RESUMO
We report a 52-year old man presenting with acute acalculous cholecystitis triggered by hepatitis B virus infection. The patient developed protective antibodies and cleared the infection. The relevant data is also discussed.
Assuntos
Colecistite Acalculosa , Hepatite B , Masculino , Humanos , Pessoa de Meia-Idade , Colecistite Acalculosa/diagnóstico , Colecistite Acalculosa/etiologia , Vírus da Hepatite B , Hepatite B/complicações , Hepatite B/diagnósticoRESUMO
BACKGROUND/AIMS: Discontinuation of nucleos(t)ide analog is controversial in HBeAg-negative chronic hepatitis B patients not achieved HBsAg loss. We aimed to evaluate re-treatment rates and risk factors in non-cirrhotic HbeAg-negative chronic hepatitis B patients for whom nucleosi(t)ides analogs were discontinued. MATERIALS AND METHODS: Demographic, clinical, and laboratory data before and at the end after discontinuation of nucleos(t)ide analogs were collected retrospectively. RESULTS: Seventy-two patients followed up between January 2000 and December 2019 were included; 43 were male, with a mean age of 46.3 (±10.8). Baseline median alanine aminotransferase (ALT) and hepatitis B virus DNA levels were 55.5 IU/L and 465 925 IU/mL, respectively. The median histologic activity index was 5.5 and the fibrosis score was 2. The median duration of treatment and consolidation therapy were 59 and 56 months, respectively. The median follow-up time after discontinuation of treatment was 55 months. Among 56 patients eligible for evaluation according to proposed re-treatment criteria, 29 (51.7%) patients were re-treated. The median time for relapse was 11 months. Re-treatment was significantly common in males (P = .034) and patients treated with tenofovir/entecavir (P = .04). Baseline hepatitis B virus DNA and levels of ALT, aspartate aminotransferase (AST) at the third and sixth months of treatment and at the end of treatment were statistically significantly higher in re-treated patients. A cutoff value of ≥405 000 IU/L for hepatitis B virus DNA discriminated patients for re-treatment. HBsAg was lost permanently in 2 non-re-treated patients. CONCLUSION: In resource-limited areas where follow-up of HBsAg or other markers is not possible, nucleos(t)ide analog discontinuation can be considered in patients in the early stage, with low baseline hepatitis B virus DNA and ALT levels, after a long consolidation therapy.
Assuntos
Hepatite B Crônica , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , Hepatite B Crônica/tratamento farmacológico , Antígenos de Superfície da Hepatite B , Antígenos E da Hepatite B/uso terapêutico , Estudos Retrospectivos , Antivirais/uso terapêutico , DNA Viral , Vírus da Hepatite B/genética , Resultado do TratamentoRESUMO
In this paper, we reported a 37-year-old man who developed several lymphadenopathies after using the second dose of Pfizer-BioNtech vaccination against SARS-CoV-2. The excisional lymph node biopsy showed eosinophil-rich inflammation with micro-abscesses. Although eosinophilic dermatosis and eosinophilic myocarditis have been described previously following COVID-19 vaccinations, eosinophilic lymph node abscess was not reported in the literature. In our case, all lesions were completely recovered with steroid treatment. The patient has been doing well and no recurrence has been observed for six months.
Assuntos
COVID-19 , Linfadenopatia , Masculino , Humanos , Adulto , Abscesso/etiologia , Vacinas contra COVID-19/efeitos adversos , SARS-CoV-2 , Linfadenopatia/etiologia , LinfonodosRESUMO
COVID-19 is a viral infection which can present with various clinical manifestations. While it primarily affects the respiratory tract, several other manifestations including skin involvements have been reported. Dermatologic manifestations are uncommon, and its prevalence is not well-known. In COVID-19, there have been two reports of acute genital ulceration to date, and both are female. Here, we report a male patient with COVID-19 complicated by acute genital ulceration in the course of the illness.
Assuntos
COVID-19 , Doenças dos Genitais Masculinos , COVID-19/complicações , Feminino , Doenças dos Genitais Masculinos/etiologia , Genitália , Humanos , Masculino , Úlcera/etiologiaRESUMO
Hepatitis B virus infection is a global problem and causes several liver diseases including acute and chronic hepatitis, cirrhosis, and hepatocellular carcinoma. Though uncommon, some immune mediated extra-hepatic manifestations may develop during the infection. Exudative ascites during HBV infection is one such.
