ABSTRACT
La lesión hepática inducida por medicamentos o DILI (del inglés, Drug-Induced Liver Injury) es una condición relativamente rara, y más aún durante el embarazo. Usualmente es subdiagnosticada, y cuando se presenta en nuestro medio, pocas veces es notificada a los sistemas de registros nacionales, con un importante subregistro a nivel nacional y de Latinoamérica. Su forma de presentación clínica, tiempo de latencia, patrón de lesión hepática y reacciones idiosincráticas dificultan el diagnóstico oportuno, así como la ausencia tanto de pruebas diagnósticas objetivas, como de cambios histológicos patognomónicos que confirmen esta entidad. Se presenta el primer caso reportado en la literatura de una mujer en primer trimestre de gestación, quien cursó con DILI secundario al uso de tionamidas por sospecha clínica de hipertiroidismo.
Drug-induced liver injury (DILI) is a relative rare condition among general population and among pregnant women. It is usually underdiagnosed, and when identified, it is rarely notified to the national registry systems, especially locally, and in general in Latin America. Clinical presentation, time before symptom onset, patterns of liver injury and idiosyncratic reactions make an early diagnosis difficult, as well as the absence of diagnostic tests or histological changes that are unique to this pathology to confirm the diagnosis. We present the first case reported in the literature of a woman, who during the first trimester of pregnancy presented with DILI, secondary to the use of thionamides due to suspected hyperthyroidism.
Subject(s)
Humans , Pregnant Women , Chemical and Drug Induced Liver Injury , Toxicity , MethimazoleABSTRACT
La fístula biliopleurobronquial (FBB) es una comunicación anormal entre la vía biliar y el árbol bronquial. Es una condición infrecuente, generalmente secundaria a un proceso infeccioso local o a un evento traumático. La bilioptisis es patognomónica. Presentamos el caso de una mujer de 37 años con historia de cirrosis biliar secundaria, en lista para trasplante hepático, con múltiples episodios de colangitis previos y usuaria de derivación biliar externa, quien curso con bilioptisis y mediante gammagrafía HIDA con SPECT se confirmó fistula biliopleurobronquial. Éste caso se resolvió con derivación percutánea de la vía biliar
Bronchobiliary fistula (BBF) is an abnormal communication between the biliary tract and the bronchial tree. Is an infrequent condition, usually secondary to a local infectious process or a traumatic event. Bilioptisis is pathognomonic. We present the case of a 37 year old woman with secondary biliary cirrhosis, in list for liver transplantation, with several episodes of cholangitis and carrier of external biliary diverivation, who presented bilioptisis and HIDA scintigraphy with SPECT confirmed BBF. This case was resolved with percutaneous derivation of the biliary tract
Subject(s)
Adult , Female , Humans , Biliary Fistula/diagnosis , Bronchial Fistula/diagnosis , Cholecystectomy, Laparoscopic/adverse effects , Postoperative Complications/etiology , Bile , Bile Ducts/injuries , Biliopancreatic Diversion , Tomography, Emission-Computed, Single-Photon , Cholangitis/etiology , Biliary Fistula/etiology , Biliary Fistula/diagnostic imaging , Bronchial Fistula/etiology , Bronchial Fistula/diagnostic imaging , Cough , Catheters , Conversion to Open Surgery , Liver Cirrhosis, Biliary/etiologyABSTRACT
Bronchobiliary fistula (BBF) is an abnormal communication between the biliary tract and the bronchial tree. Is an infrequent condition, usually secondary to a local infectious process or a traumatic event. Bilioptisis is pathognomonic. We present the case of a 37 year old woman with secondary biliary cirrhosis, in list for liver transplantation, with several episodes of cholangitis and carrier of external biliary diverivation, who presented bilioptisis and HIDA scintigraphy with SPECT confirmed BBF. This case was resolved with percutaneous derivation of the biliary tract.
