成功治疗慢性乙型和丙型肝炎伴血小板减少症2例报告

慢性乙型肝炎(CHB)和慢性丙型肝炎(CHC)在未发展至肝硬化阶段即可发生血小板重度减低,为临床进行抗病毒治疗带来较大障碍,尤其对需要使用干扰素治疗的CHC患者。尽管合并血小板重度减低的CHB、CHC患者只占较少比例,但对于这部分人群的治疗尚无指南可循,治疗所面临的风险相对较大。这部分患者通常辗转多家医院、花费巨资却得不到恰当治疗或仅对症治疗。为此,作者选择临床工作中成功治疗的2例     

Acute pancreatitis associated with herpes zoster: Case report and literature review

Varicella-zoster virus (VZV) is a type of herpes virus known to cause varicella, mainly in young children, and herpes zoster in adults. Although generally non-lethal, VZV infection can be associated with serious complications, particularly in adults. Acute pancreatitis caused by VZV infection is a rare event, with reports primarily concerning immunocompromised individuals. Here we report a 44-year-old immunocompetent female who developed acute pancreatitis associated with VZV infection. The patient presented with vomiting and persistent pain in the upper quadrant less than one week after diagnosis and treatment for a herpes zoster-related rash with stabbing pain on the abdomen and dorsal right trunk side. A diagnosis of acute pancreatitis was confirmed based on abdominal pain, elevated levels of urine and serum amylase, and findings of peri-pancreatic exudation and effusions by computed tomography and magnetic resonance cholangiopancreatography. This case highlights that, though rare, acute pancreatitis should be considered in VZV patients who complain of abdominal pain, especially in the epigastric area. Early detection and proper treatment are needed to prevent the condition from deteriorating further and to minimize mortality.     

Acute hepatitis E complicated by acute pancreatitis: a case report and literature review

The coincidence of viral hepatitis and acute pancreatitis is well described. Most of the cases are related to acute hepatitis A or B. Hepatitis E virus (HEV) infections are rare in Europe, and very few reports describe HEV as a causative agent of acute pancreatitis in areas of endemic hepatitis E prevalence. We report a case of acute pancreatitis in the course of acute hepatitis E in a 28-year-old male patient. The majority of reported cases, including our case, show several common epidemiological and clinical features: young age, male predominance, onset of acute pancreatitis at the early stage of acute hepatitis, and favorable outcome. Acute pancreatitis should be considered in acute hepatitis E, especially in young, male patients presenting with severe epigastric pain early in the course of disease. The pancreatitis in these patients usually runs a benign course. The patients should be closely monitored because life-threatening complications have been reported.     

Methyldopa hepatitis: A report of six cases and review of the literature

Six cases of methyldopa hepatitis, including two in which the patients died are reported; and 77 cases from the literature are reviewed. Patients in whom severe hepatotoxic reactions to methyldopa develop usually complain of prodromal symptoms typical of hepatitis, often with fever, one to four weeks after therapy is initiated. Jaundice, when it occurs, is usually manifest within three months.

Asymptomatic, transient elevations of serum transaminase levels may occur in patients receiving methyldopa. However, since the clinical and histologic features of hepatic injury from methyldopa are indistinguishable from viral hepatitis, it is suggested that the incidence of this iatrogenic disease is higher than generally appreciated.

Serum transaminase levels should be determined at the initiation of therapy with methyldopa and four weeks later. Moreover, any patient who has unexplained fever or the prodromal symptoms of hepatitis should undergo liver chemistry studies immediately.     

Acute pancreatitis in peritoneal dialysis: a case report with literature review

Abdominal pain with a discoloured dialysate in a patient on peritoneal dialysis (PD) is usually attributed to infective peritonitis. Although acute pancreatitis (AP) is not usually a complication of end-stage renal disease, some studies suggest an increased risk especially in patients on PD. We report a case of idiopathic AP in a 41-year-old female on PD who presented with abdominal pain, fever, vomiting and a clear dark dialysate. Initial diagnosis of PD-associated infective peritonitis was made but dialysate cultures proved negative. Serum amylase showed a mild rise and computed tomography revealed necrotising pancreatitis. No common risk factors for AP were identified and she was successfully treated with conservative therapy. A literature review was carried out using a PubMed search with the words 'acute pancreatitis and peritoneal dialysis'. The literature search found a total of 94 cases of AP in the setting of PD. In more than a quarter, no cause for AP was found. Serum amylase was normal in 12.8% of episodes. Complications developed in 25 cases, and 28 patients died from the condition. Therefore, AP can be a rare, but serious complication of PD with a high mortality and must be considered in the differential diagnosis of abdominal pain in a PD patient.     

