氨苯砜综合征1例

1．临床资料：患者男性,34岁,2005年12月8日以发热10d、皮疹6d、转氨酶升高2d入院。患者1个半月前双下眼睑出现皮疹,1个月前我院皮肤科诊为“颜面播散性粟粒性狼疮”,开始氨苯砜100mg/d顿服,服药第28天,即入院前10d     

Autoimmune cholangitis: case report.

We report on 2 patients who showed mixed signs of primary biliary cirrhosis and autoimmune hepatitis. Both patients were female, in their fifties (54 and 58), their laboratory tests indicated cholestasis, and a liver biopsy revealed liver cirrhosis with significant lesions of the bile ducts. Both were treated with prednisolone with their liver tests showing a rapid normalization of their aminotransferases. These patients can be considered as presenting with what is known as the overlap syndrome or autoimmune cholangitis, which has the clinical, biochemical, immunological, and histopathological characteristics of primary biliary cirrhosis and autoimmune hepatitis type I.     

Coeliac disease and autoimmune cholangitis: a case report

Autoimmune cholangitis can be associated with other autoimmune disorders. The case is described of a 58-year-old female who developed severe microcytic anaemia resistant to oral iron treatment. Evaluation of the patient led to the diagnosis of coeliac disease, a rarely described association. Gluten-free diet and treatment with oral haematinics led to reversal of the anaemia.     

Xanthogranulomatous cholangitis causing obstructive jaundice： A case report

This article reports the case of a 34-year-old woman with xanthogranulomatous cholangitis who developed obstructive jaundice. Microscopically, the bile duct was surrounded and narrowed by a xanthogranulomatous lesion, but no xanthogranulomatous cholecystitis was seen. Although percutaneous cholangiograms done via the transhepatic biliary drainage showed smooth narrowing of the upper to middle bile duct, the cytology of bile was diagnosed as class V adenocarcinoma. Therefore, right extended hepatectomy and extrahepatic bile duct resection were performed. The differentiation of benign and malignant strictures at the hepatic hilum is often difficult. Xanthogranulomatous cholangitis is one possible diagnosis of a bile duct stricture. Precise review of all the preoperative information is required to make a correct diagnosis.     

Bacterial cholangitis causing secondary sclerosing cholangitis: A case report

Background  

Although bacterial cholangitis is frequently mentioned as a cause of secondary sclerosing cholangitis, it appears to be extremely rare, with only one documented case ever reported.     

原发性胆汁性肝硬化/原发性硬化性胆管炎重叠综合征合并狼疮性脂膜炎1例报告

正1病例资料患者女性,51岁,因"发现肝功能异常7年,乏力1年"于2015年8月11日入院。患者主要不适为乏力,无皮肤瘙痒、高脂血症及脂肪瘤等表现。既往1994年因"口腔溃疡、面部及双上肢散在皮下结节"于吉林大学第一医院诊断为"红斑狼疮",并予皮质醇激素治疗(具体剂量及时间不详),症状缓解。     

Autoimmune pancreatitis with evolution to cholangitis: a case report

We report the case of a 47-year-old Caucasian male patient who presented with obstructive jaundice and mild epigastric pain. Autoimmune pancreatitis was diagnosed based on magnetic resonance imaging, biopsy and clinical evolution, and the patient was successfully treated with corticosteroids. However, a few months later ERCP showed an image compatible with sclerosing cholangitis. Again, treatment with corticosteroids was given, after which the bile ducts became normal. A few months later, again there was a relapse and azathioprine was started. After decreasing the dose of immunesuppression, we saw relapses of cholangitis and pancreatitis, with eventually evolution to chronic calcifying pancreatitis. The aim of this report is to describe autoimmune pancreatitis as a cause of obstructive jaundice, and to illustrate that evolution to an immunesuppression-responsive cholangitis, with evolution to chronic calcifying pancreatitis is possible. Also, our patient had a small fluid collection, possibly a pseudocyst, an unusual finding in autoimmune pancreatitis, which disappeared during treatment.     

