A. A. Pereira

Caso clínicoDiarreia crónicaChronic diarrhea

We report a case of a 46-year old woman with chronic diarrhoea for the previous eight years associated with significant weight loss. Subsequently the patient developed neurological symptoms with recurrent syncope events as well as urinary and anal incontinence. The diagnostic approach included a detailed clinical history and physical examination plus laboratory, endoscopic, radiology and neurological exams. A definitive diagnosis was made of familial amyloidotic polyneuropathy after confirmation of the specific protein mutation – TTRMet30- linked to this condition. The patient underwent successful liver transplantation.

Colitis pseudomembranosa refractaria

Costridium difficile -associated diarrhea is an important complication of antibiotic use. It is in many instances hospital-acquired and affects more commonly elderly patients with significant comorbidities, accounting for a significant number of deaths. Approximately 20% of all cases of diarrhea in developed countries are estimated to be secondary to antibiotic use. The most implicated antibiotics predisposing to this condition are clindamycin, penicilins, cephalosporins and fluoroquinolones (1). In recent years the disease has become more frequent, more severe in its clinical course, more refractory to conventional therapy and more prone to recurrences (1). Once diagnosis is established, previous antibiotic treatment should be discontinued and metronidazole (250 mg orally tid or 500 mg intravenous qid) or vancomycin 125 mg qid for 7-14 days must be administered.