Vaginitis emphysematosa (VE) is a rare, benign, and self-limited condition often diagnosed by the presence of intramuscular vaginal air observed on computed tomography (CT) scan. Although it is a nonpathologic, self-limited condition requiring no intervention, it is important to rule out a more serious infectious pathology. This report highlights a clinical dilemma and the potential consequences of over-reliance on CT in distinguishing benign VE from pathologic necrotizing vaginitis. A high clinical suspicion for infection should be maintained, especially when relevant clinical and laboratory markers suggest a more serious pathology. We describe the case of a 45-year-old woman who presented to the hospital with abdominal pain and vaginal bleeding. CT scan demonstrated intramuscular vaginal air, which was reported as VE. Classic imaging findings of VE falsely reassured clinicians. She died shortly thereafter of necrotizing vaginitis.
Introduction Weight gain after pancreas transplant is a poorly understood phenomenon thought to be related to increased posttransplant insulin production, immunosuppressive medications, and appetite changes. No study has investigated the effect of increased exocrine secretion posttransplant. Aims and Hypothesis We hypothesized that exocrine function, measured by fecal elastase-1 (FE-1), was normal posttransplant and not correlated with weight gain. Our primary aim was to investigate changes in FE-1 levels with pancreas transplantation and to correlate this with weight gain. Establishing weight trends and identifying additional correlating factors were secondary aims. Design Forty-two patients that underwent simultaneous pancreas and kidney or pancreas after kidney transplant at a single center between 2013 and 2021 were included. Fecal elastase was measured prospectively in each patient at a single time point, with >500 µg/g categorized as high. Weight and C-peptide values were obtained. All the patients were on steroid-free immunosuppression. Results Nineteen patients (45%) had fecal elastase levels >500 µg/g, with a maximum of 3910 µg/g; 43% had levels greater than twice the upper limit of normal. The biggest increase in weight occurred between years 1 and 2, which continued to a median weight gain of 14% at 3 years. There was no correlation between weight gain and FE-1, pretransplant C-peptide levels, or duration of diabetes. Conclusion This study demonstrated supranormal fecal elastase levels and weight gain posttransplant; however, there was no correlation. Future study with serial FE-1 before and after transplant is needed to better assess its correlation with weight gain.
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