[Ulcerative colitis associated with Vogt-Koyanagi-Harada disease]. / Colitis ulcerosa asociada a enfermedad de Vogt-Koyanagi-Harada.

We report the case of a female patient who was diagnosed with Vogt-Koyanagi-Harada disease at the age of 14 years and who developed myelopathy, resulting in paraparesis. A cerebral magnetic resonance imaging scan revealed the presence of T2-hyperintense lesions in the periventricular white matter, suggesting demyelinization. Twelve years later, ulcerative colitis was diagnosed during workup for abdominal pain associated with bloody diarrhea. The association of these two diseases has previously been reported anecdotically. The management of the ulcerative colitis was complicated by the patient's neurological manifestations. Even though recent reports support the use of anti-TNF drugs in the management of Vogt-Koyanagi-Harada-associated uveitis, because of the lack of experience in patients with neurological symptoms, and the presence of apparently demyelinating lesions in our patient, we did not use these drugs in this case.

Colitis ulcerosa asociada a enfermedad de Vogt-Koyanagi-Harada / Ulcerative colitis associated with Vogt-Koyanagi-Harada disease

A continuación se presenta el caso de una paciente diagnosticada a los 14 años de enfermedad de Vogt-Koyanagi-Harada (VKH) en la que posteriormente se desarrolló paraparesia por mielopatía secundaria a esta enfermedad. Asimismo, se detectaron en la resonancia magnética craneal lesiones en la sustancia blanca periventricular, hiperintensas en secuencias ponderadas en T2, indicativas de desmielinización. Doce años después, la paciente se realizó un estudio debido a un cuadro de dolor abdominal asociado a diarrea con productos patológicos siendo diagnosticada de colitis ulcerosa (CU).La asociación de estas 2 enfermedades se ha comunicado con anterioridad de forma anecdótica.Las manifestaciones neurológicas de la paciente complicaron el tratamiento terapéutico de la CU, ya que, aunque publicaciones recientes avalan el tratamiento con anti-TNF (antitumor necrosis factor‘antifactor de necrosis tumoral’) en la uveítis propia de enfermedad de VKH, la falta de experiencia en casos asociados a focalidad neurológica y el desconocimiento de la verdadera patogénesis de las lesiones parenquimatosas indicativas de desmielinización desaconsejaron el uso de estos fármacos en este caso (AU)

We report the case of a female patient who was diagnosed with Vogt-Koyanagi-Harada disease at the age of 14 years and who developed myelopathy, resulting in paraparesis. A cerebral magnetic resonance imaging scan revealed the presence of T2-hyperintense lesions in the periventricular white matter, suggesting demyelinization. Twelve years later, ulcerative colitis was diagnosed during workup for abdominal pain associated with bloody diarrhea.The association of these two diseases has previously been reported anecdotically.The management of the ulcerative colitis was complicated by the patient's neurological manifestations. Even though recent reports support the use of anti-TNF drugs in the management of Vogt-Koyanagi-Harada-associated uveitis, because of the lack of experience in patients with neurological symptoms, and the presence of apparently demyelinating lesions in our patient, we did not use these drugs in this case (AU)

Síndrome constitucional asociado a hepatotoxicidad por metformina / Constitutional syndrome associated to metformin induced hepatotoxictyn

La metformina es un antidiabético oral frecuentemente utilizado en el tratamiento de la diabetes mellitus tipo 2. En un 5-20% de los pacientes provoca trastornos gastrointestinales inespecíficos. Son mucho más raros otros efectos secundarios de mayor envergadura, como la acidosis láctica. Se han documentado algunos casos aislados de hepatotoxicidad por este fármaco. Presentamos el caso de un paciente con síndrome constitucional y alteración de la bioquímica hepática atribuible a hepatotoxicidad por metformina, tras descartarse mediante múltiples estudios una etiología tumoral y observarse una resolución completa del cuadro con la suspensión del fármaco

Metformin is an oral antidiabetic agent frequently used to manage type II diabetes. This drug produces nonspecific gastrointestinal symptoms in 5-20% of patients and, more rarely, has also been associated with severe adverse effects such as lactic acidosis. Only a few isolated cases of hepatotoxicity due to this drug have been documented. We report the case of an 83-year-old man with constitutional syndrome and hepatic biochemical alterations, which were attributedto metformin after ruling out an oncologic etiology and observing complete clinical and biochemical resolution after withdrawal of the drug

[Constitutional syndrome associated to metformin induced hepatotoxicity]. / Síndrome constitucional asociado a hepatotoxicidad por metformina.

Metformin is an oral antidiabetic agent frequently used to manage type II diabetes. This drug produces nonspecific gastrointestinal symptoms in 5-20% of patients and, more rarely, has also been associated with severe adverse effects such as lactic acidosis. Only a few isolated cases of hepatotoxicity due to this drug have been documented. We report the case of an 83-year-old man with constitutional syndrome and hepatic biochemical alterations, which were attributed to metformin after ruling out an oncologic etiology and observing complete clinical and biochemical resolution after withdrawal of the drug.