RESUMEN
Both psoriasis and inflammatory bowel disease (IBD) are immunomediated diseases. Some of their therapeutic tools are monoclonal antibodies. Ixekizumab is an interleukin-17 (IL-17) inhibitor approved for the treatment of psoriasis. Cases of IBD onset have been reported in patients treated with this drug. We present the case of a 35-year-old patient with the onset of ulcerative colitis (UC) type of IBD after starting ixekizumab treatment.
RESUMEN
Hepatic focal lesions are a heterogeneous group of lesions that can be either benign or malignant in nature. They are typically diagnosed through ultrasound in all cases needing to rule out a metastatic nature. We present the case of a 51-year-old male from Morocco diagnosed with hepatic SOLs in the context of abdominal pain and constitutional syndrome.
RESUMEN
Liver cirrhosis is a disease related to numerous severe complications such as portal hypertension or collateral circulation. Varices that are located outside the gastroesophageal region (ectopic varices) such as the anorectal region, colon, ileum or gallbladder are unusual. In many cases, they are related to the existence of portal vein thrombosis. We report the case of a patient with a severe hemorrhage of gallbladder varices due to alcohol-related cirrhosis.
Asunto(s)
Vesícula Biliar/irrigación sanguínea , Hemorragia/etiología , Cirrosis Hepática/complicaciones , Várices/complicaciones , Resultado Fatal , Vesícula Biliar/diagnóstico por imagen , Hemoperitoneo/diagnóstico por imagen , Hemoperitoneo/terapia , Hemorragia/diagnóstico por imagen , Humanos , Cirrosis Hepática/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Várices/diagnóstico por imagenAsunto(s)
Enfermedades Autoinmunes del Sistema Nervioso/etiología , Enfermedades Cerebelosas/etiología , Enfermedad de Crohn/complicaciones , Enfermedad Aguda , Adulto , Anticuerpos Antinucleares/sangre , Enfermedades Autoinmunes del Sistema Nervioso/diagnóstico por imagen , Enfermedades Autoinmunes del Sistema Nervioso/inmunología , Ataxia Cerebelosa/etiología , Enfermedades Cerebelosas/diagnóstico por imagen , Enfermedades Cerebelosas/inmunología , Enfermedad de Crohn/inmunología , Diplopía/etiología , Humanos , Imagen por Resonancia Magnética , Masculino , Neuroimagen , Reflejo Anormal , Tomografía Computarizada por Rayos XAsunto(s)
Equinococosis Hepática/complicaciones , Hipertensión Portal/etiología , Antagonistas Adrenérgicos beta/uso terapéutico , Adulto , Albendazol/uso terapéutico , Antihelmínticos/uso terapéutico , Angiografía por Tomografía Computarizada , Equinococosis Hepática/diagnóstico por imagen , Equinococosis Hepática/cirugía , Procedimientos Quirúrgicos Electivos , Várices Esofágicas y Gástricas/etiología , Hemorragia Gastrointestinal/etiología , Hepatectomía , Humanos , Imagen por Resonancia Magnética , Masculino , RecurrenciaRESUMEN
BACKGROUND: Liver enzyme (LE) elevation is a common finding in routine blood analysis. There is very little information on the most prevalent causes of these alterations in our population. In addition, a number of tests and several visits to the specialist are required to reach a diagnosis. For these reasons, we designed a protocol to streamline the evaluation of patients with LE elevations in a single-act office visit. METHODS: From March 2008 until June 2010, we studied all patients with incidental LE elevation (isolated transaminase elevation, combined elevation of alkaline phosphatase [FA] and gamma-glutamyl transpeptidase [GGT], or isolated elevation of GGT) who were referred by their primary care physicians. At the time of referral, a complete biochemistry analysis was performed (LE, viral serology, autoantibodies, ceruloplasmin, iron metabolism, alpha-1-antitrypsin and thyroid hormones) and the patients underwent an abdominal ultrasound scan on the day of the office evaluation by the hepatologist. RESULTS: A total of 427 patients were included in our study. The most common cause of transaminase elevation was non-alcoholic fatty liver disease (NAFLD) (40%), followed by alcohol intake (17%), and hepatitis C virus infection (13%). Elevated GGT levels were most commonly related to NAFLD (30%), closely followed by alcohol intake (27%), and hepatotoxicity (8%). Combined elevation of GGT and FA was associated with NAFLD (21%), alcohol (17%), and hepatotoxicity (11%). Self-limited elevation was seen in 9% of the patients and we could not identify a definite cause in 11%. A definitive diagnosis was reached in 79% of the patients. CONCLUSIONS: The single-act office visit has proven to be efficient, yielding a diagnosis in most of the patients. The most common cause of elevated LE was NAFLD. Transaminase elevation must be confirmed before a more thorough work-up is started.
