RESUMEN
Portopulmonary hypertension (POPH) is a not infrequent but serious complication of liver cirrhosis. Continuous intravenous epoprostenol infusion is a treatment option for this condition. Progressive splenomegaly with pancytopenia (hypersplenism) is associated with epoprostenol use in POPH. After recognizing a case of epoprostenol-induced hypersplenism that resolved upon stopping the drug, the authors retrospectively reviewed all patients treated with epoprostenol at the center for both POPH and pulmonary hypertension due to other causes. Five of 11 patients with POPH developed hypersplenism secondary to epoprostenol. In 1 patient, and possibly in a second, the hypersplenism resolved upon discontinuation of epoprostenol. None of 9 patients with pulmonary hypertension due to other causes developed splenomegaly. This report confirms hypersplenism as a complication of epoprostenol therapy for POPH. Furthermore, the authors demonstrate for the first time that hypersplenism may be reversed by stopping the medication and propose a mechanism for this phenomenon.
Asunto(s)
Antihipertensivos/efectos adversos , Epoprostenol/efectos adversos , Hipertensión Portal/tratamiento farmacológico , Hipertensión Pulmonar/tratamiento farmacológico , Esplenomegalia/inducido químicamente , Antihipertensivos/uso terapéutico , Epoprostenol/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Anemia Ferropénica/diagnóstico , Derivación Gástrica/efectos adversos , Hemocromatosis/cirugía , Complicaciones Posoperatorias/diagnóstico , Anemia Ferropénica/sangre , Anemia Ferropénica/etiología , Femenino , Hemocromatosis/sangre , Humanos , Persona de Mediana Edad , Obesidad/sangre , Obesidad/cirugía , Complicaciones Posoperatorias/sangre , Complicaciones Posoperatorias/etiologíaRESUMEN
Patients with an autoimmune disease have a propensity for development of a second autoimmune disease. We report the first instance of a patient with both idiopathic thrombotic thrombocytopenic purpura (TTP) and Graves disease. The TTP remitted with a combination of plasmapheresis and prednisone. Methimazole led to sustained remission of the hyperthyroid state within 6 weeks. Although hyperthyroidism may induce immune imbalance causing autoimmunity, it is unclear if this influenced the development of TTP in our patient and if treatment of hyperthyroidism alone could have resulted in the cure of both diseases.
Asunto(s)
Enfermedad de Graves/complicaciones , Púrpura Trombocitopénica Trombótica/complicaciones , Femenino , Enfermedad de Graves/diagnóstico , Enfermedad de Graves/terapia , Humanos , Persona de Mediana Edad , Plasmaféresis , Púrpura Trombocitopénica Trombótica/diagnóstico , Púrpura Trombocitopénica Trombótica/terapiaRESUMEN
We report a 27-year-old man with HIV-1 infection who developed acute promyelocytic leukemia (APL) with a novel complex three-way chromosomal translocation t(15;16;17). Induction of remission and consolidation with all-trans-retinoic acid (ATRA)- and anthracycline-based chemotherapy was followed by maintenance therapy consisting of ATRA, 6-mercaptopurine (6-MP), and methotrexate (MTX). Highly active antiretroviral therapy (HAART) was continued with brief interruptions. He remains in complete remission 40 months after diagnosis.
Asunto(s)
Infecciones por VIH/complicaciones , VIH-1 , Leucemia Promielocítica Aguda/virología , Adulto , Antraciclinas/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Terapia Antirretroviral Altamente Activa , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/virología , Homosexualidad Masculina , Humanos , Leucemia Promielocítica Aguda/diagnóstico , Leucemia Promielocítica Aguda/tratamiento farmacológico , Masculino , Mercaptopurina/administración & dosificación , Metotrexato/administración & dosificación , Resultado del Tratamiento , Tretinoina/administración & dosificaciónAsunto(s)
Biopsia con Aguja/efectos adversos , Hematoma/etiología , Adulto , Examen de la Médula Ósea/efectos adversos , Femenino , Hematócrito , Hematoma/diagnóstico por imagen , Humanos , Conducto Inguinal , Masculino , Persona de Mediana Edad , Pancitopenia/complicaciones , Transfusión de Plaquetas , Púrpura Trombocitopénica Idiopática/complicaciones , Muslo , Tomografía Computarizada por Rayos XAsunto(s)
Celulitis (Flemón)/diagnóstico , Hematoma/diagnóstico , Enfermedades Musculares/diagnóstico , Adulto , Celulitis (Flemón)/sangre , Diagnóstico Diferencial , Hematoma/sangre , Humanos , Imagen por Resonancia Magnética , Masculino , Enfermedades Musculares/sangre , Tiempo de Tromboplastina ParcialRESUMEN
We present the case of a 42-year-old woman with myotonic dystrophy and thymoma. She was treated with combination chemotherapy followed by external beam radiation, and remains in remission 19 months after thymoma was diagnosed. The myotonic dystrophy is unchanged. Only six cases of this nature have been reported in the literature, and this patient is the first to be successfully treated with combined modality therapy.