Isolated intrahepatic biliary dilatation in a patient with acquired immune deficiency syndrome (AIDS): AIDS cholangiopathy versus incidental unilobar Caroli's disease

We describe a case of possible monolobar Caroli's disease in a patient with acquired immune deficiency syndrome (AIDS) who presented with features of cholangitis. Diagnostic workup, which included endoscopic retrograde cholangiography, revealed focal intrahepatic biliary dilatation confined to the right lobe. The patient subsequently underwent right hepatic lobectomy. Pathology revealed multiple cysts filled with calculi and inflammation in the cyst walls. Special stain results for fungi and acid-fast organisms were negative. The presence of advanced AIDS in this patient raised the possibility of this being a possible manifestation of AIDS cholangiopathy.     

Aspergillus infection limited to renal allograft: case report and review of literature

We report a case of a 28-year-old recipient of a cadaveric renal transplant who developed Aspergillus infection in the allograft without having disseminated disease. We review the previously reported cases of isolated Aspergillus in kidney transplant recipients and discuss the possible route of transmission in our patient. We also discuss the alternate but successful treatment that our patient received.     

Myocardial involvement in the Marfan syndrome

A patient with the Marfan syndrome and echocardiographic and angiocardiographic evidence of hypertrophic cardiomyopathy is presented. Endomyocardial biopsy was performed. Histologic abnormalities of the endomyocardium noted in this patient were considered to be related to the basic generalized connective tissue abnormality, and the patient subsequently developed myocardial disease compatible with hypertrophic non-obstructive cardiomyopathy. We believe that this case emphasizes the possible co-existence of subclinical myocardial disease in patients with the Marfan syndrome.     

Ultrasound and jaundice.

We have examined 26 consecutive jaundiced patients referred to the ultrasound clinic. A differentiation between extrahepatic and other causes of jaundice was possible in 23 of the 24 patients satisfactorily examined. The use of ultrasonic techniques in the jaundiced patient offers a high degree of accuracy to the clinician, and little or no discomfort to the patient.     

Acute myocardial infarction in a patient with iatrogenic thyrotoxicosis--a case report

We present a patient with myocardial infarction and normal coronary angiogram. The patient had no classical coronary risk factors, but had thyrotoxicosis, which was taken into consideration as a possible cause of myocardial infarction.     

Stroke? Localized, otogenic meningitis!

We report the case of a patient admitted with aphasia, treated for a stroke. Subsequently, it was revealed that the symptoms were caused by complicated otitis media with localized meningitis. This case draws attention to the possible intracranial spread of infection when neurological symptoms occur in a patient with otitis media.     

The Rapunzel Syndrome: An Unusual Trichobezoar

We report the fourth and youngest patient in the literature with a trichobezoar extending from the stomach through the entire length of the small intestine to the cecum. The clinician must consider the possible presence of a "tail" in any patient presenting with a bezoar. Salient clinical features of trichobezoars are reviewed.     

Malignancy: Case report: Myelodysplasia Following Treatment of Chronic Lymphocytic Leukaemia with Fludarabine

Recently there has been an increased awareness of a possible link between the use of purine nucleoside analogues and myelodysplasia. We report the case of a patient who developed myelodysplasia with complex cytogenetic changes after receiving fludarabine. We review the literature, discuss the possible links between myelodysplasia and nucleoside analogues and putative mechanisms for secondary neoplasia.     

Hyperinfection strongyloidiasis in a liver transplant recipient treated with parenteral ivermectin

Abstract: Severe strongyloidiasis, including hyperinfection and dissemination, is a recognized complication of solid organ transplantation. However, the development of strongyloidiasis in a liver transplant recipient has not been previously described. We present a case of severe strongyloidiasis occurring in a patient 4 months after liver transplantation and 1 month after receiving treatment for acute rejection. We assess the management challenges in this patient who remained symptomatic despite oral treatment with ivermectin and albendazole and eventual successful treatment with parenteral ivermectin. We review the published experience with alternative methods of ivermectin administration. We also investigate the possible source of infection, as the patient was not from an endemic area.     

Retrobulbar optic neuritis after pamidronate administration in a patient with a history of cutaneous porphyria

Summary We describe the case of a patient who developed reversible retrobulbar optic neuritis after intravenous pamidronate therapy for established osteoporosis. This possible complication has never been previously reported and, since our patient had a history of porphyria, it suggests that bisphosphonates should be administered cautiously in patients with this disease.     

Paroxysmal nocturnal hemoglobinuria preceding malignant lymphoma

We diagnosed lymphoma 14 months after the patient presented with paroxysmal nocturnal hemoglobinuria. To our knowledge, this is the first presentation of both conditions in a patient. One possible explanation is that both conditions could be traced to an alteration in the most primitive hemic stem cell. Such an alteration would have resulted in abnormalities of both lymphoid and nonlymphoid cell lines.     