Asunto(s)
Fosfatasa Alcalina/sangre , Hepatopatías/sangre , Hepatopatías/enzimología , Hígado/enzimología , Transaminasas/sangre , gamma-Glutamiltransferasa/sangre , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Visita a Consultorio Médico , Adulto JovenRESUMEN
Inflammatory bowel disease is accompanied by extraintestinal manifestations in a high percentage of patients. Cutaneous lesions are the second most prevalent of these manifestations, and within these, metastatic Crohn's disease is one of the least common, being the least frequent specific cutaneous manifestation of Crohn's disease. This entity includes cutaneous and subcutaneous lesions with a non-caseating granulomatous appearance on histological analysis identical to that of Crohn's disease. These lesions are not found adjacent to the digestive tract. Due to the low prevalence of these manifestations, conclusive trials on the treatment of choice have not been performed and there is no well-defined therapeutic strategy. Distinct therapies with varying results have been reported. We report the case of a female patient with longstanding and complex Crohn's disease who developed metastatic cutaneous manifestations while receiving adalimumab. The cutaneous manifestations responded well to dose intensification of this drug. A review of the literature is provided.
Asunto(s)
Antiinflamatorios/administración & dosificación , Anticuerpos Monoclonales Humanizados/administración & dosificación , Enfermedad de Crohn/complicaciones , Enfermedades de la Piel/tratamiento farmacológico , Enfermedades de la Piel/etiología , Adalimumab , Adulto , Femenino , Humanos , Inducción de RemisiónAsunto(s)
Colitis Ulcerosa/inducido químicamente , Isotretinoína/efectos adversos , Queratolíticos/efectos adversos , Acné Vulgar/complicaciones , Acné Vulgar/tratamiento farmacológico , Adulto , Colitis Ulcerosa/patología , Femenino , Humanos , Mucosa Intestinal/patología , Isotretinoína/uso terapéutico , Queratolíticos/uso terapéutico , Recto/patologíaRESUMEN
BACKGROUND/AIMS: The objective of our study was to determine the epidemiological, laboratory, and serological characteristics of patients with chronic hepatitis B virus (HBV) infection and normal transaminases. The study also aimed to evaluate liver damage by measuring the liver fibrosis (LF) grade and to identify possible factors associated with the presence of fibrosis. METHODS: A retrospective observational study was conducted in patients with chronic HBV infection and classified as inactive carriers or immune-tolerant. Epidemiological variables of age, sex, immigrant, alcohol consumption, and body mass index (BMI), as well as virological variables (HBV DNA) and transaminase level were collected throughout the follow-up. The LF grade was evaluated by transient elastography. The cutoff value for significant fibrosis (SF) was liver stiffness ≥7.9 kPa. RESULTS: A total of 214 patients were included in the analysis, and 62% of them had a BMI ≥25 kg/m². During follow-up, 4% of patients showed transaminase elevation ( < 1.5 times normal). Most patients had a viral DNA level < 2,000 IU/mL (83%). Data on LF were available in 160 patients; of these, 14% had SF, 9% F3, and 6% F4. The variables associated with the presence of SF were transaminase alteration during follow-up, as 23% of patients with SF had elevated transaminases versus 3% of patients without SF (P < 0.005), and BMI, as the vast majority of patients with SF (88%) had a BMI ≥25 kg/m² versus 56% of patients without SF (P < 0.05). CONCLUSIONS: In patients with chronic HBV infection and normal transaminases, liver damage does not seem to be related to DNA levels, alcohol consumption, or immigrant status. SF seems to be associated with transaminase alteration during follow-up and elevated BMI. It is therefore recommended to measure LF grade with validated non-invasive methods in such patients.
