Internal medicine
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Case Reports
Development of Severe Acute Pancreatitis Following Uncovered Metallic Stent Placement: A Rare Case Report.
Self-expandable metallic stents (SEMSs) are widely used for malignant biliary stricture (MBS). Acute pancreatitis is an early complication following SEMS placement. ⋯ After seven days, an uncovered SEMS was placed; however, severe acute pancreatitis occurred, and the SEMS was drawn out emergently. In SEMS placement for patients with MBS caused by non-pancreatic cancer, SEMS should be selected carefully while considering each patient's case.
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Case Reports
A Superinfection of Salmonella typhi and Hepatitis E Virus Causes Biphasic Acute Hepatitis.
A 47-year-old Japanese man was referred to our hospital because of a sustained high fever with diarrhea 12 days after a flight from India. Liver enzymes were elevated with rose spots, hepatosplenomegaly, relative bradycardia, and acute cholecystitis. ⋯ Laboratory tests yielded positive reactions for Salmonella typhi and hepatitis E virus RNA. The pathophysiological presentations of concurrent typhoid and type E hepatitis are discussed.
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A patient with recurrent plasmacytoma with massive ascites exhibited vancomycin intoxication and cefepime-induced encephalopathy due to renal dysfunction. The ascitic accumulation of these drugs was suspected because of the refractory intoxicated state. ⋯ If patients with renal dysfunction and massive ascites develop vancomycin intoxication and cefepime-induced encephalopathy that cannot be improved by drug discontinuation, physicians should suspect ascitic accumulation and evaluate the ascitic concentration. Furthermore, if a high accumulation in massive ascites occurs, physicians should perform abdominal drainage along with blood purification.
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A patient with no medical history was admitted to our hospital with consciousness disturbance and diagnosed with intracerebral hemorrhaging in the bilateral hemisphere based on computed tomography. A blood test showed an abnormal coagulation capacity. He died of intracerebral hemorrhaging 11 hours after the onset. ⋯ Notably, we found no evidence of intracerebral hemorrhaging, including arteriovenous malformation or cancer metastasis, in the brain. He was ultimately diagnosed with intracerebral hemorrhaging due to coagulopathy associated with latent advanced prostate cancer. Coagulopathy caused by advanced prostate cancer, which was first identified by autopsy, can lead to intracerebral hemorrhaging.
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Case Reports
Acute Myeloid Leukemia Developing with Acute Pancreatitis Mimicking Autoimmune Pancreatitis.
A 33-year-old man was admitted to our hospital for fever and abdominal pain. A blood analysis revealed pancytopenia and increased serum pancreatic enzymes with disseminated intravascular coagulation. ⋯ We hypothesized that the etiology of acute pancreatitis was invasion of leukemia cells. Acute pancreatitis is rare as a symptom of leukemia; however, we should consider the possibility of leukemia during the differential diagnosis of acute pancreatitis.