Arsenic intoxication presenting as a myelodysplastic syndrome: a case report

A case of arsenic intoxication presenting as a myelodysplastic syndrome is reported. A 41-year-old woman with a 6-month history of gastrointestinal and neurological symptoms was noted to be pancytopenic at presentation. A bone marrow aspirate revealed dysmyelopoietic changes involving all three marrow cell lines. Subsequent analysis of urine for heavy metals demonstrated very high levels of arsenic. Treatment with British anti-Lewisite (BAL) resulted in the resolution of gastrointestinal symptoms and hematological abnormalities although the neurological complications progressed. This case emphasizes that heavy metal intoxication should be considered in the differential diagnosis of any individual presenting with the hematological features of myelodysplasia especially when accompanied by clinical features considered atypical for primary or secondary myelodysplasia.     

Severe acute cholangitis after endoscopic sphincterotomy induced by barium examination: A case report

Endoscopic sphincterotomy (EST) is considered as a possible etiological factor for severe cholangitis. We herein report a case of severe cholangitis after endoscopic sphincterotomy induced by barium examination. An adult male patient presented with epigastric pain was diagnosed as having choledocholithiasis by ultrasonography. EST was performed and the stone was completely cleaned. Barium examination was done 3 d after EST and severe cholangitis appeared 4 h later. The patient was recovered after treated with tienam for 4 d. Barium examination may induce severe cholangitis in patients after EST, although rare, barium examination should be chosen cautiously. Cautions should be also used when EST is performed in patients younger than 50 years to avoid the damage to the sphincter of Oddi.     

IgG4相关性硬化性胆管炎1例报告

<正>1病例资料患者男性,56岁,因"尿色加深2个月,间断上腹痛1个月"入院。入院前2个月发现尿色加深、大便颜色发白。1个月前出现夜间剑突下胀痛,20 d前疼痛加重,改变体位不能缓解,不伴肩背部放射痛,服用止痛药(具体不详)后好转。伴有皮肤黏膜轻度黄染;无恶心呕吐、无发热。查体:一般情况好,血压135/80 mm Hg,颈部、锁骨上、腋窝、腹股沟均未触及肿大淋巴结。全     

Somatostatin-producing pancreatic endocrine carcinoma presented as relapsing cholangitis -- a case report.

Somatostatin-producing endocrine tumors are rare neoplasms usually arising in the pancreas and duodenum and they account for less than 1% of all gastrointestinal endocrine tumors. Besides somatostatinoma syndrome, which is characterized by diabetes mellitus, steatorrhea and cholelithiasis, patients with somatostatin-producing endocrine tumors commonly complain of nonspecific symptoms such as vague abdominal pain, weight loss or changes in bowel habits. Tumor behavior cannot be predicted by histological features alone, and malignancy is determined by the presence of metastases. We report here a case of malignant pancreatic endocrine tumor producing somatostatin presented as relapsing cholangitis who was treated with Whipple pancreatoduodenectomy.     

Sclerosing cholangitis associated with multifocal fibrosis: a case report.

The association of sclerosing cholangitis, retroperitoneal fibrosis, and Riedel's thyroiditis has been reported twice before, and on both occasions the authors successfully used steroids to control the fibrotic process. A further case of fibrosis with this triad of organ involvement in which a combination of surgery and steroid treatment has arrested disease progression is described. This suggests an inappropriate immune response in this type of fibrotic overlap syndrome.     

