Glimepiride-induced cholestasis in a man with diabetes mellitus: a case report

<p>Abstract</p> <p>Introduction</p> <p>There has been a progressive increase in the incidence of type II diabetes mellitus cases over the past decade. The availability of a wide variety of oral hypoglycemics has given rise to a number of adverse effects. In this case report, we describe the case of a patient recently diagnosed with type II diabetes. He was receiving treatment with glimepiride and experienced rapid onset of cholestatic liver injury as a side effect, which reversed upon cessation of therapy.</p> <p>Case presentation</p> <p>We present the case of a 58-year-old Egyptian man with a recent diagnosis of type II diabetes mellitus. He presented with a clinical picture of progressive jaundice three days before admission. Laboratory investigations revealed elevated bilirubin, alkaline phosphatase and gamma glutamyl transferase levels. Ultrasonography revealed intrahepatic biliary duct dilatation and two small lymph nodes in the porta hepatis; there was, however, no extrahepatic biliary duct dilatation or stones in the gall bladder. Abdominal computed tomography excluded pancreatic or hepatic focal lesions, but the tumor marker CA19-9 was elevated. The progressive improvement in the patient's symptomatology and laboratory investigations after admission argued against malignancy. A thorough and detailed history revealed that the patient had started on a new medication, glimepiride, five months earlier for the treatment of diabetes mellitus and an improvement was noted after discontinuation of this oral hypoglycemic and the introduction of insulin therapy to control his blood sugar.</p> <p>Conclusion</p> <p>Drugs are an important, often unrecognized, cause of acute cholestasis. Among the rare causes responsible for this complication is the sulfonylurea glimepiride. A thorough drug history is therefore helpful in any case of unexplained cholestasis.</p

Negative pressure pulmonary edema in the prone position: a case report

Acute airway obstruction can result in life - threatening pulmonary edema. It can develop rapidly, without warning, in otherwise healthy patients. Negative pressure pulmonary edema has been described after acute airway obstruction in situations when a patient is breathing against an obstructed airway such as croup, epiglottitis or laryngospasm. In the following case, we observed a rare occurrence of pulmonary edema in a female following sedation in the prone position

Toxic epidermal necrolysis following treatment of pseudotumour cerebri: a case report

Toxic Epidermal Necrolysis and Steven-Johnson syndrome are entities on a spectrum of cutaneous reactions that usually occur as an idiosyncratic reaction to certain drugs. The distinction between TEN and SJS is based on the percentage of skin involved with SJS being less than 10% and TEN being more than 30%. They exhibit severe skin blistering and sloughing with mucosal involvement and can be fatal in many cases. Discontinuation of the offending agent is mandatory together with reduction of skin manipulation and avoiding infection. Plasmapharesis, intravenous immunoglobulins and immunosuppressants have been used with conflicting results. In this manuscript we are describing a 22 year old female patient from Egypt who presented with severe skin sloughing with mucosal involvement following carbamazepine therapy. The incriminated drug was discontinued and urgent life saving therapy in the form of broad spectrum antibiotic, immunosuppression with cyclophosphamide, Intensive Care Unit admission and nursing care was started followed by dramatic response. The clinical presentation, pathogenesis and modalities of treatment will be described in details

Anteroposterior chest radiograph vs. chest CT scan in early detection of pneumothorax in trauma patients

Pneumothorax is a common complication following blunt chest wall trauma. In these patients, because of the restrictions regarding immobilization of the cervical spine, Anteroposterior (AP) chest radiograph is usually the most feasible initial study which is not as sensitive as the erect chest X-ray or CT chest for detection of a pneumothorax. We will present 3 case reports which serve for better understanding of the entity of occult pneumothorax. The first case is an example of a true occult pneumothorax where an initial AP chest X-ray revealed no evidence of pneumothorax and a CT chest immediately performed revealed evidence of pneumothorax. The second case represents an example of a missed rather than a truly occult pneumothorax where the initial chest radiograph revealed clues suggesting the presence of pneumothorax which were missed by the reading radiologist. The third case emphasizes the fact that "occult pneumothorax is predictable". The presence of subcutaneous emphesema and pulmonary contusion should call for further imaging with CT chest to rule out pneumothorax. Thoracic CT scan is therefore the "gold standard" for early detection of a pneumothorax in trauma patients. This report aims to sensitize readers to the entity of occult pneumothorax and create awareness among intensivists and ER physicians regarding the proper diagnosis and management

Brachial Plexus Injury Following Spinal Surgery

Object: In the present study, the authors identified the etiology, precipitating factors, and outcomes of perioperative brachial plexus injuries following spine surgery. Methods: We reviewed all the available literature regarding postoperative/perioperative brachial plexus injuries, with special concern for the patient\u27s position during surgery, duration of surgery, the procedure performed, neurological outcome, and prognosis. We also reviewed the utility of intraoperative electrophysiological monitoring for prevention of these complications. Results: Patient malpositioning during surgery is the main determining factor for the development of postoperative brachial plexus injury. Recovery occurs in the majority of cases but may require weeks to months of therapy after initial presentation. Conclusion: Brachial plexus injuries are an increasingly recognized complication following spinal surgery. Proper attention to patient positioning with the use of intraoperative electrophysiological monitoring techniques could minimize injury