Introduction. Primary amyloidosis is a disorder resulting from the deposition of fibrillary protein in extracellular tissue. Diagnosis of primary amyloidosis in the celiac/para-pancreatic lymph nodes via endoscopic ultrasound-guided fine needle aspiration has not been reported in the literature. In this article, we report our first observation. Our patient is a 64-year-old Caucasian man who was referred to our institution from an outlying hospital for recurrent abdominal pain. Radiological imaging revealed an enlarged abdominal lymph node that was already biopsied under computed tomography needle guidance but diagnosis was not achieved on pathological examination. At our institution, endoscopic ultrasound-guided fine needle aspiration showed enlarged para-celiac/pancreatic lymph nodes. Endosonography-guided fine needle aspiration revealed the diagnosis of primary amyloidosis. The patient tolerated the procedure well with follow-up as an outpatient. Conclusions. Lymph node involvement in amyloidosis is not uncommon. However, the involvement of the pancreatic/celiac lymph nodes by amyloidosis is obscure in this case. This case shows a rare presentation of amyloidosis diagnosed for the first time by the technique of endosonography-guided fine needle aspiration. In the future, this might serve as an establishment to standardize diagnosing abdominal lymph node amyloidosis, once suspected, by endosonography-guided fine needle aspiration.
One of the most commonly encountered medical problems affecting all age groups in health care is abdominal pain. There are many surgical and medical causes behind this symptom; however, a rare cause of abdominal pain and other unspecific abdominal complaints are gastric bezoars. Gastric bezoars are defined as the accumulation of undigested or partially digested foreign materials in the stomach. They are typically found incidentally during upper endoscopy. Patients may present with abnormal behavior or eating disorders such as pica. Therefore, proper history taking and establishing a good rapport with the patient play a key role in diagnosis. We present a case of trichobezoar-induced heartburn in an 18-year-old female. In this article, we will discuss the types, risk factors, clinical picture, diagnosis, and treatment of this condition.
Menotrophin is a protein-based hormonal therapy. It is used as a fertility medication that is given as injection either subcutaneously or intramuscularly. Menotrophin has not been previously reported to cause drug-induced liver injury. Drug-induced liver injury (DILI) is commonly seen nowadays with the expansion of the drug industry. It is associated with prescribed medications, over the counter drugs, herbal and dietary supplements. We report the first case of Menotrophin-induced autoimmune hepatitis in a 26-year-old Caucasian woman who was diagnosed with primary infertility due to failure to conceive after five years of marriage. She had received several cycles of Menotrophin, then developed new onset jaundice and fatigue associated with increase in transaminases. She had normal baseline liver function and enzymes prior to receiving treatment with Menotrophin. Evaluation showed no evidence of viral hepatitis, metabolic, alcoholic or vascular causes of liver injury. Autoimmune screening was positive for antinuclear antibody (ANA) with titer of 1 : 640 fine speckled, immunoglobulin G (IgG) level was 1900 mg/dl. Antimitochondrial antibodies (AMA) and antismooth muscle antibodies were negative. Liver biopsy showed features of chronic hepatitis with interface hepatitis and prominence of plasma cells, which best reflects autoimmune hepatitis. Her liver enzymes and bilirubin completely normalized after discontinuation of further Menotrophin therapy and starting treatment with prednisolone and Azathioprine.
Henoch-Schonlein purpura (HSP) is an autoimmune condition also referred to as anaphylactoid purpura. It is a self-limited systemic, IgA-mediated small vasculitis. It is non-granulomatous, autoimmune complex, with multi-organ involvement, and most commonly in children. Its etiology is unclear but is associated with upper respiratory tract infections, drugs, foods, insect bites, vaccinations, tumors (non-small cell lung cancer, prostate cancer, and hematological malignancies), alpha-1-antitrypsin deficiency, and Familial Mediterranean Fever.Case StemWe present a 17 years old caucasian male with 3 weeks history of itchy erythematous, palpable pruritic rash which progressed proximally from both feet to thighs and upper extremities. He went to an outlying facility and was given steroids for a few days. Symptoms subsided temporary. Later the patient developed peri-umbilical abdominal pain which was colicky in nature, 8/10 in intensity, associated with vomiting, bloody diarrhea, joint pain and fever. Review of systems was unremarkable otherwise. Abdominal examination showed mild tenderness in the peri-umbilical area, non-blanching palpable purpuric rash involving both upper and lower extremities.Laboratory tests showed leukocytosis, high CRP and ESR.Normal Hb, Hct, BUN, Serum Creatinine, Urinalysis, C3 and C4.Anti-HAV IgM: Negative; HbsAg: Negative; Anti-HBc IgG Negative.Colonoscopy showed pancolitis. Abdominal ultrasonography detected increased bowel wall thickness, skin biopsy was not specific because it was taken after 24 hrs of once of rash.The patient was diagnosed with HSP as per the American College of Rheumatology and European League Against Rheumatism (EuLAR) as well as Pediatric Rheumatology Society (PReS) criteria.He was treated with intravenous fluids and was abstained from food and liquids. He was started on oral prednisone. He recovered well and was discharged with a follow up appointment.ConclusionAlthough HSP patients mostly range from 4–7 years old it can still presents in adolescent age group. Non-thrombocytopenic palpable purpura with multi-organ involvement (gastrointestinal, skin and joints) should make one consider the diagnosis. skin biopsy should be taken less than 24 hrs from the presentation because in more chronic lesions, vessel damage leads to nonspecific leakage of all isotypes of immunoglobulin.Abstract ID: 67 Figure 1
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.