Assuntos
Carcinoma Hepatocelular , Hepatite B Crônica , Hepatite B , Neoplasias Hepáticas , Ascite/complicações , Ascite/etiologia , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/diagnóstico , Hepatite B/complicações , Hepatite B/diagnóstico , Vírus da Hepatite B , Hepatite B Crônica/complicações , Hepatite B Crônica/diagnóstico , Humanos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/diagnósticoRESUMO
COVID-19 is an infection which can present with various clinical manifestations. While it affects respiratory tract primarily, several other manifestations including gastrointestinal involvements have been reported. The prevalence of all gastrointestinal complaints is approximately 17 percent and diarrhea, nausea/vomiting and abdominal pain are the most common symptoms. In COVID-19, acute abdominal pain requiring surgical evaluation and abdominal imaging is uncommon and there is also a lack of knowledge about COVID-19 related gastrointestinal complications. Here, we report a case of mild COVID-19 infection complicated by omental infarction during the course of the illness.
Assuntos
COVID-19 , Gastroenteropatias , Humanos , Infarto/diagnóstico por imagem , Infarto/etiologia , SARS-CoV-2 , VômitoRESUMO
In this case, we report a patient who developed acute trigeminal neuritis after using a Pfizer-BioNtech vaccination against SARS-CoV-2. The patient was completely recovered with steroid treatment.
Assuntos
Vacinas contra COVID-19 , COVID-19 , Neuralgia do Trigêmeo , COVID-19/prevenção & controle , Vacinas contra COVID-19/efeitos adversos , Humanos , SARS-CoV-2 , Neuralgia do Trigêmeo/induzido quimicamente , Vacinação/efeitos adversosRESUMO
We investigated the cases with Aeromonas bacteremia in terms of clinical and microbiological characteristics, underlying disease and mortality rates. Patients with positive blood cultures were included in this research. Aeromonas bacteremia was diagnosed as at least one positive blood culture for Aeromonas species. The bacteremia was defined as community origin if the onset was in the community or within 72 hours of hospital admission. The others were considered as nosocomial. All bacteria were defined as Aeromonas with conventional method. Species identification was verified by VITEK system. Antibiotic susceptibility tests were analyzed with the disc diffusion, E-test method or VITEK system. Thirty-three patients were diagnosed with bacteremia due to Aeromonas spp. Hematologic and solid tumors were the leading underlying conditions, followed by cirrhosis. Two patients (6%) had community-acquired infections. Aeromonas hydrophila was the most common isolated bacterium. The crude mortality rate was 36%. 12 patients died and 6 deaths and 4 deaths were detected in patients with bacteremia caused by A. hydrophila and Aeromonas sobria respectively. All strains were resistant to ampicillin and more than 90% of the strains were susceptible to trimethoprim-sulfamethoxazole, fluoroquinolone, third generation cephalosporins, and carbapenems. Aeromonas sp. is not a frequent cause of bacteremia however, it may lead to high mortality rates, especially in the immunocompromised hosts and patients with liver cirrhosis. Nosocomial Aeromonas bacteremia is not uncommon in these populations. Broad-spectrum cephalosporins, piperacillin-tazobactam, fluoroquinolones, and carbapenems remain as effective antimicrobial agents for therapy of Aeromonas bacteremia.
RESUMO
AIMS: We aimed to determine the contribution of quantitative HBsAg in differentiating chronic infections from chronic hepatitis in HBeAg negative patients with HBV DNA 2000-20,000â¯IU/ml. MATERIAL AND METHODS: A total of 79 untreated HBeAg negative patients were included. Patients were divided into 3 groups based on HBV DNA levels: group 1 (HBV DNAâ¯≤ 2000â¯IU/ml), group 2 (HBV DNA: 2000-20,000â¯IU/ml) and group 3 (HBV DNAâ¯> 20,000â¯IU/ml). We collected serum from all patients for quantitative HBsAg analysis. We compared serum quantitative HBsAg levels with biochemical parameters, HBV DNA and liver biopsy results. RESULTS: In this study 46 patients were female and the mean age was 42 years. Serum quantitative HBsAg levels were found to be significantly lower in chronic infections compared with chronic hepatitis. There was a positive correlation between quantitative HBsAg and HBV DNA, ALT (alanine aminotransferase), HAI score (histological activity index), fibrosis score and disease stage. The cut-off level of quantitative HBsAg was determined as 4425â¯IU/ml to differentiate chronic infection from chronic hepatitis. With the test specificity of 95%, we found quantitative HBsAg cut-off values 1026â¯IU/ml and 20,346â¯IU/ml for the diagnosis of chronic infection and chronic hepatitis, respectively. CONCLUSION: Our study suggests that the quantitative HBsAgâ¯≤ 1000â¯IU/ml limit value might be used for the diagnosis of chronic infection not only in HBV DNAâ¯≤ 2000â¯IU/ml but also in patients with HBV DNA between 2000-20,000â¯IU/ml. In addition, antiviral treatment could be considered in patients with quantitative HBsAgâ¯> 20,000â¯IU/ml and HBV DNAâ¯> 2000â¯IU/ml without further examinations such as liver biopsy.
