Chlorpropamide-induced granulomas. A probable hypersensitivity reaction in liver and bone marrow.

Anicteric hepatitis, associated with fever and exfoliative dermatitis, developed in a diabetic patient two weeks after intake of a long-acting sulfonylurea, chlorpropamide (Diabinese). Granulomas showing heavy infiltration with eosinophils were found in the liver and bone marrow. These were interpreted as manifestations of an allergic reaction. The clinical signs, abnormal laboratory findings, and hepatic lesions subsided spontaneously on withdrawal of the drug. Bone marrow changes, however, persisted seven months after cessation of the drug. To our knowledge, this is the first report of a patient with liver and bone marrow inflammation characterized by granulomas with eosinophilic infiltration following intake of chlorpropamide.

The clinical presentation of mesenteric vascular disease.

The clinical presentation of 17 patients with mesenteric vascular disease admitted to Mount Sinai Medical Center was reviewed. The signs and symptoms were similar in most cases. However, the acute onset of the symptom triad of abdominal pain, diarrhea, and bloody stools in an elderly patient should make one suspect the possibility of mesenteric vascular disease. The gross and light microscopic appearance of the intestinal tract was characterized by hemorrhagic infarcts regardless of the cause of the bowel ischemia. Mortality from this disease remains high, with only four of our 17 patients alive four months after operation.