Autoimmune pancreatitis associated with hemorrhagic pseudocysts: a case report and literature review

Autoimmune pancreatitis (AIP) is a new category of pancreatic diseases. AIP associated with pseudocysts is rare; only 8 cases have been reported in the literature. A 63-year-old man was admitted to our department because of upper left abdominal pain and back pain. Various imaging studies demonstrated swelling of the tail of the pancreas with hemorrhagic pseudocysts. The patient underwent a surgical operation. A pancreatogram of the specimen revealed total occlusion of the main pancreatic duct in the tail of the pancreas. Histopathological examination revealed that it was AIP with hemorrhagic pseudocysts.     

Acute calculous cholecystitis associated with brucellosis: a report of two cases and review of the literature

Acute cholecystitis is a very rare complication of Brucella infections. We report 2 cases of acute cholecystitis due to Brucella and review previously reported cases.     

Acute pancreatitis in systemic lupus erythematosus: report of twenty cases and a review of the literature

A retrospective study was undertaken of patients with systemic lupus erythematosus in whom serum amylase had been determined. Sixty-three patients were identified, and of these 53 had abdominal pain at the time of the amylase measurement. Twenty-seven (51 percent) had a normal serum amylase, and 12 of this group had defined reasons for the abdominal pain. Of the 26 patients with hyperamylasemia, 6 had extrapancreatic causes for the elevated amylase. In 20 patients (37 percent of those with abdominal pain) the clinical diagnosis of pancreatitis was made. The amylase levels showed no correlation with renal function nor with dose of corticosteroid. Four patients with pancreatitis were identified in whom no contributing factor other than SLE could be ascertained. No serious complication of the pancreatitis was seen, and recovery occurred despite continued steroid therapy. Pancreatitis is not a rare occurrence in SLE, and may be related in part to the vasculitis seen during periods of disease activity.     

Acute pancreatitis secondary to neuroendocrine pancreatic tumors: report of 3 cases and literature review

Pancreatic tumors (particularly neuroendocrine) are an uncommon cause of acute pancreatitis (AP). This is a report of 3 cases of acute pancreatitis secondary to advanced neuroendocrine tumors and a literature review. Including these cases, only 30 have been reported. Most cases are non-functioning, diagnosed in an advanced stage, associating mild pancreatitis and in patients older than forty. Pancreatic neuroendocrine tumors are an uncommon cause of AP but must be included in the differential diagnosis of this disease, especially if the patient is older than 40 and the etiology of the AP is not clear.     

Autoimmune pancreatitis:report of two cases and literature review

BACKGROUND:Autoimmune pancreatitis(AIP)is a unique chronic inflammation of the pancreas in which autoimmune mechanisms are involved in the pathogenesis.It is characterized by clinical,histopathological,radiographic,serologic and therapeutic features.Since it was first described in 1995,increasing numbers of AIP patients have been diagnosed.METHODS:In this study,the data from 2 patients with AIP who had elevation of serum immunoglobulin G,positive autoantibody,swelling of the pancreas and narrowing of the ma...     

Acute pancreatitis associated with boceprevir: a case report

Approximately 170 million people are infected with hepatitis C, and the sustained virological response rate to treatment with pegylated interferon and ribavirin is 30–50%. In an attempt to improve the chances of cure, boceprevir is being added to therapy, but it is associated with an increased incidence of adverse events. We herein report a case of acute pancreatitis developed during treatment with pegylated interferon, ribavirin and boceprevir. Boceprevir was the most likely cause of drug-associated pancreatitis after the most common causes were ruled out, since this adverse event had not occurred when the patient had previously been exposed to pegylated interferon and ribavirin and there was no recurrence of the episode of pancreatitis when these two drugs were reintroduced. Acute pancreatitis is a rare adverse event associated with boceprevir therapy, but a potentially fatal event. Sequential determination of pancreatic enzymes should be considered during hepatitis C treatment with boceprevir.     

Acute pancreatitis associated with immunoglobulin A vasculitis: report of fifteen cases

Clinical Rheumatology - Immunoglobulin A vasculitis (IgAV) is a systemic small vessel vasculitis common in children. Pancreatic involvement in IgAV is rare. The purpose of this study was to analyze...     

