1/4. Granulomatous phlebitis of small hepatic vein.Several cases of granulomatous phlebitis of small hepatic veins are reported in the literature, though the etiology remains unclear. We experienced a similar case of granulomatous phlebitis involving terminal hepatic venules and this case will be reported in comparison with two previous cases presenting in our laboratory. A 39-year-old-female had a long course of medical treatment for epilepsy. She suffered from acute liver injury after prolonged fever for more than 1 week. leukocytosis (11,100/ micro L) without eosinophilia, and inflammatory reactions such as c-reactive protein (21.0 mg/dL) were pointed out. She suffered from transient disseminated intravascular coagulation, but these abnormalities recovered with antibiotic and steroid therapy. Liver biopsy revealed granulomatous lesions mainly involving terminal hepatic venules. The possibility of tuberculosis was excluded by a negative Thiel-Nielsen stain and a negative molecular study for bacterial deoxyribonucleic acid of Mycobacteria species. Extrahepatic involvements were not clear clinically. This case and the previous two cases shared granulomatous phlebitis of the intrahepatic small hepatic veins, as well as clinical features suggestive of bacterial infection. Clinicians should be aware of such a rare clinicopathological entity.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
2/4. Perforated diverticulum of the terminal ileum. A previously unreported cause of suppurative pylephlebitis and multiple hepatic abscesses.We describe the case of a 58-year-old man who presented to the hospital with central abdominal pain, nausea, fever, chills, and dyspnea. While in the hospital, jaundice appeared and the liver function tests revealed features of both cholestasis and hepatocellular injury. He developed gram-negative septicemia and died on the sixth hospital day. autopsy disclosed a perforated terminal ileal diverticulum and a contiguous mesenteric abscess. There was also severe phlebitis of mesenteric venous radicles which extended superiorly to the intrahepatic portal venules and veins. The portal veins were surrounded by multiple hepatic abscesses that varied in size from microscopic to 2.5 cm. This appears to be the first report in the world literature of suppurative pylephlebitis and hepatic abscesses resulting from a perforated ileal diverticulum. The subject of small bowel non-Meckelian diverticulosis is reviewed because of the rarity of this condition and the diagnostic challenges it poses.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
3/4. Retinal periphlebitis as an early sign of bacterial endophthalmitis.Retinal periphlebitis appeared as an early sign of bacterial endophthalmitis in three patients, a 36-year-old man with bilateral Terson's syndrome who underwent vitrectomy for dense vitreous hemorrhage, a 78-year-old woman who had had intracapsular cataract extraction and penetrating keratoplasty after repair of a wound leak and pars plana anterior membranectomy, and an 18-year-old man who suffered an accidental penetrating ocular injury. staphylococcus organisms were recovered from vitreous samples in all three cases. Although recovery of useful vision is rare after postvitrectomy endophthalmitis, the first patient attained a final visual acuity of 20/50. The visual acuities of the second and third patients returned to 20/25 and 20/20 respectively. In an experimental primate (cynomolgus monkey) model of bacterial endophthalmitis, retinal periphlebitis developed early and closely resembled the clinical findings in humans. Histopathologic studies confirmed the presence of inflammatory cells that infiltrated the retinal venules.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
4/4. Intramural mesenteric venulitis. A new cause of intestinal ischaemia.Venous damage is an uncommon cause of intestinal ischaemia. We report on a 44-year-old woman who presented signs and symptoms of acute intestinal ischaemia requiring surgical treatment. Histological examination of the resected right colon showed features of an intramural lymphocytic venulitis with no other demonstrable causes of ischaemic injury of the bowel. Extramural mesenteric veins appeared dilated and congested, without evidence of thrombotic occlusion or of inflammatory involvement. The patient, who was not taking any long-term medication and had no clinical evidence of collagen-vascular disease, promptly recovered after surgery. Follow-up for 7 months with no recurrences suggested a self-limited or indolent process. We propose the name 'intramural mesenteric venulitis' for this condition and believe that it could represent one extreme (the microscopic variant or intramural phase) of the spectrum comprising entero-colic phlebitis and mesenteric inflammatory veno-occlusive disease. The immunohistochemical evidence of a marked preponderance of T phenotype in the perivenular lymphocytes suggests lymphocyte-mediated vascular damage as the pathogenesis of the lesion.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |