Ascites is the abnormal buildup of fluid in the abdomen. Despite appropriate workup, including diagnostic paracentesis with fluid analysis and abdominal imaging, the cause of ascites is sometimes unknown. In this case, testing for less common causes should be performed, including checking thyroid function test (TFT) because hypothyroidism has also been reported to be a rare cause of ascites. Patients may also have concomitant malnutrition as an effect of severe hypothyroidism, rather than as its cause. We report the case of a 62-year-old female with a history of hypothyroidism and non-compliance who presented with unexplained ascites and then also developed severe malnutrition, requiring total parenteral nutrition (TPN). Extensive testing, including laparotomy, was unable to reveal the cause of ascites and malnutrition until the patient mentioned, during her hospital stay, non-compliance with her home dose of levothyroxine (175 μg) because of the cost. TFT results indicated that the patient had severe hypothyroidism, with a thyroid-stimulating hormone (TSH) level of 21.9 IU/mL and a free thyroxine level (T4) level of 0.2 IU/mL. The patient’s home levothyroxine dose was resumed. The patient clinically improved and was discharged on an oral diet. The patient’s ascites resolved completely, the TSH level was 2.39 IU/mL, and the T4 level was 1.7 IU/mL at the eight-week follow-up.
INTRODUCTION: Hepatic Steatosis is associated with cardiovascular disease independently of classic risk factors. Hepatocytes secrete proprotein Convertase Subtilisin/Kexin type 9 (PCSK9) which in turn inhibits the uptake of low-density lipo-proteins by targeting the receptor for degradation and possibly lipogenesis. Anti-PCSK9 drugs reduce LDL-cholesterol but it is unclear how it affects the liver function in patients with underlying steatosis. AIM: To evaluate the efficacy and safety of PCSK9 inhibitors in patients with Fatty Liver disease. METHODS: A retrospective chart review study was done from September 2015 to January 2018 to include patients currently prescribed PCSK9 inhibitors who had an ICD code of hepatic steatosis or fatty liver disease. Blood AST (aspartate aminotransferase), ALT (alanine aminotransferase), Triglycerides, Cholesterol and HBA1c were charted of patients who were started on this medication and were followed after interval of 12 months while on the medication. This was compared to a control of patients who were not on PCSK9 but did have underlying diagnosis of fatty liver disease. RESULTS: A total of 37 patients on PCSK9 were identified having the ICD 9 and 10 code for fatty liver disease. A random control of 73 patients with the same ICD9/10 code were identified. The mean age of all the patients was 63 (32-90 years), 36% male and 64% female. The mean ALT in the study group after 12 months of PCSK9 therapy was 51 which was not statistically different from the control group (P = 0.05). The average AST value was 43 in the group that was studied and was not statistically significant (P = 0.09). Mean Triglyceride value was 180 (P = 0.87) and mean cholesterol was 143 (P < 0.01). This shows that the drug does significantly reduce the cholesterol values. CONCLUSION: PCSK9 may not have a detrimental effect on the liver profile as observed in our study. There was no significant difference in the liver function test after initiation of the drug. These drugs may serve as alternative agents for those who have experienced or are at risk of hepatic injury.
Introduction: Actinomyces spp. is a gram-positive, facultative, anaerobic rod that can be found in humans as normal flora in the oral cavity, gastrointestinal and urogenital tracts. Actinomycosis can affect multiple body organs, but most commonly it has either cervicofacial, abdominopelvic, or thoracic involvement. Herein, we describe a case of acute hypoxemic respiratory failure that was found to be due to pulmonary actinomycosis along with cryptogenic organizing pneumonia. Methods: case report and literature review on Pubmed database, using the term "pulmonary actinomycosis". Case Description: A 64-year old man who developed shortness of breath, cough, and increased oxygen requirements 2 days after right total hip arthroplasty. A chest computed tomography (CT) angiography showed new symmetric bilateral ground-glass opacities with associated interstitial thickening within upper lobes, new mediastinal and bilateral hilar adenopathy, and bilateral sub-pleural reticular opacities suspicious for underlying fibrotic changes. aas in the figure. We started intravenous diuresis with furosemide, prednisone and doxycycline. O 2 requirements continued to get worse over the next 2 days increasing up to 10 liters of O 2 /minute by nasal cannula, so he was transferred to our intensive care unit (ICU). On ICU day 5, he spiked a fever and new chest CT showed worsening opacities and reticulation. He was started on piperacillin-tazobactam and vancomycin. A rheumatological panel was negative. He underwent video-assisted thoracoscopic surgery with lung biopsy. He remained intubated after surgery. Biopsy showed cryptogenic organizing pneumonia. He was started on high dose steroids. Two days later, tissue culture grew actinomyces. Prior antibiotcs were stopped, Penicillin G was started but was later switched to ceftriaxone due to a new pneumonia from Klebsiella, which delayed patient liberation from the ventilator. Patient had tracheostomy, and was transferred to a long-term facility. Ceftriaxone was completed and then penicillin V was started for 6 months. Discussion: Actinomyces is a slow-growing facultative anaerobic, gram-positive bacterium. Commonly, it is found in the oral cavity, dental caries, and tonsils. Pulmonary actinomycosis is a rare chronic, suppurative, granulomatous disease caused by Actinomyces israelii from inhalation of oropharyngeal secretions. Risk factors include poor oral hygiene, smoking, chronic bronchitis and bronchiectasis. Symptoms include fever, weight loss, cough, and shortness of breath. It can be confused with tuberculosis and lung cancer. Treatment is high dose intravenous penicillin for 2-6 weeks followed by penicillin V orally for 6-12 months.
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.