Thrombotic microangiopathy and disseminated intravascular coagulation in a patient with carcinomatosis of the bone marrow due to gastric adenocarcinoma: Case report.

Carcinomatosis of the bone marrow is a rare clinical condition characterized by diffuse tumor infiltration of the bone marrow accompanied by hematological abnormalities, including thrombotic microangiopathy (TMA) and disseminated intravascular coagulation (DIC). In patients with gastric carcinoma, this association is infrequent. Below we present a case of a 19-year-old female patient with no known pathological history who presented with upper digestive tract bleeding. Upon examination, anemia and thrombocytopenia were documented, with schistocytes in the peripheral blood smear and prolonged coagulation times. Endoscopic studies indicated a lesion in the Borrmann IV gastric body, and the bone marrow biopsy showed the presence of signet ring cells. Because there was no possibility of systemic therapy, the patient died during hospitalization. This case contributes to the medical literature by describing an unusual presentation of a very frequent pathology.

Lesión hepática inducida por consumo de Valeriana officinalis y Passiflora incarnata, reporte de caso / Hepatic injury induced by the consumption of Valeriana officinalis and Passiflora incarnata, a case report

Los medicamentos homeopáticos y fitoterapéuticos que contienen productos herbarios son cada vez más utilizados, sin embargo, se desconoce el potencial de efectos adversos por parte de los usuarios y personal sanitario. Se reporta el caso de una mujer de 34 años quien consulta por dolor abdominal y náuseas, con alteraciones al ingreso de función hepática con patrón hepatocelular, se descartaron múltiples etiologías y se consideró que pudiera ser lesión hepática medicamentosa secundaria al consumo de medicamentos desde hacía una semana para dismenorrea, y a fitoterapéuticos que consumía de forma crónica, los cuales se suspendieron. A los doce días de su egreso, reingresó por sintomatología similar; se documentó nuevamente perfil hepático con patrón hepatocelular. Al reinterrogatorio, la paciente comentó la ingesta crónica de Valeriana officinalis y Passiflora incarnata, que retomó al egreso hospitalario, por lo que luego de descartar diagnósticos diferenciales, se consideró que el cuadro era inducido por el consumo de dichos medicamentos. Durante la hospitalización se suspendió su consumo, con normalización del perfil hepático. Es importante que los consumidores estén informados sobre los riesgos potenciales de los productos herbarios, sus efectos por consumos prolongados y las implicaciones de la autoformulación.

Homeopathic and phytotherapeutic medicines containing herbal products are increasingly used, however the potential for adverse effects on users and healthcare personnel is unknown. We report the case of a 34-year-old woman who consulted for abdominal pain and nausea, accompanied by hepatocellular pattern on liver function tests. Multiple etiologies were ruled out and it was considered that it could be a drug-induced liver injury secondary to the consumption of medications she had been taking a week prior for dysmenorrhea, and phytotherapeutics that she had been taking for seve-ral years, which were all discontinued. Twelve days after her discharge, she was readmitted due to similar symptoms; a liver profile with a hepatocellular pattern was again documented. Upon further questioning, the patient mentioned a chronic intake of Valeriana officinalis and Passiflora incarnata, which she resumed upon discharge. After ruling out the differential diagnoses, it was concluded that the symptoms of the patient were induced by the consumption of these herbal products. During hos-pitalization, their consumption was suspended, with normalization of the liver profile. It is important that consumers are informed about the potential risks of herbal products, their effects from long-term use, and the implications of self-medication.