Subject(s)
Peritonitis , Pyometra , Female , Humans , Aged , Pyometra/complications , Peritonitis/complications , Fever/etiologySubject(s)
Lymphoma , Splenic Neoplasms , Humans , Lymphoma/pathology , Lymphocytes/pathology , Spleen/pathologySubject(s)
Hernia, Hiatal , Humans , Hernia, Hiatal/diagnosis , Hernia, Hiatal/diagnostic imaging , Fundoplication , HerniorrhaphySubject(s)
Foreign Bodies/diagnosis , Foreign Bodies/therapy , Wood , Adult , Anti-Bacterial Agents/therapeutic use , Female , Foreign Bodies/pathology , HumansSubject(s)
Abdominal Abscess/diagnostic imaging , Candidiasis, Invasive/diagnosis , HIV Infections/complications , Jaundice, Obstructive/diagnosis , Lymphoma/diagnosis , Pancreatic Diseases/diagnostic imaging , Pancreatic Neoplasms/diagnosis , Abdominal Abscess/complications , Abdominal Abscess/therapy , Anti-Bacterial Agents/therapeutic use , Antifungal Agents/therapeutic use , Candidiasis, Invasive/complications , Candidiasis, Invasive/drug therapy , Diagnosis, Differential , Drainage , Enterococcus , Ertapenem/therapeutic use , Female , Fluconazole/therapeutic use , Hepatitis B, Chronic/complications , Humans , Jaundice, Obstructive/etiology , Middle Aged , Pancreatic Diseases/complications , Pancreatic Diseases/therapyABSTRACT
A healthy young man presented to the emergency department with mild hemoptysis associated with cannabis abuse. He was on no medications and cocaine abuse was ruled out by both history and negative toxicology screens. There were neither signs of an infection, nor of a systemic or cardiac disease. Imaging studies were consistent with diffuse alveolar hemorrhage, a reported, albeit rare adverse drug reaction of tetrahydrocannabinol (Naranjo score 6). The patient improved spontaneously within a few days, hemoptysis stopped and repeat imaging was entirely normal. With the increase in cannabis abuse and enhanced cannabis potency worldwide clinicians may increasingly encounter even unusual cannabis-associated adverse drug reactions, including associated diffuse alveolar hemorrhage.
Subject(s)
Hemoptysis/etiology , Marijuana Abuse/complications , Pulmonary Alveoli/abnormalities , Humans , Male , Pulmonary Alveoli/physiopathology , Smokers , Young AdultSubject(s)
Gastroenterology , Gastrointestinal Diseases , Analgesics, Opioid/adverse effects , Colon , HumansSubject(s)
Alcohol Drinking/adverse effects , Brain Stem Infarctions/etiology , Cerebellar Diseases/etiology , Subclavian Steal Syndrome/complications , Aged , Brain Stem Infarctions/diagnosis , Brain Stem Infarctions/diagnostic imaging , Cerebellar Diseases/diagnosis , Cerebellar Diseases/diagnostic imaging , Computed Tomography Angiography , Humans , Male , Subclavian Steal Syndrome/diagnosis , Subclavian Steal Syndrome/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
A healthy, urban-dwelling man presented with lassitude, jaundice without increased liver enzymes or obstructive features on imaging, brief acute kidney injury, leucocytosis with near-normal C reactive protein and markedly increased serum amylase and lipase. Leptospirosis was not considered for 10 days because of the low incidence of the disease in the country, absent animal contact and physicians' low index of suspicion. Presentation without fever and without the commonly associated abdominal pain, myalgia, headache, thrombocytopaenia or elevated serum creatine kinase added to the diagnostic challenge. Once an infectious cause of acute pancreatitis was contemplated, leptospirosis was immediately sought and diagnosed by PCR of urine and microscopic agglutination test, and he fully recovered on ceftriaxone. Physicians in countries with a low incidence of leptospirosis should be more aware of the possibility of the disease even when several key features such as fever or pain are missing and the patient has a rare infectious acute pancreatitis.