Assuntos
Antígenos de Superfície da Hepatite B , Antígenos E da Hepatite B , Adulto , Alanina Transaminase , DNA Viral/genética , Feminino , Vírus da Hepatite B/genética , HumanosRESUMO
Herpes simplex virus encephalitis (HSE) is the most common sporadic fatal encephalitis. Although timely administered acyclovir treatment decreases mortality, neuropsychiatric sequelae is still common among survivors. Magnetic resonance imaging is frequently utilized for the diagnosis of HSE, which typically involves temporal lobe(s) and can be mixed with brain tumors involving the same area. Here, we report a case of HSE, who received acyclovir with a delay of 90 days because of presumptive tumor diagnosis and survived with minimal sequelae.
Assuntos
Aciclovir/uso terapêutico , Antivirais/uso terapêutico , Encefalite por Herpes Simples/tratamento farmacológico , Herpesvirus Humano 1/efeitos dos fármacos , Lobo Temporal/efeitos dos fármacos , Adulto , Diagnóstico Tardio , Encefalite por Herpes Simples/diagnóstico por imagem , Encefalite por Herpes Simples/patologia , Encefalite por Herpes Simples/virologia , Feminino , Herpesvirus Humano 1/crescimento & desenvolvimento , Herpesvirus Humano 1/patogenicidade , Humanos , Imageamento por Ressonância Magnética , Lobo Temporal/diagnóstico por imagem , Lobo Temporal/patologia , Lobo Temporal/virologia , Resultado do TratamentoRESUMO
Female genital tuberculosis (FG-TB) is an important disease leading to substantial morbidity including infertility and abnormal vaginal bleeding. While the incidence of FG-TB is < 1% in a developed area, its incidence is >1% in developing countries. Due to its subtle presentation, many cases are overlooked and diagnosed incidentally. Accordingly, the actual incidence of FG-TB is unknown. The definitive diagnosis of the disease is based on histopathological or microbiological examination but in most cases, the bacteriological test is overlooked. In addition, there is no specific laboratory or imaging evaluation to distinguish FG-TB from others. The first step in the diagnosis of FG-TB is suspicion of the disease. In the case of infertility, FG-TB should be included in the differential diagnosis in developing countries after excluding other common diseases and tissue biopsy should be sent for not only histopathology but also microbiological investigations.
RESUMO
BACKGROUND: Vaccinations have been widely used worldwide since their invention to prevent various diseases, but they can also have some adverse effects ranging from mild local reactions to serious side effects. These adverse effects are generally self-limited and resolve within a short time without any treatment. While a sterile abscess following vaccination is a rare condition in adults, many cases have been reported regarding children in the literature. Here, we report a case of recurrent sterile abscesses, which occurred after a Td vaccination, treated with corticosteroids. CASE PRESENTATION: A 22-year old woman was admitted to our department with a complaint of swelling at the site of the vaccination. On physical examination, this mass was about 6 × 6 cm in size and fluctuating, but there were no pain complaints and no redness present. She had received her Td vaccination 3 weeks ago and the swelling had started at the site of the injection 4 days following this immunization. Oral amoxicillin/clavulanic acid and local antibiotic cream were administered for 10 days. The laboratory values were unremarkable. Despite the administration of antibiotics, the swelling did not regress, and on the contrary, continued to increase in size. On ultrasound, two interconnected abscesses were observed in the subcutaneous area, and did not involve the muscle tissue. Later, the abscesses were completely drained, and the samples were cultured. The current antibiotics were continued. The gram staining of the samples revealed abundant leukocytes but no microorganisms. The solid and liquid cultures of the materials remained negative. Despite the administration of multiple drainages and antibiotics, the mass recurred. Finally, the patient was considered to have a sterile abscess due to Td immunization. The antimicrobials were stopped. Local and oral corticosteroids were initiated. The swelling regressed significantly, and the treatments continued for 7 days. The patient has been doing well and has had no recurrence for over a year. CONCLUSIONS: Corticosteroids appeared to improve the patient and therefore we suggest that the efficacy and route of administration of steroids in this situation should be explored further.