Is it necessary to repeat the interferon gamma? Disseminated tuberculosis in a patient receiving anti-TNF alpha treatment.

Before starting a drug that suppresses immunity, it is of paramount importance to screen for hidden infections in patients with inflammatory diseases. Latent tuberculosis infection (LTBI) is a condition characterized by an immune response to M. tuberculosis antigens without clinical manifestations. The highest risk of progression to active disease occurs in individuals who are immunosuppressed or in children. Patients who are candidates for treatment with TNF-alpha inhibitors should be evaluated with interferon gamma release assays and a chest radiograph. We present a case of a 42 year old woman with a history of Crohn disease treated with infliximab and fever with adenopatys.

Endoscopic ultrasound-guided resolution of right hydronephrosis secondary to local compression by an inflammatory pancreatic mass.

We present the case of 67 years-old man with unremarkable medical history. He was admitted to our department for abdominal pain compatible with choledocholithiasis associated with acute cholecystitis. ERCP was performed but direct papillary canulation attempts failed by means of conventional sphincterotome. So, pre- cut papillotomy was successfully attempted getting free access to distal choledochus and retrieving a small lithiasis. Unfortunately, the patient developed severe post-ERCP acute pancreatitis.