RESUMO
OBJECTIVES: Dilatation of the common bile duct (CBD) can be an ominous sign for malignancy of the pancreatobiliary tract; however, it has also been described as a presumably harmless side effect of opioid use. We investigated the prevalence and determinants of CBD dilatation among drug users receiving methadone maintenance therapy in the Netherlands. METHODS: A cross-sectional study was conducted in a prospectively studied and well-defined cohort of drug users with chronic hepatitis C virus infection, attending the Public Health Service of Amsterdam, the Netherlands. Patients underwent abdominal ultrasonography as part of pretreatment screening. A multivariable logistic regression model was used to analyze potential demographic and drug use-related determinants of radiological CBD dilatation. RESULTS: Between September 2004 and December 2011, 222 hepatitis C virus-infected drug users were evaluated. Dilatation of the CBD was found in 50 of 222 patients (22.5%), with a median diameter of 8.0 mm (interquartile range, 7.0 to 10.0; n = 43). Dilatation was associated with current use of methadone (adjusted odds ratio = 20.50; 95% confidence interval, 2.79 to 2.61 × 10(3)), independent of the current methadone dose, and with age per 10-year increase (adjusted odds ratio = 1.68; 95% confidence interval, 1.06 to 2.71). Regular use of heroin in the 6 months before ultrasonography was not found to be associated with dilatation. CONCLUSIONS: Dilatation of the CBD is common in drug users under methadone treatment and seems to be a harmless side effect of opioid agonists.
Assuntos
Doenças do Ducto Colédoco/virologia , Hepatite C Crônica/patologia , Metadona/administração & dosagem , Tratamento de Substituição de Opiáceos/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/virologia , Adulto , Análise de Variância , Doenças do Ducto Colédoco/diagnóstico por imagem , Doenças do Ducto Colédoco/patologia , Estudos Transversais , Dilatação Patológica , Progressão da Doença , Feminino , Hepatite C Crônica/diagnóstico por imagem , Humanos , Masculino , Metadona/efeitos adversos , Pessoa de Meia-Idade , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/patologia , UltrassonografiaRESUMO
Cytomegalovirus (CMV) can cause severe infections with serious consequences in renal transplant recipients. Disseminated CMV infections can affect almost every organ, but obstructive cholestasis and cholangitis, as a consequence of a CMV-induced papillitis, is extremely rare. We are reporting a rare case of obstructive cholestasis and cholecystitis due to CMV-related inflammation of the major duodenal papilla in a 60-year-old woman 3 months after renal transplantation. In addition, the patient suffered from a disseminated CMV infection with ulcerative esophagitis and gastritis. Because of the severe CMV infection, failure of the renal graft occurred. Obstructive cholestasis was resolved through internal stenting, and the progressive cholecystitis necessitated an emergency cholecystectomy. Following antiviral therapy with ganciclovir, the gastrointestinal ulcerations regressed and renal function was restored. Diagnosis of the CMV-related disease was established only in tissue samples, whereas standard serologic tests had failed.
Assuntos
Colecistite Acalculosa , Ampola Hepatopancreática/virologia , Colangite , Colestase Intra-Hepática , Doenças do Ducto Colédoco , Infecções por Citomegalovirus , Transplante de Rim/efeitos adversos , Colecistite Acalculosa/complicações , Colecistite Acalculosa/virologia , Aloenxertos , Colangite/complicações , Colangite/virologia , Colestase Intra-Hepática/complicações , Colestase Intra-Hepática/virologia , Doenças do Ducto Colédoco/complicações , Doenças do Ducto Colédoco/virologia , Citomegalovirus/isolamento & purificação , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/virologia , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
Acute pancreatitis with cholangiopathy is an uncommon complication in renal transplant patients. Further, a combination of pancreatitis and cholangiopathy due to CMV disease in renal allograft recipient is further uncommon. We report a renal transplant recipient who developed acute pancreatitis and cholangiopathy with CMV papillitis of the Ampulla of Vater.
Assuntos
Ampola Hepatopancreática/virologia , Doenças do Ducto Colédoco/virologia , Infecções por Citomegalovirus/etiologia , Transplante de Rim/efeitos adversos , Pancreatite/virologia , Doença Aguda , Adulto , Ampola Hepatopancreática/patologia , Antivirais/uso terapêutico , Biópsia , Colangiopancreatografia Retrógrada Endoscópica , Colangiopancreatografia por Ressonância Magnética , Doenças do Ducto Colédoco/diagnóstico , Doenças do Ducto Colédoco/terapia , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/tratamento farmacológico , Ganciclovir/uso terapêutico , Humanos , Imunossupressores/efeitos adversos , Doadores Vivos , Masculino , Pancreatite/diagnóstico , Pancreatite/tratamento farmacológico , Fatores de Risco , Esfinterotomia Endoscópica/instrumentação , Stents , Transplante Homólogo , Resultado do TratamentoRESUMO
A 57-yr-old male on long-term steroid therapy presented with hematemesis, fever, and a retroperitoneal fluid collection. Hemobilia was diagnosed, but the cause was not identified by ERCP, computed tomography, or angiography. Peroral cholangioscopy revealed multiple biliary ulcers. Cholangioscopic biopsies diagnosed cytomegalovirus (CMV) infection. Intravenous ganciclovir therapy was initiated, and was associated with cessation of bleeding. Biliary CMV disease is rare in HIV-negative persons, but should be considered in a patient with unexplained hemobilia. Cholangioscopy may be useful for diagnosis.