Gemcitabine is widely used in oncology practice. There are rare reports of gemcitabine causing hepatotoxicity with all affected patients dying from acute liver failure. We describe a patient with stage 4 lymphoma who presented with an acute deterioration in liver function tests and hepatic encephalopathy not directly attributed to his disease. He had been taking gemcitabine for 5 months before admission. His clinical and biochemical problems resolved after discontinuing the drug. This is the first case described of a severe hepatotoxic reaction associated with gemcitabine that was followed by a complete recovery.
We report a patient who presented with an altered bowel habit and incidentally described a change in the colour of his urine. The urine was grey in colour and when left to stand there were metallic filings in the sediment. Investigations confirmed a colovesical fistula secondary to sigmoid diverticular disease. The colour change of his urine was due to oral ferrous sulphate passing into the bladder via the fistula. This presentation of colovesical fistula has not been described previously in the literature.
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