1961/4137. Fulminant amebic colitis in a homosexual man. This report describes a case of fulminant amebic colitis leading to perforation and death in a 35-yr-old homosexual man. Although entamoeba histolytica may be isolated from stool specimens in 20 to 30% of selected homosexual populations, reports of severe or invasive disease are rare. Some workers have suggested that amebae are only passive colonizers of the colon in homosexual men. In our patient, pathological examination confirmed the presence of extensive colitis with penetration of amebae through the bowel wall. Pertinent data concerning pathogenicity of E. histolytica in homosexuals are reviewed and the public health implications of a virulent strain of amebae are discussed. ( info) |
| iron poisoning continues to be a major toxicologic problem, with major impact on the gastrointestinal and circulatory systems. Failure to recognize the severity of iron intoxication may result in an inappropriate level of intervention. By using estimates of the total body burden of iron, clinical symptoms, and the serum iron concentration, an appropriate decision can be made to initiate aggressive chelation therapy with deferoxamine. In severe intoxication, the use of intravenous deferoxamine is indicated, along with supportive care, with particular attention to maintaining the intravascular volume. Other important measures include correction of acidosis and disorders of coagulation and replacement of blood components when there is evidence of gastrointestinal hemorrhage. Under rare circumstances in which large numbers of iron tablets are present in the gastrointestinal tract, surgical removal may be indicated. In addition, measures such as hemodialysis and exchange transfusion should be reserved for those unusual poisonings in which more conservative therapy is unsuccessful. In rare cases of iron intoxication, late sequelae such as hepatic necrosis and gastrointestinal scarring with obstruction may occur. The prompt recognition and initiation of management of children with acute iron poisoning is the single most critical element in decreasing the morbidity and mortality associated with these products. ( info) |
1963/4137. Hepatotoxicity after treatment with sulfasalazine. A 42-year-old man with fever, right lower quadrant abdominal pain, and occasional rectal bleeding was diagnosed as having Crohn's disease. He was started on sulfasalazine (Azulfidine) therapy, and a generalized rash subsequently developed. When laboratory data indicated possible sulfasalazine hepatotoxicity, use of the drug was discontinued. Symptoms continued to worsen, however, and the patient died of fulminant hepatic necrosis. Comparison with similar cases showed that a hypersensitivity reaction was probably responsible for the liver damage, with a latent period that made recognition difficult. Thus, while fulminant hepatic necrosis is rare, this possibility must always be considered by the clinician when prescribing and monitoring therapy with sulfasalazine. ( info) |
| liver enzymes were followed in 99 patients treated with D-penicillamine for rheumatoid arthritis. In six abnormalities were found which consisted of elevated levels of lactic dehydrogenase. ALAT/ASAT, alkaline phosphatases or combinations of these. The changes were reversible on stopping the drug with one possible exception. No evidence of biliary cirrhosis, chronic active hepatitis or HBag-associated hepatitis was found. liver biopsy was performed in 4 cases--one was taken 2 months after the treatment was discontinued, and was normal. One biopsy showed mild inflammatory changes, whereas in two histologic evidence of toxic liver necrosis was present. liver damage should be included among possible complications of D-PA treatment. ( info) |
| Two patients with inflammatory bowel disease and no history of bilio-pancreatic disorders or alcoholism developed acute pancreatitis after therapy with sulfasalazine. The treatment lasted two months in the first case and four days in the second. The onset of pancreatic complications was heralded by jaundice; abdominal pain was a late symptom. The clinical course was dramatic in both cases, and one patient died. These findings agree with the hypothesis that sulfasalazine like other sulfonamidic compounds is a potentially pancreotoxic drug. ( info) |
1966/4137. death due to chronic syrup of ipecac use in a patient with bulimia. A 17-year-old girl presented with malaise, weakness, palpitations, dysphagia, myalgias, and weight loss of 1 month's duration. Within 24 hours of admission to the hospital, she had hypotension unresponsive to medical management, intractable congestive heart failure, and arrhythmias; she died. Several empty bottles of syrup of ipecac were later found among her belongings. Syrup of ipecac is commonly used to induce emesis in patients who had ingested toxic substances. The chief pharmacologic property of this agent is due to its alkaloid component, emetine. There have been many previous reports of death due to emetine poisoning in patients receiving ipecac fluid extract and in those treated for amoebic dysentery. However, the literature cites only three case reports of fatalities secondary to chronic ipecac use as a means of losing weight. This is the first report of a death due to chronic ipecac use in an adolescent patient with bulimia. emetine persists in the body for long periods, and in patients who have ingested it chronically, emetine is extremely toxic, specifically to cardiac smooth and skeletal muscles. With an increased awareness of the importance of weight control in the adolescent age group, the physician must carefully evaluate these patients for the use of emetics. ( info) |
1967/4137. enteritis necroticans among Khmer children at an evacuation site in thailand. A severe illness characterised by bloody diarrhoea and intestinal dysfunction was recognised at an evacuation site on the Thai-Kampuchean border. From June, 1985, to July, 1986, the illness occurred in 62 Khmer children aged 10 months to 10 years (mean 4 years); it was characterised by bloody diarrhoea (94%), fever (90%), and abdominal pain (78%). The overall mortality rate was 58%. Among 16 children who died and underwent necropsy, small-intestinal necrosis of varying severity was found; in 5 of these children small-intestinal lesions with areas of full-thickness necrosis were seen that histologically resembled those in cases of enteritis necroticans (pigbel) in papua new guinea. Beta-toxin-producing clostridium perfringens type C was isolated from 2 of 23 children from whom specimens for anaerobic cultures were collected, and antibodies to beta toxin were detected in 5 of 9 survivors but not in 10 healthy, age-matched control children. These cases show that enteritis necroticans can cause substantial morbidity and mortality outside papua new guinea. ( info) |
| polyarteritis nodosa in a 23-year-old man gave rise to caecal perforation, colonic infarction and, later, severe gastrointestinal bleeding with fatal outcome. The necessity of early surgical intervention to improve prognosis in cases with severe gastrointestinal improvement is emphasized. ( info) |
1969/4137. Cutaneous manifestations of Takayasu's arteritis. A clinicopathologic correlation. Takayasu's arteritis is a chronic, granulomatous, large-vessel arteriopathy of unknown cause. We retrospectively reviewed the medical records of 38 patients with Takayasu's arteritis and identified 21 with cutaneous findings. Seven patients had lesions that were related to their systemic vasculitis. We found a Churg-Strauss granuloma, a pyodermatous leg ulcer, and inflammatory leg nodules in these patients. biopsy specimens from three patients with presumed "erythema nodosum" did not support the clinical diagnosis but did show arteritis. In patients with Takayasu's arteritis, small-vessel inflammation, and other inflammatory lesions may be present, in addition to large-vessel disease. Histopathologic study is necessary to categorize the nature of inflammatory leg nodules of these patients. ( info) |
1970/4137. Ischemic injury of the hand from intra-arterial propylhexedrine injection. A number of adverse consequences can result in the upper limb from parenteral drug abuse. Propylhexedrine, a drug similar to amphetamine, is easily obtained and causes severe injury to the limb when injected intra-arterially. This report describes an inadvertent case of intra-arterial propylhexedrine injection into the radial artery, the natural course of which resulted in digital amputations. The cause and diagnosis of this injury is discussed, and a protocol for treatment is presented. ( info) |