Acute Appendagitis Presenting with Features of Appendicitis: Value of Abdominal CT Evaluation

We report a case of acute appendagitis in a patient who presented initially with typical features of acute appendicitis. The diagnosis of acute appendagitis was made on pathognomonic signs on computed tomography (CT) scan. Abdominal pain is a common surgical emergency. CT is not always done if there are clear features of acute appendicitis. The rare but important differential diagnosis of acute appendagitis must be borne in mind when dealing with patients with suspected acute appendicitis. A CT scan of the abdomen may avoid unnecessary surgery in these patients

Report: Fatal case of disseminated BCG infection in an infant born to a mother taking infliximab for Crohn’s disease

Abstract We present the case of a 28 year old lady with refractory Crohn's Disease treated with infliximab throughout her pregnancy. Her baby was born healthy and received a Bacillus Calmette-Guérin (BCG) vaccine aged 3 months. Soon after this the infant became unwell and died aged 4.5 months. At post-mortem the cause of death was attributed to an unusual complication of the BCG vaccine, known as disseminated BCG. BCG vaccination is contraindicated in individuals who are receiving immunosuppressive drugs. We recommend physicians should exercise caution before such vaccines are used in infants born to mothers taking anti-TNF therapies or other potentially immunosuppressive IgG1 antibodies. © 2010 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved. Case report This case is of a 28 year old Caucasian lady diagnosed with pan-colitis and erythema nodosum secondary to Crohn's Disease (CD) in 2001. She was treated early on with mesalazine and azathioprine at a dose of 2 mg per kg bodyweight but experienced recurrent flare-ups requiring repeated courses of prednisolone with eventual loss of response. In 2004, infliximab 5 mg/kg was commenced with initial good symptomatic benefit but subsequent loss of response. Therefore, in 2006 the dose of infliximab was increased to 10 mg/kg every eight weeks. In 2008 she became pregnant. The pros and cons of continuing infliximab were discussed at length with the patient. Due the severity and corticosteroid refractory nature of her CD, the benefits of maintaining remission with infliximab was felt to outweigh the risks of foetus exposure to the drug. She consented to continue eightweekly infusions of infliximab 10 mg/kg as monotherapy for CD. Her disease remained in remission during pregnancy and in July 2008 she gave birth to a healthy baby boy. The baby was born at 36 + 3 gestation via spontaneous vaginal deliver

Prohepcidin Levels in Refractory Anaemia Caused by Lead Poisoning

Recent research evidence suggests a central role for hepcidin in iron homeostasis. Hepcidin is a hormone synthesized in the liver. Hepcidin is also thought to play a vital role in the pathogenic mechanism of anaemia in patients with inflammation or chronic disease. A 38-year-old female who presented with recurrent abdominal pain was found to have raised urinary porphyrins and a blood lead level of 779 μg/l. Her haemoglobin level was 8.3 g/dl. Her MCV was normal. Serum ferritin, B12 and folate were normal. Her serum prohepcidin level was 2,489 ng/ml (normal <450 ng/ml). To our knowledge, this is the first report of raised prohepcidin levels in a patient with anaemia of chronic disease resulting from lead poisoning

Presence of hepcidin-25 in biological fluids: Bile, ascitic and pleural fluids

AIM: To examine body fluids such as ascitic fluid (AF), saliva, bile and pleural effusions for the presence of hepcidin using a novel radioimmunoassay (RIA)

Severe Refractory Coeliac Disease with Response Only to Parenteral Nutrition

Refractory coeliac disease (RCD) is characterised by recurrent or persistent malabsorptive symptoms and villous atrophy, despite strict adherence to a gluten-free diet for at least 6 months and where other causes of malabsorption including malignancy have been excluded. There is limited evidence and guidance on the effective management of these patients. We describe a case of severe RCD in our hospital, with symptoms controlled effectively only by total parenteral nutrition (TPN). This 68-year-old woman initially presented to the clinic with persistent non-bloody diarrhoea and vomiting. A diagnosis of coeliac disease was confirmed with a positive tissue transglutaminase assay and histology. A strict gluten-free diet was ineffective and she represented 6 months later with 13 kg weight loss (16.7%), ongoing abdominal pain and diarrhoea, with bowels opening 16 times a day. She was oedematous, had an albumin of 12 g/l and required hospital admission. She was treated for pancreatic insufficiency and presumptively for small bowel bacterial overgrowth with no resolution of symptoms. We ruled out infectious causes and investigated for small bowel malignancy; all results were negative. Small bowel enteroscopy showed ulcerative jejunitis. She was given 5 days of TPN, following which her symptoms improved and albumin normalised. This was sustained with symptom resolution and weight gain seen at follow-up. TPN successfully and rapidly induced remission in this case. Thus, a short period of TPN should be considered as a potential component of management in patients with severe RCD

Hepcidin levels in hereditary hyperferritinemia: Insights into the iron-sensing mechanism in hepatocytes

AIM: To study the role of hepcidin in hereditary hyperferritinemia cataract syndrome (HHCS)