when he had the first episode of pneumococcal mitral valve endocarditis. He received pneumococcal vaccination two years ago. On examination during this admission, he was found to be febrile (104.3 F) and confused and had a grade 2/6 systolic murmur at the apex without any radiation. Laboratory data was significant for a white blood cell count of 22,000/mm3 (normal: 4000–11000/mm3). Blood cultures (4/4 bottles) grew penicillin-sensitive Streptococcus pneumoniae. Transesophageal echocardiogram revealed small vegetation on the posterior mitral leaflet without any evidence of abscess and severe mitral regurgitation. Patient clinically responded to intravenous ceftriaxone. However, due to recurrent pneumococcal mitral valve endocarditis and severe mitral regurgitation, the patient underwent mitral valve replacement. Patient had an uneventful recovery and was discharged home. Pneumococcal endocarditis itself is being uncommon in this current, penicillin, era; our case highlights the recurrent nature of pneumococcal endocarditis in a splenectomized host and the importance of pursuing aggressive treatment options in this clinical scenario

Delayed duodenal/gastric fistula resulting in persistent perihepatic abscesses as a late complication of laparoscopic cholecystectomy.

Since the early 1990s, laparoscopic cholecystectomy has become the gold standard for the treatment of symptomatic gallbladder disease. Although the incidence of postoperative complications is generally lower with this approach, gallbladder perforation represents a serious risk that is among the most common complications of laparoscopic cholecystectomy. The sequalae that can follow iatrogenic perforation have not been well documented and only a few case reports exist in the current literature. In this paper we discuss two case reports of delayed perihepatic abscesses following prior laparoscopic cholecystectomy, ultimately resulting in fistulous tracts. The course of the disease is discussed along with the diagnostic workup and eventual successful management of the aforementioned complications. Treating enteric fistulae requires a systematic approach and is carried out in phases. Enteric fistula formation following laparoscopic cholecystectomy is a rare complication of retained gallstones that can present months to years following the index operation. Significant care should be taken to avoid perforation and all efforts should be made to retrieve stones if spillage occurs

Turmeric-Induced Hepatotoxicity: Report of 2 Cases

The use of herbal and dietary supplements is rising in the United States. Turmeric has been one of the most popular supplements recently, used widely for various conditions such as arthritis, digestive disorder, and liver conditions. Although rarely reported, hepatotoxicity can happen with turmeric use. Here, we present 2 cases of drug-induced liver injury due to turmeric use with the complete resolution after cessation

Metastasis of Ewing Sarcoma to the Pancreas: Case Report and Literature Review

Ewing sarcoma (ES) is a highly aggressive malignant bone cancer. ES is part of the Ewing sarcoma family of tumors (ESFT), which express characteristic t(11;22) translocation as well as higher levels of CD99. Given that metastasis and tumor burden are significant prognostic factors in patient’s response to treatment, prompt diagnosis is needed to effectively treat ESFT patients. However, the challenges in classifying and characterizing ESFT complicate effective management and treatment of ES. In this report, we present a rare case of ES metastasis to the pancreas. Upon review of the literature, we found 39 cases of ESFT involving the pancreas, but only 3 were metastatic to the pancreas while the remaining cases of ESFT primarily originated from the pancreas. Given the rarity of such metastasis, the positive outcome in our patient’s case may explain the importance of prompt diagnosis in order to initiate appropriate treatment

Incidence and factors associated with portal vein thrombosis in patients with acute pancreatitis: A United States national retrospective study.

BACKGROUND/OBJECTIVE: Portal vein thrombosis (PVT) is a well-known complication in patients with acute pancreatitis (AP). Limited data exist on the incidence and factors of PVT in patients with AP. We investigate the incidence and clinical predictors of PVT in AP. METHODS: We queried the 2016-2019 National Inpatient Sample database to identify patients with AP. Patients with chronic pancreatitis or pancreatic cancer were excluded. We studied demographics, comorbidities, complications, and interventions in these patients and stratified the results by the presence of PVT. A multivariate regression model was used to identify factors associated with PVT in patients with AP. We also assessed the mortality and resource utilization in patients with PVT and AP. RESULTS: Of the 1,386,389 adult patients admitted with AP, 11,135 (0.8%) patients had PVT. Women had a 15% lower risk of developing PVT (aOR-0.85, p \u3c 0.001). There was no significant difference between the age groups in the risk of developing PVT. Hispanic patients had the lowest risk of PVT (aOR-0.74, p \u3c 0.001). PVT was associated with pancreatic pseudocyst (aOR-4.15, p \u3c 0.001), bacteremia (aOR-2.66, p \u3c 0.001), sepsis (aOR-1.55, p \u3c 0.001), shock (aOR-1.68, p \u3c 0.001) and ileus (aOR-1.38, p \u3c 0.001). A higher incidence of in-hospital mortality and ICU admissions was also noted in patients with PVT and AP. CONCLUSION: This study demonstrated a significant association between PVT and factors such as pancreatic pseudocyst, bacteremia, and ileus in patients with AP

Expression of WIF-1 in inflammatory bowel disease

The WNT/β-catenin cellular network has been extensively studied in numerous diseases including inflammatory bowel disease (IBD). IBD is a condition that increases the risk of developing colorectal cancer. WIF-1 is an inhibitory protein that acts by blocking the interactions of WNT with its receptor complex, thus leading to downregulation of end products of this pathway. While WIF-1 has been characterized in several cancers, its relationship with IBD has yet to be elucidated. In this study, the expression of WIF-1 in patients with IBD was analyzed in order to provide insights into the pathophysiology and rationale for alternative therapies. Biopsies of both normal and inflamed colonic mucosa from patients with Crohn’s disease or ulcerative colitis were histologically examined for the degree of morphologic changes, immune cell infiltration and presence of WIF-1 through immunohistochemistry. No differences were observed in WIF-1 expression linked to a particular condition, but WIF-1 stain was significantly enhanced in the crypts and lamina propria as inflammation increased in biopsies from patients with both, ulcerative colitis and Crohn’s disease. These findings could give guidance to new therapeutic applications of the WNT/β-catenin system and WIF-1 in IBD