RESUMEN
Decerebrate posturing is commonly associated with a global brain insult as in massive strokes, brain stem infarction, or hypoxic brain injury. The clinical presentation of hepatic encephalopathy is variable. ranging from an abnormal sleep pattern to somnolence and deep coma. Decerebrate or decorticate posturing is a rare manifestation of hepatic encephalopathy. We report a patient with liver cirrhosis who presented with a mild degree of hepatic encephalopathy that rapidly progressed to coma with decerebrate posturing. Although the pathophysiology of hepatic encephalopathy is unknown, it appears to be reversible as in our patient who completely recovered with the management of encephalopathy. Despite being uncommon, it should be considered in patients presenting with hepatic encephalopathy progressing to coma since it might save unnecessary workup.
RESUMEN
A strong association of gemcitabine to acute coronary syndrome (ACS) is not currently established in the literature. In this series, we highlight that both patients with gemcitabine-related ACS were more than 50 years old, had underlying coronary artery disease and suffered from metastatic cancer. However, further prospective studies are required to validate the significance of these observations.
RESUMEN
When considering rheumatoid arthritis (RA)-associated pulmonary diseases, interstitial lung disease and pleural disease are the most common RA-associated pulmonary manifestations while spontaneous pneumothorax and bronchopleural fistula (BPF) are among the extremely rare ones. To the best of our knowledge, all the previous reports of RA-associated BPFs were attributed to peripherally located pulmonary nodules that necrotized, burst into the pleural cavity, and eventually lead to the fistula formation. However, we hereby present the first case of BPF in an RA patient that formed in the absence of any underlying rheumatic pulmonary nodules. Additionally, our patient was on chronic methotrexate therapy, and there are no data in the literature that suggest methotrexate-induced parenchymal lung disease can predispose to BPF formation. Our report is the first to introduce a probe to further investigate this association.