Asunto(s)
Humanos , Consumo de Bebidas Alcohólicas , Índice de Masa Corporal , ADN , ADN Viral , Diagnóstico por Imagen de Elasticidad , Emigrantes e Inmigrantes , Fibrosis , Estudios de Seguimiento , Antígenos e de la Hepatitis B , Hepatitis B Crónica , Hepatitis Crónica , Cirrosis Hepática , Hígado , Estudio Observacional , Estudios Retrospectivos , TransaminasasRESUMEN
No disponible
Asunto(s)
Humanos , Femenino , Anciano de 80 o más Años , Histiocitosis de Células de Langerhans/diagnóstico , Neoplasias del Colon/diagnóstico , Dolor Abdominal/etiología , Colonoscopía , Diagnóstico DiferencialRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Hemorragia Gastrointestinal/etiología , Cirrosis Hepática/complicaciones , Várices/complicaciones , Enfermedades de la Vesícula Biliar/complicaciones , Enfermedades de la Vesícula Biliar/diagnóstico por imagen , Resultado FatalRESUMEN
No disponible
Asunto(s)
Humanos , Femenino , Adulto , Tretinoina/efectos adversos , Colitis Ulcerosa/inducido químicamente , Acné Vulgar/tratamiento farmacológico , ColonoscopíaRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Adulto , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/diagnóstico por imagen , Enfermedades Cerebelosas/complicaciones , Enfermedades Cerebelosas/diagnóstico por imagen , Diplopía/complicaciones , Neurosífilis/complicaciones , Autoinmunidad/efectos de los fármacos , Metilprednisolona/uso terapéutico , Imagen por Resonancia Magnética , Cabeza/diagnóstico por imagen , Anticuerpos Antinucleares/análisis , Inmunosupresores/uso terapéuticoAsunto(s)
Productos Biológicos/uso terapéutico , Enfermedad de Crohn/tratamiento farmacológico , Trasplante de Hígado , Adalimumab , Adulto , Anticuerpos Monoclonales Humanizados/uso terapéutico , Productos Biológicos/efectos adversos , Enfermedad de Crohn/inmunología , Humanos , Huésped Inmunocomprometido , Inmunosupresores/uso terapéutico , Masculino , Tacrolimus/uso terapéutico , Factor de Necrosis Tumoral alfa/antagonistas & inhibidoresAsunto(s)
Humanos , Masculino , Persona de Mediana Edad , Hidrotórax/complicaciones , Hidrotórax/diagnóstico , Cirrosis Hepática/complicaciones , Cirrosis Hepática/diagnóstico , Encefalopatía Hepática/complicaciones , Encefalopatía Hepática/diagnóstico , Estreñimiento/complicaciones , Antibacterianos/uso terapéutico , Diuréticos/uso terapéutico , Encefalopatía Hepática/fisiopatología , Encefalopatía Hepática , Radiografía Torácica/tendencias , Radiografía Torácica , /instrumentación , /métodos , Ascitis/complicaciones , AscitisRESUMEN
Resumen La enfermedad inflamatoria intestinal se acompaña de manifestaciones extraintestinales en un elevado porcentaje de pacientes. Las manifestaciones cutáneas son las segundas en prevalencia, y dentro de ellas, la enfermedad de Crohn metastásica es una de la más raras, siendo de hecho la forma menos frecuente de manifestación cutánea específica de la enfermedad de Crohn. Esta entidad reúne lesiones cutáneas y subcutáneas con una histología granulomatosa no caseificante idéntica a la enfermedad de Crohn, que no se encuentran contiguas al tracto digestivo. Precisamente, debido a su escasa prevalencia, no se han podido realizar ensayos concluyentes sobre su tratamiento de elección, no existiendo una estrategia terapéutica definida y habiéndose comunicado el empleo de diversas terapias con resultado variable. Presentamos el caso de una paciente con enfermedad de Crohn de evolución larga y compleja, que estando en tratamiento con adalimumab desarrolló una enfermedad de Crohn metastásica cutánea que respondió tras intensificar el tratamiento con el mismo anti-TNF. Se realiza una revisión de la literatura médica (AU)
Abstract Inflammatory bowel disease is accompanied by extraintestinal manifestations in a high percentage of patients. Cutaneous lesions are the second most prevalent of these manifestations, and within these, metastatic Crohn's disease is one of the least common, being the least frequent specific cutaneous manifestation of Crohn's disease. This entity includes cutaneous and subcutaneous lesions with a non-caseating granulomatous appearance on histological analysis identical to that of Crohn's disease. These lesions are not found adjacent to the digestive tract. Due to the low prevalence of these manifestations, conclusive trials on the treatment of choice have not been performed and there is no well-defined therapeutic strategy. Distinct therapies with varying results have been reported.We report the case of a female patient with longstanding and complex Crohn's disease who developed metastatic cutaneous manifestations while receiving adalimumab. The cutaneous manifestations responded well to dose intensification of this drug. A review of the literature is provided (AU)