RESUMEN
Primary tuberculosis (TB) of the graft presenting as multiple liver abscesses is previously unreported. A 14-month-old male child in the early post liver transplant (LT) period presented with high-grade fever spikes and on evaluation was found to have multiple pyogenic liver abscesses (PLA) in the CT abdomen. His fever was not responding to intravenous antibiotics and liver biopsy was done which showed numerous acid fast bacilli. Genetic analysis confirmed the bacilli as Mycobacterium tuberculosis (MTB). Timely diagnosis and prompt introduction of antituberculosis therapy were lifesaving.
Asunto(s)
Absceso Piógeno Hepático , Mycobacterium tuberculosis , Tuberculosis , Antituberculosos/uso terapéutico , Humanos , Lactante , Absceso Piógeno Hepático/tratamiento farmacológico , Masculino , Tuberculosis/tratamiento farmacológicoRESUMEN
Fascioliasis is caused by the trematode liver fluke Fasciola hepatica. Humans are accidental hosts getting infected after ingesting contaminated plants or water. 90 million people in 75 nations are at risk of infection with F hepatica. Immunosuppressed patients are higher risk of acquiring infection and may present with atypical manifestations. Patients can present with hepatic involvement, biliary features or a combination of both. Confirmation of the diagnosis is by demonstration of live parasites or eggs in bile or feces, serology (immunoelectrophoresis, indirect immunofluorescence, indirect hemagglutination), ELISA, typical imaging findings or a combination of any of the above. The drug of choice for treatment is triclabendazole. Fascioliasis should always be considered as a possibility in post-LT patients with findings of hepatobiliary disorder from endemic areas. Unfamiliarity with this infection in non-endemic areas often eludes prompt diagnosis thereby increasing the morbidity. We report the first case of fascioliasis in a pediatric liver transplant recipient leading to graft loss and mortality.
Asunto(s)
Enfermedad Hepática en Estado Terminal/cirugía , Fascioliasis/complicaciones , Rechazo de Injerto/parasitología , Trasplante de Hígado , Animales , Niño , Colangitis/tratamiento farmacológico , Medios de Contraste , Enfermedad Hepática en Estado Terminal/diagnóstico por imagen , Fasciola hepatica , Femenino , Humanos , Terapia de Inmunosupresión , Inmunosupresores/uso terapéutico , India , Marruecos , Ácido Micofenólico/uso terapéutico , Trasplante de Células Madre , Tacrolimus/uso terapéutico , Tomografía Computarizada por Rayos XRESUMEN
Liver cirrhosis in infancy can be secondary to various etiologies such as biliary atresia, familial cholestatic and metabolic disorders. Wolman's disease (WD) is a lysosomal storage disorder caused by the absence of lysosomal acid lipase enzyme activity and a significant association with infantile cholestasis and cirrhosis. We encountered an infant presenting with advanced cirrhosis and decompensation having splenomegaly for which the underlying etiology was found to be WD and the diagnostic clue came from abdominal X-ray showing bilateral adrenal calcifications. The diagnosis was confirmed by genetic analysis. The outcome was poor and died before 6 months of age without enzyme replacement therapy or hematopoietic stem cell transplantation.