Recurrent bacteremia after injection of N-butyl-2-cyanoacrylate for treatment of bleeding gastric varices: a case report and review of the literature.

BACKGROUND: Bleeding from gastric varices has high mortality rate, and obliteration using N-butyl-2-cyanoacrylate is the treatment of choice. Recurrent bacteremia is rarely reported following the procedure. We aimed to report a case of recurrent bacteremia after N-butyl-2-cyanoacrylate treatment and to review published cases. CASE PRESENTATION AND REVIEW: In May 2014, a 43-year-old Brazilian male presented with lower gastrointestinal bleeding. Endoscopy showed active bleeding from gastric varix. Injection of N-butyl-2-cyanoacrylate was performed and the patient was discharged. Over the next 4 months he presented with three episodes of bacteremia with severe sepsis and no identifiable focus of infection. Oral prophylaxis was initiated in September 2014 and he has remained free of bacteremia. Six other cases of recurrent bacteremia following sclerosis with N-butyl-2-cyanoacrylate were reported in the literature. All patients had portal hypertension and bleeding from gastric varices. Average age of patients was 55.7 years and the median time from endoscopic procedure to the first episode of bacteremia was 105 days (range 14-365). The mean number of episodes of bacteremia per patient was 2.5. CONCLUSION: Recurrent bacteremia associated with endoscopic treatment with N-2-butyl-cyanoacrylate is rare, but should be suspected in patients in which investigation shows no other focus of infection. Secondary prophylaxis should be considered after the first episode.

Doença de Kikuchi-Fujimoto: relato de três casos e revisão da literatura / Kikuchi-Fujimoto disease: description of three cases and review of the literature

A doença de Kikuchi-Fujimoto (DKF) é uma entidade rara, de caráter sistêmico que acomete principalmente mulheres em idade fértil. Manifesta-se clinicamente como linfadenopatia febril e dolorosa, usualmente em região cervical. Apresenta, geralmente, um curso autolimitado, embora existam relatos de evolução para doenças de fundo imunológico, em especial o lúpus eritematoso sistêmico (LES). Apresentamos três casos de DKF com dados clínicos e histopatológicos, sendo que se manifestou junto com LES, outro teve remissão espontânea e o terceiro apresentou manifestações sistêmicas mais graves, com acometimento hepático, e só entrou em remissão após corticoterapia. Discutimos as características clínicas, histopatológicas, etiológicas bem como o tratamento desta entidade. Enfatizamos, ainda, um acompanhamento contínuo desses pacientes, haja visto a possibilidade de acometimento sistêmico grave ou evolução para doença autoimune.