ABSTRACT
Rare cases of carcinoid syndromes can develop from either gastrointestinal neuroendocrine tumors (NETs) without liver metastasis or large retroperitoneal involvement. We report a case of a patient with isolated flushing highly suggestive of carcinoid syndrome caused by an ileal NET with adjacent lymph node metastases but with no liver metastases. The final diagnose was delayed for this patient due to a combination of misleading clinical presentation and negative usual screening tests (urinary 5-HIAA and serum chromogranine A). Given its high sensitivity and specificity, 68Ga-DOTATATE PET/CT confirmed the diagnosis of neuroendocrine tumor. Therefore, this case reminds clinicians that carcinoid syndrome may manifest as flushing only and highlights that imaging is a major aspect of the evaluation and diagnosis of patients with suspected gastrointestinal NETs.
Subject(s)
Carcinoid Tumor , Neuroendocrine Tumors , Carcinoid Tumor/diagnosis , Humans , Neuroendocrine Tumors/diagnosis , Positron Emission Tomography Computed Tomography , Positron-Emission Tomography , RadiopharmaceuticalsABSTRACT
BACKGROUND: Hepatitis E virus (HEV) may be resistant to immunosuppression reduction and ribavirin treatment in kidney transplant recipients because of mutant strains and severe side effects of ribavirin which conduct to dose reduction. Sofosbuvir efficacy is controversial. Peg-interferon 2 alpha (PEG-IFN) is currently contraindicated due to a high risk of acute humoral and cellular rejection. The present study assessed, for the first time, the effect of PEG-IFN in a kidney transplant recipient infected with HEV. CASE PRESENTATION: The patient had chronic active HEV that was resistant to immunosuppression reduction and optimal ribavirin treatment. He developed significant liver fibrosis. PEG-IFN was administered for 10 months, and it was well tolerated and did not induce rejection. A sustained virological response was obtained. CONCLUSIONS: We conclude that prolonged treatment with PEG-IFN in kidney transplant recipients infected with HEV could be considered as a salvage option.
Subject(s)
Drug Resistance, Viral/drug effects , Hepatitis E/drug therapy , Hepatitis, Chronic/drug therapy , Interferon-alpha/therapeutic use , Kidney Transplantation , Polyethylene Glycols/therapeutic use , Ribavirin/therapeutic use , Transplant Recipients , Hepatitis E/virology , Hepatitis E virus/drug effects , Hepatitis E virus/physiology , Hepatitis, Chronic/virology , Humans , Male , Middle Aged , Recombinant Proteins/therapeutic use , Remission Induction , Sustained Virologic Response , Treatment OutcomeABSTRACT
We report the first successful use, to our knowledge, of fumagillin alone in a pediatric patient to cure intestinal microsporidiosis in a liver-kidney transplanted child. Detection of Enterocytozoon bieneusi in stool became negative from the first post-therapeutic control, while digestive symptoms disappeared in 4 days. During a 9-month follow-up, polymerase chain reaction and direct examinations remained negative for microsporidia in her feces. No major undesirable effects were noted during the anti-microsporidial therapy.