Intractable Hepatic Hydrothorax: A Successful Outcome following CPAP Treatment.

Hepatic hydrothorax is an uncommon complication in patients with end-stage liver disease. It may result in dyspnoea, hypoxia and infection, and carries a poor prognosis. Initial treatment is based on a sodium-free diet together with diuretics. In case of recurrent hydrothorax, a transjugular intrahepatic portosystemic shunt (TIPS) or liver transplant should be considered. Here we describe an 80-year-old woman with decompensated liver cirrhosis related to NASH who presented with refractory hepatic hydrothorax. Treatment with CPAP resulted in a marked improvement in her pleural effusion. LEARNING POINTS: Hydrothorax is uncommon, occurring in up to 4-6% of all patients with cirrhosis and in up to 10% of patients with decompensated cirrhosis.Hepatic hydrothorax can be refractory to diuretics and salt restriction.CPAP may be an interesting alternative treatment.

Acute Recurrent Pericarditis as the Inaugural Manifestation of Familial Mediterranean Fever.

Familial Mediterranean fever (FMF) is an inherited autosomal recessive disorder commonly found among individuals of Mediterranean or Middle Eastern descent and caused by Mediterranean Fever gene (MEFV) mutations on chromosome 16. It is the most frequent periodic febrile syndrome among the autoinflammatory syndromes. Typical febrile attacks include serosal inflammation, but although FMF is characterized by recurrent polyserositis, there is a little documentation of pericardial disease among patients. We report the case of a patient who presented recurrent pericarditis. Each episode occurred with a high fever and elevation of the C-reactive protein level. Treatment with colchicine was effective. The patient was found to be heterozygous for the V726A mutation. LEARNING POINTS: The aetiology of recurrent pericarditis is still largely unknown.The occurrence of pericarditis as a manifestation of familial Mediterranean fever is controversial.

Spontaneous Periodic Hypothermia in the Elderly: A Rare or Under-Recognised Syndrome.

Spontaneous periodic hypothermia is a rare syndrome presenting with recurrent, centrally mediated hypothermia without an identifiable systemic cause or brain lesion. The case of an 88-year-old woman with recurrent hypothermia is reported. Despite intensive investigation, no other manifestations of hypothalamic or autonomic dysfunction were found. No corpus callosum lesion was seen on MRI. The patient was successfully treated with clomipramine chlorhydrate. LEARNING POINTS: Periodic hypothermia in the elderly is a rare and possibly under-recognised syndrome.The causes of the syndrome remain unknown.Pharmacological trials have only been modestly successful.

Cannabis Hyperemesis Syndrome: A Still Under-Recognized Syndrome.

Cannabis is one of the most widely used illicit drugs in the world. Its use is associated with several short- and long-term side-effects such as changes in mood, impaired memory, impaired attention, depression and anxiety, and it is correlated with schizophrenia. Cannabinoid hyperemesis syndrome (CHS) is characterized by chronic cannabis use, cyclic intractable nausea and vomiting, and compulsive hot bathing. Patients are typically diagnosed with CHS only after multiple medical evaluations. Recent research has identified type 1 cannabinoid receptors in the intestinal nerve plexus that have an inhibitory effect on gastrointestinal motility. This effect may explain hyperemesis in cannabis users. The thermoregulatory role of endocannabinoids may be responsible for compulsive hot bathing. We describe the cases of two young men seeking repeated emergency room care with recurrent nausea and vomiting. Abstinence from cannabis led to resolution of vomiting symptoms and abdominal pain. LEARNING POINTS: Cannabis is one of the most widely used illicit drugs in world.Cannabinoid hyperemesis syndrome is an under-recognized syndrome that can lead to expensive and unrevealing investigations.Abstinence from cannabis led to resolution of symptoms.