Cronkhite-Canada综合征1例

病例：女,35岁,因持续腹泻3年余,伴消瘦、乏力1个月入院。患者于20014年6月食用“优酸乳”后出现腹泻、泻稀水便10余次,伴腹胀、恶心、呕吐,给以抗炎、补液治疗,症状略有好转．腹泻次数减少,约3-4次／d,呈稀水便。之后每因食用蔬菜类食物而大便次数增多．多达20次／d。腹泻时轻时重,间断服用蒙脱石散、颠茄磺苄啶片、地衣芽孢杆菌胶囊等止泻药物治疗,病情未见缓解。近3年体重减少30妇,食欲差、睡眠盗汗,自发病起无发热、黄疸,无腹痛、便血、多饮、多尿,无脓血便、血便。体格检查：发育正常,营养差,     

Wellens综合征一例

<正>1病例资料患者男,44岁。因"反复胸痛5 d"于2011年5月4日入院。患者近5 d来反复胸痛发作,位于胸骨后,呈压榨样,伴出汗、左上肢酸胀。每次持续20～40 min,服硝酸异山梨酯30 mg约5 min可缓解。发作时于当地医院查心电图正常(图1)。此次发作症状较重,心电图有T波改变,以"急性冠     

Lyme carditis presenting as acute coronary syndrome: a case report

A case of a 26-year-old man with Lyme carditis (LC) mimicking acute coronary syndrome is presented. Considering clinical presentation, electrocardiographic findings and markedly elevated levels of cardiac biomarkers, emergency coronary angiography was performed and revealed normal coronaries. Ventricular arrhythmias of Lown grade IVb during catheterization were recorded. Echocardiography showed mild global left ventricular dysfunction with ejection fraction of 50%. The diagnosis of LC was confirmed by ELISA and Western blot serologic testing. After 21 days of continuous antibiotic therapy with ceftriaxone (2.0 g/d) the patient recovered completely. We also present the current state of knowledge on the cardiovascular aspects of Lyme borreliosis.     

Fitz-Hugh-Curtis综合征1例报道

正Fitz-Hugh-Curtis综合征(FHCS)也称为肝周围炎,是盆腔炎(PID)的骨盆外表现。其发病机制是宫颈炎未规范化治疗或机体抵抗力下降,导致病原菌上行感染,引起子宫内膜炎、输卵管炎、腹腔内感染,累及上腹部而引起FHCS~([1])。我科近期诊治1例Fitz-Hugh-Curtis综合征患者,现报道如下。1病例资料患者女,34岁。主因发热9天入院。患者于入院前9天无明显诱因出现发热,体温38℃,自觉腹部不适,位置不固定,伴恶心、未呕吐。无鼻塞、流涕,无咳嗽、咳痰,无排尿不适或腹泻。就诊于社区医院,查血WBC 9.2×10~9/L,N 0.72,     

一例表现为 Av ellis 综合征的延髓梗死

Av ellis 综合征于1891年由德国喉科医师Av ellis率先报道,其受累病灶主要位于疑核上部和脊髓丘脑侧束,临床症状主要表现为吞咽困难,病灶侧软腭、喉和会厌麻痹,声音嘶哑,言语不清,病灶对侧肢体分离性感觉障碍,以及病灶对侧面部痛温觉减退等［1-3］。 Av ellis 综合征的相关病例报道主要集中于延髓梗死患者,与动脉粥样硬化和血栓形成导致椎基底动脉和延髓动脉管腔狭窄或闭塞引起的急性脑缺血密切相关［4］,但国外也有报道头部外伤、鼻翼神经营养性溃疡、Borrelia疏螺旋体感染、全身性血管炎、溃疡性结肠炎等疾病引起该综合征的病例［5-8］。疑核上部受损可引起严重的咽喉麻痹,其严重程度可能与延髓外侧缺血性病变范围有关［9］。当病灶位于疑核上部时,Avellis综合征的吞咽困难、声音嘶哑等临床表现更为明显;脊髓丘脑侧束受损时,可出现对侧手臂、躯干和腿浅感觉减退;腹侧三叉神经丘脑束（包括腹侧三叉神经核上行纤维）受损则出现病灶对侧面部浅感觉减退［10］。由于腹侧三叉神经核上行纤维临近延髓外侧的脊髓丘脑侧束,若同时损伤上述2个部位则会出现相应叠加的临床表现［11］。 Avellis 综合征的发病率相对较低,在国内鲜有报道,现报道1例。