Polyarteritis nodosa presenting as massive upper gastrointestinal hemorrhage

We report the first case of massive upper gastrointestinal hemorrhage as the initial presentation of polyarteritis nodosa (PAN), which is an uncommon form of systemic necrotizing vasculitis that may involve many organ systems and could affect any age group. Abdominal pain is the most common sign of gastrointestinal involvement. Gastrointestinal bleeding occurs less frequently in approximately 6% of cases. Reported cases of gastrointestinal hemorrhage have been in the form of coffee ground emesis, melena, or hematochezia. Such bleeding complications have resulted from ischemic ulceration or perforation of the small or large intestine. However, we are unaware of previous reports showing massive hematemesis to be the initial presentation of PAN.     

Polyarteritis nodosa presenting as a biliary stricture.

Polyarteritis nodosa, a disease of the media of small and medium-sized arteries, has protean manifestations and many presenting signs and symptoms. Gastrointestinal involvement is common but involvement of the biliary tree is rare. We report a unique case of polyarteritis presenting as a biliary stricture.     

Invasive gastrointestinal zygomycosis in a liver transplant recipient: case report.

BACKGROUND: Gastric zygomycosis is a rare but potentially lethal complication in transplant patients. Forty-two cases of gastric mucormycosis have been described in the literature, with a mortality of 98%. METHODS: We report of a case of gastric mucormycosis in a 45-year-old male undergoing liver transplantation for alcohol-induced cirrhosis. The diagnosis was made 20 days after transplantation in a biopsy of a bleeding gastric ulcer identified during a reoperation for a common bile duct stricture. RESULTS: After the surgical procedure and therapy with amphotericin B, the patient made a good recovery and is alive and well 2 years after transplantation. CONCLUSIONS: Gastric mucormycosis should be suspected in those patients in whom gastrointestinal symptoms such a pain or bleeding are present. Because the diagnosis is dependent on histology, the importance of biopsy cannot be underestimated. Once diagnosed, a successful outcome depends on effective treatment with amphotericin.     

Kaposi's sarcoma presenting as a protracted multisystem illness in an adolescent liver transplant recipient

Kaposi's sarcoma (KS) is a common malignancy in patients with acquired immunodeficiency syndrome (AIDS), classically appearing as red to purple plaques containing small papules and nodules. We report our experience with an adolescent orthotopic liver transplant recipient who presented with an unusual presentation of KS. The patient had a protracted multisystem illness that began with hemolytic anemia, fevers, and fatigue and progressed to pancreatitis, sinusitis, lymphadenopathy, and mouth ulcers. The diagnosis was made by a lymph node biopsy that was performed to evaluate for Epstein-Barr virus. The classical subcutaneous nodules characteristic of KS did not become evident until shortly before the patient died. We present this case to emphasize that KS in pediatric liver transplant patients can present as a multisystem disease that progresses to disseminated organ involvement before the characteristic subcutaneous manifestations are evident. (Liver Transpl Surg 1997 Sep;3(5):541-4)     

Tuberculosis presenting as acute hepatitis in a renal transplant recipient

We observed a kidney transplant recipient in whom acute hepatitis was the initial manifestation of tuberculosis, preceding radiological lung involvement by several weeks. The diagnosis was suspected and treatment initiated based on the finding of a granulomatous hepatitis on liver biopsy. Mycobacterial, tuberulosis was grown and identified first in liver samples and only later in sputum and bone marrow. This case illustrates the protean manifestations of tuberculosis in immunosuppressed patients.     

Dactylaria gallopava infection presenting as a pulmonary nodule in a single-lung transplant recipient.

We describe the first case of a pulmonary nodule caused by Dactylaria gallopava in a lung-transplant recipient. An asymptomatic lung-allograft recipient was found to have a 2-cm nodule in the native lung 450 days after transplantation. Culture of a transthoracic needle biopsy of the solitary pulmonary nodule revealed Dactylaria gallopava. Treatment was initiated with amphotericin B for a period of 21 days followed by oral itraconazole for an 8-month period.     

Progressive disseminated histoplasmosis presenting as cellulitis in a renal transplant recipient

With the advent of potent immunosuppressive therapies used in solid organ transplantation, patients are more susceptible to a variety of infectious organisms. Infections may result from atypical pathogens and present in an unusual manner. We describe a case of progressive disseminated histoplasmosis presenting as cellulitis in a renal transplant recipient and review this disease.     

Citrobacter perinephric abscess presenting as pneumoscrotum in transplant recipient

A case of Citrobacter diversus perinephric abscess presenting as pneumoscrotum in a transplant recipient is reported. Reference is made to the increasing incidence of the organism in clinical infection and its ability to produce gas within tissues. Pertinent clinical literature is briefly discussed.     

Disseminated histoplasmosis in a liver transplant recipient.

A 61-yr-old liver transplant recipient presented with abdominal cramping and nonbloody diarrhea resulting in orthostasis. Multiple ulcerations throughout the colon were seen during endoscopy, and biopsies from the ulcer edges revealed histoplasmosis. Treatment with a course of itraconazole improved the diarrhea. The patient later presented with pericarditis and symptomatic pleural effusions, the latter of which was confirmed to be a result of disseminated histoplasmosis. Treatment with amphotericin B led to resolution. Histoplasmosis should be considered in liver transplant patients with diarrhea and large ulcers in the colon. The presence of disseminated histoplasmosis should be ruled out once colonic histoplasmosis has been diagnosed.     

Ureteral urine leak presenting as a pleural effusion in a renal transplant recipient

We report a 15-year-old girl who developed a ureteral perforation soon after living-related donor renal transplantation. Her presentation was unusual in that a symptomatic pleural effusion accumulated as an extension of the perinephric urine collection. Recognition and surgical correction of the ureteral pathology led to resolution of respiratory symptomatology and full recovery of renal function. Received October 15, 1997; received in revised form February 17, 1998; accepted February 20, 1998