A 44-year-old woman presented with progressively worsening neurological symptoms of 1 week duration. Physical examination revealed absent reflexes of the lower extremities and proximal muscle weakness, bilaterally. Cerebrospinal fluid analysis and electrophysiological studies were consistent with the diagnosis of Guillain-Barré syndrome (GBS) and the patient was started on intravenous immunoglobulin infusion. Along with positive neurological findings, rheumatological work up revealed elevated antinuclear antibody titres, positive double-stranded DNA and anti-Smith antibodies. These results, in conjunction with positive clinical findings, confirmed an underlying diagnosis of systemic lupus erythematosus (SLE). The patient's hospital course was complicated by an episode of severe left upper quadrant abdominal pain, fever, tachycardia and elevated inflammatory markers. CT scan of the abdomen revealed a splenic infarct following completion of IVIg infusion, making this a contributor to thrombus formation in the setting of an already thrombophilic state, and a rare complication of an approved method of treatment.
Gastric bezoar is an uncommon cause of gastric outlet obstruction, as well as a rare complication of bulimia nervosa (BN). The authors report a case of a young female with a history of BN presenting with acute gastric outlet obstruction. Radiologic imaging revealed a markedly dilated stomach and a retained gastric bezoar was identified during endoscopy. She was treated conservatively with nasogastric intubation and fluid resuscitation, followed by the consumption of Coca-Cola ® to promote fragmentation of the bezoar. The patient's symptoms improved and she was transferred to a skilled eating disorder facility for further treatment of her underlying condition.
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