Myocardial infarction caused by the thrombosis of the common trunk of the left coronary artery. Fatal outcome despite an early obstruction removal by angioplasty. Apropos of a case

We report an exceptional case of acute myocardial infarction due to thrombosis of the left main coronary artery in a 39-year old male patient. After failure of recanalization by systemic fibrinolysis, percutaneous angioplasty under circulatory assistance was successfully performed pending a possible transplantation. The patient unfortunately died of haemodynamic disturbances 48 hours after the infarction.     

A new ATTR Phe64Ile mutation with late-onset multiorgan involvement

We describe a novel transthyretin mutation in which phenylalanine is replaced with isoleucine in exon 3 at codon 64: Phe64Ile. The mutation was found in an isolated patient and it was not possible to perform a family study. The phenotype included heart and peripheral nerve involvement associated with a possible gastrointestinal and renal involvement.     

Malignancy and hypercoagulability: a two-way association revisited

Increasing evidence is highlighting the relationship between malignancy and hypercoagulability as a bidirectional association. We herein share our experience with a patient in whom such an association may be entertained. The patient, who had a history of venous thromboembolism, presented to our care with manifestation of stroke. Extensive workup revealed that the patient carries prothrombotic mutations in the prothrombin and methylenetetrahydrofolate reductase genes. The patient, a non-smoker, was also diagnosed with non-small cell lung carcinoma. The possible association between the patient’s malignancy and prothrombotic state are further discussed.     

Cardiac resynchronization via the femoral vein: a novel method in cases with contraindications to the pectoral approach.

We describe a case involving biventricular pacemaker implantation via the right femoral vein in a patient where subclavian vein access was not possible.     

Splenic marginal zone lymphoma associated with hepatitis B virus infection,remission after viral treatment,and splenectomy: A case report and review of the literature

We report the case of a patient diagnosed with a splenic marginal zone lymphoma with a simultaneous finding of hepatitis B virus infection, who responded to antiviral treatment and splenectomy. We highlighted this association described in the literature and its possible causal role, as well as the available therapeutic choices.     

Rapid recovery from coma with multifocal PLEDs in a patient with severe dementia and transient hypoxemia

We report a patient with severe dementia who acutely developed transient coma following possible acute anoxic encephalopathy, and presented multifocal periodic lateralized epileptiform discharges (PLEDs) on EEG, who had a good recovery from the acute state. Two EEGs were recorded from this patient. In the first EEG taken immediately after admission, multifocal PLEDs were prominent, and the background activity consisted of low voltage, continuous and irregular theta activity (4-6 Hz). The patient recovered from coma (GCS-3) to the conscious state (GCS-15) within 14 hours and was not associated with newly developed focal or global neurological deficits except for stable severe dementia which had developed in the previous several years. Another EEG taken 5 days later showed disappearance of multifocal PLEDs. Transient appearance of multifocal PLEDs might represent at least the transient, vulnerability associated with underlying dementia in this particular patient. We concluded that multifocal PLEDs do not always indicate a poor outcome in patients with possible acute anoxic encephalopathy, and rapid diagnosis and appropriate treatment should be done even if the initial EEG shows multifocal PLEDs.     

A new ATTR Phe64Ile mutation with late-onset multiorgan involvement.

We describe a novel transthyretin mutation in which phenylalanine is replaced with isoleucine in exon 3 at codon 64: Phe64Ile. The mutation was found in an isolated patient and it was not possible to perform a family study. The phenotype included heart and peripheral nerve involvement associated with a possible gastrointestinal and renal involvement.     

Brain abscesses caused by Abiotrophia defectiva: complication of immunosuppressive therapy in a patient with connective-tissue disease

We report the case of a patient who developed brain abscesses caused by Abiotrophia defectiva. The patient was treated with prednisone and cyclophosphamide for connective-tissue disease (lupus-Sj?gren's overlap syndrome). A few cases of central nervous system infections due to Abiotrophia species have been previously reported in immunocompetent patients following neurosurgical procedures, suggesting possible introduction of this organism at the time of surgery. This case report is the first report of brain abscesses due to A. defectiva in a pharmacologically immunosuppressed patient.     

Pneumatosis Intestinalis and AIDS: A Case Report and Review of the Literature

We report five AIDS patients who developed pneumatosis intestinalis and review the pertinent literature to clarify the contributory importance of underlying infections, to suggest a management plan, and to determine whether pneumatosis intestinalis alters prognosis. Of the five patients reported, three had concurrent infections including cryptosporidiosis (one patient), presumptive CMV (one patient), and toxoplasmosis of the central nervous system (one patient). One patient also had neutropenia. Another patient was immunosuppressed during treatment for lymphoma, and the fifth patient had been taking corticosteroids before the diagnosis of CNS lymphoma. In four of five patients pneumatosis involved the right colon. Pneumatosis was linear in all five patients and also was cystic in two of the five. All patients were followed conservatively without short term adverse events, despite the known association of linear pneumatosis with bowel necrosis. We advocate conservative management and an attempt to avoid surgery whenever possible.