RESUMO
No disponible
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Cirrose Hepática Alcoólica/complicações , Varizes Esofágicas e Gástricas/etiologia , Varizes Esofágicas e Gástricas , Mediastino/patologia , Mediastino , Tomografia Computadorizada EspiralRESUMO
Las reacciones adversas hepáticas relacionadas con la administraciónde fármacos (hepatotoxicidad) son cuadros relativamentefrecuentes que presentan una amplia variabilidad clínica e histológica.La identificación precoz de estos cuadros es fundamental enla práctica clínica debido a su potencial gravedad. En la mayoríade los casos la suspensión del fármaco desencadenante es suficientepara la resolución del cuadro clínico.A pesar de que los esteroides son utilizados en una amplia variedadde situaciones clínicas, la notificación de cuadros de hepatotoxicidadsecundaria a esteroides intravenosos es excepcional.Presentamos el caso clínico de una mujer diagnosticada de esclerosismúltiple, que recibió metilprednisolona a altas dosis enforma de pulsos intravenosos como tratamiento de las reagudizacionesde su enfermedad y presentó 3 brotes recurrentes de hepatitisde predominio hepatocelular con un patrón clínico, analíticoe histológico compatible con toxicidad hepática agudasecundaria a metilprednisolona intravenosa. En el tercer episodiose realizó una biopsia hepática que demostró un patrón de hepatitisaguda con necrosis líticas confluentes, histología no descritapreviamente en pacientes tratados con esteroides intravenosos
Adverse drug reactions (hepatotoxicity) are a frequent cause ofacute liver injury with a wide clinical and histological spectrum. Anearly recognition of drug-related liver disease has been consideredessential in clinical practice due to potential risks. In most casesexposure discontinuation improves the clinical picture.Steroids are used in a variety of clinical settings. However, intravenoussteroids have rarely been associated with hepatotoxicity.We report the case of a middle-aged woman with multiple sclerosiswho received a bolus of methylprednisolone on threeoccasions for the management of relapsing disease, with the developmentof repeated episodes of elevated liver enzymes aftercorticoid administration. In the third episode a liver biopsy wasperformed, which showed acute hepatitis with bridging necrosis;such histological picture has not been described before in patientstreated with intravenous steroids
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Metilprednisolona/efeitos adversos , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Doença Aguda , Necrose , Biópsia , Recidiva , Fígado/patologia , Injeções IntravenosasRESUMO
No disponible
Assuntos
Humanos , Masculino , Idoso , Transtornos de Deglutição/etiologia , Esôfago/cirurgia , Cabelo , Faringostomia , Retalhos Cirúrgicos/efeitos adversos , Procedimentos de Cirurgia Plástica/efeitos adversosRESUMO
Adverse drug reactions (hepatotoxicity) are a frequent cause of acute liver injury with a wide clinical and histological spectrum. An early recognition of drug-related liver disease has been considered essential in clinical practice due to potential risks. In most cases exposure discontinuation improves the clinical picture.Steroids are used in a variety of clinical settings. However, intravenous steroids have rarely been associated with hepatotoxicity. We report the case of a middle-aged woman with multiple sclerosis who received a bolus of methylprednisolone on three occasions for the management of relapsing disease, with the development of repeated episodes of elevated liver enzymes after corticoid administration. In the third episode a liver biopsy was performed, which showed acute hepatitis with bridging necrosis; such histological picture has not been described before in patients treated with intravenous steroids.
Assuntos
Doença Hepática Induzida por Substâncias e Drogas/etiologia , Metilprednisolona/efeitos adversos , Doença Aguda , Biópsia , Doença Hepática Induzida por Substâncias e Drogas/patologia , Feminino , Humanos , Injeções Intravenosas , Fígado/patologia , Metilprednisolona/administração & dosagem , Pessoa de Meia-Idade , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Necrose , RecidivaRESUMO
Treatment of inflammatory bowel disease should take some general considerations into account, standing out among them the importance of nutrition, antithrombotic prophylaxis in certain situations, prevention of osteoporosis and prevention of colorectal cancer by endoscopic screening in extensive ulcerous colitis or Crohn's colitis. Ulcerous colitis is still effectively treated with salicylates and steroids in its mild and moderate forms. Severe forms require parenteral steroids, cyclosporine or infliximab, and these are successfully used with immunosuppressants (azathioprine or mercaptopurine) in steroid dependence. Maintenance with salicylates, that should be adequately complied with, is an important point. Crohn's disease is treated with steroids in its mild and moderate forms, and again in corticodependent ones with immunosuppressants, which we are using increasingly sooner. Refractory forms or fistulous forms benefit from the use of biological treatments (infliximab) generally accompanied by immunosuppressants.
Assuntos
Colite Ulcerativa/terapia , Doença de Crohn/terapia , HumanosRESUMO
El tratamiento de la enfermedad inflamatoria intestinal debe tener en cuenta unas consideraciones generales, entre las que destacan la importancia de la nutrición, de la profilaxis antitrombótica en determinadas situaciones, de la prevención de la osteoporosis y de la prevención del cáncer colorrectal mediante cribado endoscópico en la colitis ulcerosa o la colitis de Crohn extensas. La colitis ulcerosa se sigue tratando eficazmente con salicilatos y esteroides en las formas leves y moderadas. Las formas graves requieren esteroides parenterales, ciclosporina o infliximab, y se emplean con éxito inmunosupresores (azatioprina o mercaptopurina) en la dependencia a esteroides. El mantenimiento con salicilatos, que debe ser cumplido adecuadamente, es un punto importante. La enfermedad de Crohn se trata con esteroides en sus formas leves y moderadas, y en las corticodependientes de nuevo con inmunosupresores, que cada vez usamos más pronto. Las formas refractarias o las formas fistulosas se benefician del uso de tratamientos biológicos (infliximab), por lo general acompañados de inmunosupresores (AU)
Treatment of inflammatory bowel disease should take some general considerations into account, standing out among them the importance of nutrition, antithrombotic prophylaxis in certain situations, prevention of osteoporosis and prevention of colorectal cancer by endoscopic screening in extensive ulcerous colitis or Crohn's colitis. Ulcerous colitis is still effectively treated with salicylates and steroids in its mild and moderate forms. Severe forms require parenteral steroids, cyclosporine or infliximab, and these are successfully used with immunosuppressants (azathioprine or mercaptopurine) in steroid dependence. Maintenance with salicylates, that should be adequately complied with, is an important point. Crohn's disease is treated with steroids in its mild and moderate forms, and again in corticodependent ones with immunosuppressants, which we are using increasingly sooner. Refractory forms or fistulous forms benefit from the use of biological treatments (infliximab) generally accompanied by immunosuppressants (AU)