Acute pancreatitis with Purtscher''s retinopathy: case report and review of the literature

The case is described of a 32-year-old man suffering from alcoholism who came to the Emergency Unit with vomiting, fever and sharp epigastric pain irradiating to the chest and upper abdomen. A diagnosis of acute pancreatitis was made after high amylase and lipase levels were observed and the results of computed tomography scan revealed images typical of acute pancreatitis. Findings upon admission and after the initial 48 hours did not correlate with a severe or complicated course according to Ranson's criteria. On the third day after admission he suddenly developed decreased vision. A fluorescein angiogram showed arteriolar occlusion, retinal and choriocapillary ischaemia. Purtscher's retinopathy was suspected. After 4 weeks, the patient had recovered from acute pancreatitis, ophthalmoscopic examination showed normal results, and visual acuity had almost returned to normal. Activation of complement in acute pancreatitis could account for many haematologic acute disorders due to leucocyte emboli or other complement-mediated aggregates. Coagulation abnormalities may range from isolated intravascular thrombosis to severe disseminated intravascular coagulation. Purtscher's retinopathy, due to microembolizations in the choroidal and retinal arterioles, should be included among the various systemic effects of acute pancreatitis. This visual disorder is a rare systemic manifestation of acute pancreatitis which was not correlated to a severe or complicated clinical course. Treatment of these ocular complications remains to be established and outcome, therefore, depends upon resolution of the pancreatic disease.     

Acute liver failure associated with antiretroviral treatment for HIV: a report of six cases

BACKGROUND/AIMS: Severe hepatotoxicity is a rare but potentially fatal side effect of all antiretrovirals. We report a series of six human immunodeficiency virus (HIV)-infected patients admitted with acute liver failure (ALF) over a 25-month period, of whom five died. All had been treated with a range of antiretroviral therapy and only two had had acquired immune deficiency syndrome (AIDS) defining illnesses. RESULTS: Median duration of antiretroviral therapy was 12.5 months (range 1-23). Median time from the introduction of new antiretroviral therapy to the onset of ALF was 8 weeks (range 2-12). The development of ALF was unrelated to duration of HIV treatment or type of antiretroviral therapy, and was not predicted by close out-patient supervision and monitoring of liver function. Biochemical investigations were variable but revealed a predominantly hepatocellular pattern. Liver biopsy revealed typical features of mitochondrial toxicity in only one case, with confluent hepatocellular necrosis, inflammation and cholestasis seen in the others. CONCLUSIONS: There is a need to increase awareness of the potential hepatotoxicity of antiretroviral therapy and to develop means of predicting its development. With increasing usage of antiretroviral therapy, severe hepatotoxicity and ALF may arise more frequently, and the outcome is poor despite intensive supportive therapy.     

Acute pancreatitis in acute viral hepatitis

AIM： To elucidate the frequency and characteristics of pancreatic involvement in the course of acute （nonfulminant） viral hepatitis. METHODS： We prospectively assessed the pancreatic involvement in patients with acute viral hepatitis who presented with severe abdomimanl pain. RESULTS： We studied 124 patients with acute viral hepatitis, of whom 24 presented with severe abdominal pain. Seven patients （5.65%） were diagnosed to have acute pancreatitis. All were young males. Five patients had pancreatitis in the first week and two in the fourth week after the onset of jaundice. The pancreatitis was mild and all had uneventful recovery from both pancreatitis and hepatitis on conservative treatment. The etiology of pancreatitis was hepatitis E virus in 4, hepatitis A virus in 2, and hepatitis B virus in 1 patient. One patient had biliary sludge along with HEV infection. The abdominal pain of remaining seventeen patients was attributed to stretching of Glisson＇s capsule. CONCLUSION： Acute pancreatitis occurs in 5.65% of patients with acute viral hepatitis, it is mild and recovers with conservative management.     

Severe acute pancreatitis associated with hyperlipidemia: report of two cases and review of the literature in Japan

Two cases of severe acute pancreatitis associated with type V hyperlipoproteinemia are reported. A 39-year-old obese woman was hospitalized with continuous severe abdominal pain. The diagnosis was made on the day of admission to our hospital, and treatment using continuous regional arterial infusion of a protease inhibitor and an antibiotic was performed with good results. The other patient was a 35 year-old woman in the 35th week of pregnancy, and a diagnosis of gestational hyperlipidemic pancreatitis was made on the day of onset. She was treated supportively using intravenous hyperalimentation, protease inhibitors, and antibiotics. She recovered from the acute pancreatitis and delivered a healthy term infant. It is difficult to diagnose acute pancreatitis in patients with type V hyperlipoproteinemia, because even when serum amylase levels are high, the value is reduced by high serum triglycerides. Early diagnosis was achieved in both of the present cases, and early intensive therapy was performed, which may be of the utmost importance in saving the life of a patient.     

Duodenal diverticulum and associated pancreatitis: case report with brief review of literature

Pancreatitis in the elderly is a problem of increasing occurrence and is associated with severe complications.Periampullary diverticula(PAD) are extraluminal outpouchings of the duodenum rarely associated with pancreatitis.The presence of PAD should be excluded before diagnosing idiopathic pancreatitis,particularly in the elderly.However,when a duodenal diverticulum is found in the absence of any additional pathology,only then should the symptoms be attributed to the diverticulum.We describe a case of duodenal diverticulum presenting with pancreatitis to emphasize the importance of this commonly neglected etiology.