RESUMO
Portopulmonary hypertension (POPH) is a not infrequent but serious complication of liver cirrhosis. Continuous intravenous epoprostenol infusion is a treatment option for this condition. Progressive splenomegaly with pancytopenia (hypersplenism) is associated with epoprostenol use in POPH. After recognizing a case of epoprostenol-induced hypersplenism that resolved upon stopping the drug, the authors retrospectively reviewed all patients treated with epoprostenol at the center for both POPH and pulmonary hypertension due to other causes. Five of 11 patients with POPH developed hypersplenism secondary to epoprostenol. In 1 patient, and possibly in a second, the hypersplenism resolved upon discontinuation of epoprostenol. None of 9 patients with pulmonary hypertension due to other causes developed splenomegaly. This report confirms hypersplenism as a complication of epoprostenol therapy for POPH. Furthermore, the authors demonstrate for the first time that hypersplenism may be reversed by stopping the medication and propose a mechanism for this phenomenon.
Assuntos
Anti-Hipertensivos/efeitos adversos , Epoprostenol/efeitos adversos , Hipertensão Portal/tratamento farmacológico , Hipertensão Pulmonar/tratamento farmacológico , Esplenomegalia/induzido quimicamente , Anti-Hipertensivos/uso terapêutico , Epoprostenol/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Anemia Ferropriva/diagnóstico , Derivação Gástrica/efeitos adversos , Hemocromatose/cirurgia , Complicações Pós-Operatórias/diagnóstico , Anemia Ferropriva/sangue , Anemia Ferropriva/etiologia , Feminino , Hemocromatose/sangue , Humanos , Pessoa de Meia-Idade , Obesidade/sangue , Obesidade/cirurgia , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologiaRESUMO
Patients with an autoimmune disease have a propensity for development of a second autoimmune disease. We report the first instance of a patient with both idiopathic thrombotic thrombocytopenic purpura (TTP) and Graves disease. The TTP remitted with a combination of plasmapheresis and prednisone. Methimazole led to sustained remission of the hyperthyroid state within 6 weeks. Although hyperthyroidism may induce immune imbalance causing autoimmunity, it is unclear if this influenced the development of TTP in our patient and if treatment of hyperthyroidism alone could have resulted in the cure of both diseases.
Assuntos
Doença de Graves/complicações , Púrpura Trombocitopênica Trombótica/complicações , Feminino , Doença de Graves/diagnóstico , Doença de Graves/terapia , Humanos , Pessoa de Meia-Idade , Plasmaferese , Púrpura Trombocitopênica Trombótica/diagnóstico , Púrpura Trombocitopênica Trombótica/terapiaRESUMO
We report a 27-year-old man with HIV-1 infection who developed acute promyelocytic leukemia (APL) with a novel complex three-way chromosomal translocation t(15;16;17). Induction of remission and consolidation with all-trans-retinoic acid (ATRA)- and anthracycline-based chemotherapy was followed by maintenance therapy consisting of ATRA, 6-mercaptopurine (6-MP), and methotrexate (MTX). Highly active antiretroviral therapy (HAART) was continued with brief interruptions. He remains in complete remission 40 months after diagnosis.
Assuntos
Infecções por HIV/complicações , HIV-1 , Leucemia Promielocítica Aguda/virologia , Adulto , Antraciclinas/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Homossexualidade Masculina , Humanos , Leucemia Promielocítica Aguda/diagnóstico , Leucemia Promielocítica Aguda/tratamento farmacológico , Masculino , Mercaptopurina/administração & dosagem , Metotrexato/administração & dosagem , Resultado do Tratamento , Tretinoína/administração & dosagemAssuntos
Biópsia por Agulha/efeitos adversos , Hematoma/etiologia , Adulto , Exame de Medula Óssea/efeitos adversos , Feminino , Hematócrito , Hematoma/diagnóstico por imagem , Humanos , Canal Inguinal , Masculino , Pessoa de Meia-Idade , Pancitopenia/complicações , Transfusão de Plaquetas , Púrpura Trombocitopênica Idiopática/complicações , Coxa da Perna , Tomografia Computadorizada por Raios XAssuntos
Celulite (Flegmão)/diagnóstico , Hematoma/diagnóstico , Doenças Musculares/diagnóstico , Adulto , Celulite (Flegmão)/sangue , Diagnóstico Diferencial , Hematoma/sangue , Humanos , Imageamento por Ressonância Magnética , Masculino , Doenças Musculares/sangue , Tempo de Tromboplastina ParcialRESUMO
We present the case of a 42-year-old woman with myotonic dystrophy and thymoma. She was treated with combination chemotherapy followed by external beam radiation, and remains in remission 19 months after thymoma was diagnosed. The myotonic dystrophy is unchanged. Only six cases of this nature have been reported in the literature, and this patient is the first to be successfully treated with combined modality therapy.