Adam Mahomed

Takotsubo cardiomyopathy post liver transplantation.

Abstract A patient with end-stage liver disease developed stressinduced Takotsubo cardiomyopathy post liver transplantation, with haemodynamic instability requiring a left ventricular assist device. We discuss the diagnosis and management of this condition.

Tuberculosis complicating hepatitis C therapy with pegylated interferon and ribavirin: new infection in a high tuberculosis incidence area

Interferon and ribavirin therapy for hepatitis C is associated with a variety of side-effects. These include haematological, autoimmune, dermatological, metabolic and infectious complications. The propensity of this combination of treatment to readily cause neutropaenia, and in some instances, lymphopaenia, renders patients susceptible to a wide range of severe bacterial infections. 1,2 Evidence from studies that have included reports on adverse outcomes indicates that tuberculosis is included in these infections. Unlike other immunomodulatory therapies, such as anti-tumour necrosis factor, there is no requirement to exclude latent tuberculosis infection prior to the initiation of pegylated interferon or ribavarin. Sub-Saharan Africa has a high incidence of tuberculosis, with an incidence of 255 per 100 000 population per year, according to the 2012 World Health Organization statistics. Tuberculosis, as a complication of antiviral therapy for hepatitis C with pegylated interferon and ribavirin, potentially poses more of a threat to patients receiving this therapy in high-incidence areas of tuberculosis. This case study highlights the complexity of the diagnosis and management of tuberculosis in the context of antiviral therapy with pegylated interferon and ribavirin for hepatitis C.

Overdose with HAART: are we managing these patients adequately?

Increasing numbers of HIV/AIDS-infected individuals have presented to medical casualty at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) after attempting suicide by overdosing on their antiretroviral therapy. Since 2009, medical gastro-enterology at CMJAH has been the primary specialty unit for cases of accidental or intentional overdose. Psychiatry and other medical sub-specialties are consulted as needed. Our unit sees approximately 1 case a month of accidental/intentional overdose with antiretrovirals. Between January and September 2010, 6% of all overdoses seen at CMJAH were of antiretroviral origin. Supportive care is provided and patients undergo psychiatric evaluation. The information available on overdoses with antiretrovirals is from studies in developed countries, where intravenous drug users and men who have sex with men make up the bulk of the HIV-positive population. This differs significantly from South Africa, which now has the largest antiretroviral programme in the world. With little evidence related to this type of overdose, are we approaching the management, monitoring and follow-up of these patients correctly?

Cytomegalovirus duodenitis, pseudotumour and cholangiopathy in advanced HIV

Gastro-intestinal cytomegalovirus (CMV) infection manifests as oesophagitis, gastritis, enteritis and colitis. Reports of duodenal involvement are rare. We found only one reported CMV-induced pseudotumour of the duodenum and 14 CMV-induced gastrointestinal pseudotumours.