RESUMO
Crohn's disease is frequently associated with hypocalcaemia following poor calcium intake and decreased intestinal calcium absorption due to malabsorption-related vitamin D deficiency. Severe hypercalcaemia found in Crohn's disease is an unusual clinical entity. We chronicle here the case of a patient who developed hypercalcaemia with elevated 1,25-dihydroxyvitamin D during Crohn's disease exacerbation. Furthermore, we conducted a systematic literature search of MEDLINE, Cochrane, Embase, and Scopus databases regarding 1,25-dihydroxyvitamin D-associated hypercalcaemia in Crohn's disease. A comprehensive review of the search results yielded a total of five case reports only. The data on patient demographics, clinical features, serum calcium levels, Crohn's disease activity site, treatment strategy, hypercalcaemia resolution time and outcomes were collected and analysed. This paper illustrates that Crohn's disease should be added to the list of granulomatous disorders responsible for 1,25-dihydroxyvitamin D-mediated hypercalcaemia. Physicians should maintain a high index of clinical suspicion for this potential complication for prompt management.
Assuntos
Doença de Crohn/complicações , Doença de Crohn/tratamento farmacológico , Hipercalcemia/tratamento farmacológico , Metilprednisolona/uso terapêutico , Vitamina D/análogos & derivados , Dor Abdominal , Idoso , Anti-Inflamatórios/uso terapêutico , Diagnóstico Diferencial , Feminino , Humanos , Náusea , Vitamina D/sangue , VômitoRESUMO
Carcinoid tumours have the ability to secrete various peptides and bioamines that lead to carcinoid syndrome manifested as cutaneous flushing, diarrhoea, bronchial constriction and cardiac involvement. The deficiencies of vitamins D and B12 have previously been reported in patients with carcinoid tumours presumably due to chronic diarrhoea associated with the carcinoid syndrome. Herein, we chronicle the case of a patient with opioid use disorder who presented with small bowel obstruction that was found to be caused by a midgut carcinoid tumour. Laboratory studies revealed deficiencies of vitamins D and B12 even though he denied diarrhoea and had no other aetiology of deficiencies of these vitamins. Additionally, this paper presents a review of the published medical literature pertaining to clinical features, diagnostic investigations and treatment of intestinal carcinoid tumours and explores possible explanations for the observed deficiencies in these patients.
Assuntos
Carcinoma Neuroendócrino/patologia , Neoplasias do Íleo/patologia , Carcinoma Neuroendócrino/complicações , Carcinoma Neuroendócrino/diagnóstico por imagem , Carcinoma Neuroendócrino/cirurgia , Humanos , Neoplasias do Íleo/complicações , Neoplasias do Íleo/diagnóstico por imagem , Neoplasias do Íleo/cirurgia , Laparotomia , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/complicações , Deficiência de Vitamina B 12/complicações , Deficiência de Vitamina B 12/diagnóstico , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/diagnósticoRESUMO
The worldwide increasing prevalence of obesity has led to a corresponding increase in consumption of weight-loss dietary supplements. The limited de novo regulatory oversight and under-reported toxicity profile of these products reflect as a constellation of newer adverse events. We chronicle here the case of an otherwise healthy woman who developed ventricular fibrillation-related cardiac arrest secondary to the use of Hydroxycut and Metaboost preparations. Published medical literature has a handful of case reports associating these products with potentially life-threatening cardiac arrhythmias. The proposed hypothesis implicates ingredients of these diet aids to have proarrhythmogenic effects. Physicians should remain vigilant for possible cardiotoxicity associated with the use of dietary supplements. Individuals who are at risk of developing cardiac arrhythmias should avoid herbal weight-loss formulas, given the serious clinical implications. Additionally, this paper highlights the need for a proper framework to delineate the magnitude and scope of this association.
Assuntos
Fármacos Antiobesidade/efeitos adversos , Suplementos Nutricionais/efeitos adversos , Preparações de Plantas/efeitos adversos , Taquicardia Ventricular/induzido quimicamente , Feminino , Coração Auxiliar , Humanos , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/etiologiaAssuntos
Adenocarcinoma/patologia , Antineoplásicos/uso terapêutico , Carcinoma Hepatocelular/patologia , Hemorragia Gastrointestinal/patologia , Neoplasias Hepáticas/patologia , Neoplasias Peritoneais/diagnóstico , Adenocarcinoma/complicações , Adenocarcinoma/terapia , Anemia Ferropriva , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/terapia , Docetaxel/uso terapêutico , Fígado Gorduroso , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Humanos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/terapia , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Neoplasias Peritoneais/cirurgia , Sorafenibe/uso terapêuticoRESUMO
Although brucellosis in renal transplant recipients is rare, we studied the clinical characteristics of this infection in this patient population due to the significantly increased number of renal transplantations performed over the past few decades. We report one case from our experience and undertake a review of the previously reported cases retrieved from the PubMed. A total of 5 cases of brucellosis in renal transplant recipients were found to date. The mean time from transplantation to diagnosis of brucellosis was 4.7 years (range, 4 months to 13 years). Blood culture and detection of anti-Brucella antibodies were frequently used diagnostic investigations. Treatment with appropriate antibiotic regimen led to a clinical cure and marked improvement in Brucella titre in all the patients. This review illustrates that clinicians should remain vigilant for this infectious aetiology following renal transplantation. Further studies are required to delineate the magnitude and scope of this association.
Assuntos
Antibacterianos/uso terapêutico , Brucella melitensis/isolamento & purificação , Brucelose/diagnóstico , Transplante de Rim/efeitos adversos , Rim/microbiologia , Transplantados , Brucelose/tratamento farmacológico , Ciprofloxacina/uso terapêutico , Doxiciclina/uso terapêutico , Humanos , Rim/patologia , Masculino , Pessoa de Meia-Idade , Doadores de Tecidos , Resultado do TratamentoRESUMO
Cannabinoid hyperemesis syndrome (CHS) is a rare clinical syndrome characterised by nausea, cyclic vomiting and severe abdominal pain in association with chronic cannabis use. It is often under-recognised or misdiagnosed, resulting in the unnecessary workup and frequent hospitalisations. Long-term treatment of CHS is abstinence from cannabis, but acute symptomatic management has been a struggle for many clinicians. The present report highlights the use of haloperidol as an agent that successfully and safely treats the unrelenting symptoms of CHS.