RESUMO
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.
RESUMO
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.
RESUMO
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.
Assuntos
Vesícula Biliar/irrigação sanguínea , Hemorragia/etiologia , Cirrose Hepática/complicações , Varizes/complicações , Evolução Fatal , Vesícula Biliar/diagnóstico por imagem , Hemoperitônio/diagnóstico por imagem , Hemoperitônio/terapia , Hemorragia/diagnóstico por imagem , Humanos , Cirrose Hepática/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Varizes/diagnóstico por imagemAssuntos
Doenças Autoimunes do Sistema Nervoso/etiologia , Doenças Cerebelares/etiologia , Doença de Crohn/complicações , Doença Aguda , Adulto , Anticorpos Antinucleares/sangue , Doenças Autoimunes do Sistema Nervoso/diagnóstico por imagem , Doenças Autoimunes do Sistema Nervoso/imunologia , Ataxia Cerebelar/etiologia , Doenças Cerebelares/diagnóstico por imagem , Doenças Cerebelares/imunologia , Doença de Crohn/imunologia , Diplopia/etiologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Neuroimagem , Reflexo Anormal , Tomografia Computadorizada por Raios XAssuntos
Equinococose Hepática/complicações , Hipertensão Portal/etiologia , Antagonistas Adrenérgicos beta/uso terapêutico , Adulto , Albendazol/uso terapêutico , Anti-Helmínticos/uso terapêutico , Angiografia por Tomografia Computadorizada , Equinococose Hepática/diagnóstico por imagem , Equinococose Hepática/cirurgia , Procedimentos Cirúrgicos Eletivos , Varizes Esofágicas e Gástricas/etiologia , Hemorragia Gastrointestinal/etiologia , Hepatectomia , Humanos , Imageamento por Ressonância Magnética , Masculino , RecidivaRESUMO
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.
Assuntos
Fosfatase Alcalina/sangue , Hepatopatias/sangue , Hepatopatias/enzimologia , Fígado/enzimologia , Transaminases/sangue , gama-Glutamiltransferase/sangue , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Visita a Consultório Médico , Adulto JovemRESUMO
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.
Assuntos
Anti-Inflamatórios/administração & dosagem , Anticorpos Monoclonais Humanizados/administração & dosagem , Doença de Crohn/complicações , Dermatopatias/tratamento farmacológico , Dermatopatias/etiologia , Adalimumab , Adulto , Feminino , Humanos , Indução de RemissãoAssuntos
Colite Ulcerativa/induzido quimicamente , Isotretinoína/efeitos adversos , Ceratolíticos/efeitos adversos , Acne Vulgar/complicações , Acne Vulgar/tratamento farmacológico , Adulto , Colite Ulcerativa/patologia , Feminino , Humanos , Mucosa Intestinal/patologia , Isotretinoína/uso terapêutico , Ceratolíticos/uso terapêutico , Reto/patologiaRESUMO
No disponible
Assuntos
Humanos , Feminino , Idoso de 80 Anos ou mais , Histiocitose de Células de Langerhans/diagnóstico , Neoplasias do Colo/diagnóstico , Dor Abdominal/etiologia , Colonoscopia , Diagnóstico DiferencialRESUMO
No disponible
Assuntos
Humanos , Feminino , Adulto , Tretinoína/efeitos adversos , Colite Ulcerativa/induzido quimicamente , Acne Vulgar/tratamento farmacológico , ColonoscopiaRESUMO
No disponible
Assuntos
Humanos , Masculino , Adulto , Doença de Crohn/complicações , Doença de Crohn/diagnóstico por imagem , Doenças Cerebelares/complicações , Doenças Cerebelares/diagnóstico por imagem , Diplopia/complicações , Neurossífilis/complicações , Autoimunidade/efeitos dos fármacos , Metilprednisolona/uso terapêutico , Imageamento por Ressonância Magnética , Cabeça/diagnóstico por imagem , Anticorpos Antinucleares/análise , Imunossupressores/uso terapêuticoAssuntos
Produtos Biológicos/uso terapêutico , Doença de Crohn/tratamento farmacológico , Transplante de Fígado , Adalimumab , Adulto , Anticorpos Monoclonais Humanizados/uso terapêutico , Produtos Biológicos/efeitos adversos , Doença de Crohn/imunologia , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/uso terapêutico , Masculino , Tacrolimo/uso terapêutico , Fator de Necrose Tumoral alfa/antagonistas & inibidoresAssuntos
Humanos , Masculino , Pessoa de Meia-Idade , Hidrotórax/complicações , Hidrotórax/diagnóstico , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico , Encefalopatia Hepática/complicações , Encefalopatia Hepática/diagnóstico , Constipação Intestinal/complicações , Antibacterianos/uso terapêutico , Diuréticos/uso terapêutico , Encefalopatia Hepática/fisiopatologia , Encefalopatia Hepática , Radiografia Torácica/tendências , Radiografia Torácica , /instrumentação , /métodos , Ascite/complicações , AsciteRESUMO
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)