A case of thrombotic thrombocytopenic purpura associated with bupropion.

OBJECTIVE: To report a case of bupropion-associated thrombotic thrombocytopenic purpura (TTP) syndrome. CASE SUMMARY: A 55-year-old man was admitted with complaints of diarrhea, acute renal failure, and confusion ~ 54 days after bupropion initiation for smoking cessation. Subsequently he had a tonic-clonic seizure and had to be intubated because of altered consciousness. Laboratory findings were compatible with microangiopathic hemolytic anemia. He was diagnosed as TTP for which the Naranjo adverse drug reaction probability scale indicated a probable relationship with bupropion (a score of 5). He was treated with plasma exchange, systemic corticosteroids, hemodialysis and recovered fully. DISCUSSION: Bupropion is an anti-depressant drug also indicated for smoking cessation. It has widely reported neuropsychiatric and allergic adverse effects; however, TTP associated with bupropion has only been reported once. The clinical course of TTP in this case was compatible with TTP related to acute, immune mediated drug toxicity, which suggests that auto-antibodies might have been responsible. CONCLUSIONS: Given the fact that the clinical condition is compatible with acute, immune-mediated TTP syndrome, we suggest bupropion deserves evaluation for auto-antibody induction. Prescribers should be aware of the possible risk of thrombocytopenia and TTP.

Simple renal cyst prevalence in internal medicine department and concomitant diseases.

A total of 684 patients who had not been diagnosed with renal cyst but had undergone abdominal ultrasonography for various reasons were evaluated. Patients with and without renal cyst were classified into two groups and were compared in terms of hypertension (HT), hyperlipidemia (HL), diabetes mellitus (DM) and obesity (body mass index: > or = 30 kg/m2) prevalence. Although 94 patients (13.7%) were established with a renal cyst, 590 patients (86.3%) did not have a renal cyst. The mean age of the patients established with a simple renal cyst was 67.3 +/- 12.1 years (range: 28-82 years); 54 (57.4%) of them were women and 40 (42.6%) were men. Of the patients established with a simple renal cyst, 64 (68.1%) had HT, 40 (42.6%) had DM, 20 (21.3%) had HL, 42 (44.7%) were obese, 18 (19.1%) had nephrolithiasis, and 6 (6.4%) had urinary tract infection. Of the patients without a cyst, 272 (46.1%) had DM, 212 (35.9%) had HT, 122 (20.7%) had HL, and 96 (16.3%) were obese. HT and obesity were significantly higher in patients with a renal cyst when compared with those without a cyst. However, although HL incidence was higher in patients with a cyst, the difference was not significant statistically. HT, HL, and obesity are more prevalent in patients with a renal cyst when compared with patients without. Consequently, patients with a simple renal cyst should be evaluated and followed up in terms of atherosclerotic risk factors.

Retroperitoneal abscess as a late complication following laparoscopic cholecystectomy.

BACKGROUND: Gallstone spillage during laparoscopic cholecystectomy is a relatively common occurrence. These intraperitoneal gallstones are considered to be harmless. Rarely, they may give rise to complications. Surgeons should retrieve spilled stones whenever possible. CASE REPORT: We report the case of a 75-year-old man with retroperitoneal abscess that developed 6 years following laparoscopic cholecystectomy as a late complication. The cavity, though it drained purulent material, was sterile in culture. Gallstones were found in the drain effluent. To our knowledge this is the first case report in English of such a delayed complication caused by spilled gallstones. CONCLUSIONS: Every effort should be made to avoid perforation of the gall bladder during its dissection. Whether the procedure should be converted to open surgery to retrieve all the stones is subject to debate.