Muhammad Z. Bawany

Acute liver failure: An uncommon complication of commonly used medication

The incidence of drug-related acute liver failure is approximately 14 per 100,000 populations. Drug-induced liver injury may take place through a variety of mechanism. Withdrawal of the offending agent may result in complete recovery. Clindamycin is known to cause mild derangement of liver function; however, acute liver injury causing severe derangement of liver function associated with encephalopathy is uncommon.

A case report of complete remission of pulmonary metastases from epithelioid sarcoma to navelbine chemotherapy.

Management of soft tissue sarcomas can be very challenging because they have a high rate of metastasis, especially to the lungs, and respond very poorly to the currently available chemotherapeutic drugs. We present a case of epithelioid sarcoma in which complete remission of pulmonary metastases was observed after treatment with a single agent, navelbine, a vinca alkaloid, and a potential therapeutic agent. The patient has been persistently free of metastases for 4 years since treatment with navelbine. Further studies are warranted to establish the role of navelbine for the treatment of soft tissue sarcoma and their metastases.

Golimumab may induce exacerbation of inflammatory bowel disease when it is used for the treatment of ankylosing spondylitis: a case report with a review of literature.

Golimumab is a human IgG monoclonal antibody specific for human tumor necrosis factor alpha. Golimumab has been approved for use in rheumatological conditions; however, its use in inflammatory bowel disease is still being evaluated in clinical trials. We report a case of an exacerbation of ulcerative proctitis after starting on golimumab for ankylosing spondylitis.

Haemoperitoneum post colonoscopy in a continuous ambulatory peritoneal dialysis patient.

We present the case of a patient on peritoneal dialysis (PD) who had an uneventful oesophagogastroduodenoscopy and colonoscopy. His peritoneal dialysis after colonoscopy had bright red peritoneal dialysate. The patient was completely asymptomatic and a CT scan was performed which did not reveal any retroperitoneal haematoma and showed no signs of perforation or splenic tear. His PD dialysate cleared up with time. We do not find any such case in the literature in which a patient has had haemoperitoneum after a colonoscopy without any obvious cause to account for it. Our patient was unique due to his CAPD in combination with his immunosuppression for his kidney transplant which may have predisposed him to the intraperitoneal bleed after colonoscopy or it may just have been a normal phenomenon after colonoscopy. More studies need to be done as the realisation of its pathology can prevent unnecessary testing and avoid patient and healthcare workers anxiety.

Pneumoperitoneum after Endoscopic Retrograde Cholangiopancreatography due to Rupture of Intrahepatic Bile Ducts and Glisson’s Capsule in Hepatic Metastasis: A Case Report and Review of Literature

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) has been proven to be a safe and effective method for diagnosis and treatment of biliary and pancreatic disorders. Major complications of ERCP include pancreatitis, hemorrhage, cholangitis, and duodenal perforation. We report a third case in literature of pneumoperitoneum after ERCP due to rupture of intrahepatic bile ducts and Glisson’s capsule in a peripheral hepatic lesion. Case Report: A 50-year-old male with a history of metastatic pancreatic neuroendocrine tumor and who had a partially covered metallic stent placed in the biliary tree 1 year ago presented to the oncology clinic with fatigue, abdominal pain, and hypotension. He was planned for ERCP for possible cholangitis secondary to obstructed previously placed biliary stent. However, the duodenoscope could not be advanced to the level of the major papilla because of narrowed pylorus and severely strictured duodenal sweep. Forward-view gastroscope was then passed with careful manipulation to the severely narrowed second part of the duodenum where the previously placed metallic stent was visualized. Balloon sweeping of stenting was done. Cholangiography did not show any leak. Following the procedure, the patient underwent CT scan of the abdomen that showed pneumoperitoneum which was communicating with pneumobilia through a loculated air collection in necrotic hepatic metastasis perforating Glisson’s capsule. The patient was managed conservatively. Conclusion: In our case, pneumoperitoneum resulted from rupture of intrahepatic bile ducts and Glisson’s capsule in hepatic metastasis. This case emphasizes the need for close clinical and radiological observation of patients with hepatic masses (primary or metastatic) subjected to ERCP.

Cylindrical Batteries in the Stomach: Should We Wait 48 Hours for Removal?

A 31-year-old woman presented with witnessed ingestion of multiple cylindrical batteries to deliberately self-harm 2 hours prior to admission. The patient denied any symptoms. Physical exam was normal. Abdominal series showed 7 cylindrical batteries (5 AAA and 2 AA) in the upper abdomen (Figure 1). Esophagogastroduodenoscopy (EGD) under conscious sedation revealed food remnants in the stomach. Despite extensive irrigation and suctioning only 2 batteries were visualized in the stomach and both were successfully retrieved using a Roth net. No mucosal damage was apparent. The next morning, she complained of mild abdominal pain with mild epigastric tenderness. Abdominal x-ray revealed 4 batteries in the stomach, and another in the small bowel. The patient underwent repeat EGD under general anesthesia within 12 hours of the ingestion time. Stomach exam revealed 3 batteries in the body with 3 deep ulcerations (2 in the antrum and 1 in the incisura) and multiple erosions (Figure 2). Duodenal exam showed superficial mucosal erosions, and another battery was seen beyond the ligament of Treitz.

Multidrug resistant pneumonia treated with aerosolized amikacin in a patient with acute renal insufficiency.

Multidrug resistant pneumonia is an entity, which is difficult to treat, and in a patient with acute renal insufficiency, it leaves a physician with a handful of antibiotics to be considered. Aerosolized administration of antibiotics is one option that can be contemplated for a patient with acute renal insufficiency to avoid the nephrotoxic effect of the antibiotics.