S3090 Metformin-Induced Acute Hepatitis

Abstract

neurological deficits were noted. Liver enzymes were AST 9 U/L, ALT 3 U/L, total bilirubin 0.4 mg/ dL (direct 0.1), INR 1.2. Serum AFP one month prior to presentation was 24.5 ng/mL. CBC showed WBC of 3.7 K/UL, hemoglobin 8.2 g/dL and PLT 186 K/UL. Computed tomography showed a large expansile infiltration centered at the right ethmoid and upper nasal cavity extending to the superior medial aspect of the orbit, with associated mass effect upon the frontal lobes. Nasopharyngeal biopsies revealed poorly differentiated adenocarcinoma with immunostaining positive for heppar-1 compatible with metastatic HCC. The patient underwent bifrontal craniotomy for resection of the anterior skull base lesion, with a hospital course complicated by encephalopathy and sepsis necessitating ICU. The patient was discharged on comfort measures and hospice (Figure 1). Discussion: HCC metastasizing to the nasopharynx is exceedingly rare. The first case report documenting an isolated nasopharyngeal metastasis from a liver primary was described by Kattepur et al in 2014. In our case, the patient reported swelling behind the right eye as the initial presentation of a metastatic HCC after liver transplant. In patients with history of HCC, clinicians should maintain a broad differential with clinical suspicion for uncommon presentations of extra hepatic metastases, even after liver transplant.[3088] Figure 1. T1 weighted MRI orbit without contrast showing space occupying lesion extending through the right ethmoid sinuses with intracranial extension.

Efficacy of Huanglian Jiedu Decoction for Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis

“…Although these interventions have been shown to be effective in controlling blood glucose levels, many oral antidiabetic medications, such as metformin, sulfonylureas, and thiazolidinediones, can lead to undesirable side effects including gastrointestinal distress, weight gain, and increased risk of hypoglycemia, which affect patient compliance and quality of life [4]. Moreover, the prolonged use or high-dose therapy of certain medications has been linked to other health concerns, notably liver and kidney damage [5‒8]. This underscores the pressing need to explore novel therapeutic strategies and interventions.…”