Volume 66 - 2003 - Fasc.3 - Case reports
Visceral leshmaniasis diagnosed on duodenal biopsy in a child
Visceral leishmaniasis is usually easy to recognize when clinical presentation is complete : splenomegaly, fever and palor associat- ed to pancytopenia, hypoalbuminaemia and hypergamma globu- linemia. Bone marrow smears, culture and serology confirm the diagnosis.
We report the case of an infant in whom clinical and biological findings are suggestive of leishmaniasis and the diagnosis con- firmed only by duodenal biopsy. (Acta gastroenterol. belg., 2003, 66, 258-259).
Long-term albendazole treatment in one case of alveolar echinococcosis Case report
Aims: Curative therapy of alveolar echinococcosis is total surgical removal of the infected tissue and concomitant chemotherapy. However, this curative resection can be done on a limited number of patients, for the remaining ones various pallia- tive procedures can be performed.
Method : In this article it is aimed to present the result of long- term albendazole treatment in patient who had a palliative hepa- tojejunostomy for obstructive jaundice due to unresectable alveo- lar echinococcosis.
Results : Systemic albendazole treatment was initiated in this patient after palliative hepatojejunostomy procedure. During follow up there was no abnormality in blood chemistry and a considerable regression in size of the lesion was found in postoperative month 24. Residual hepatic lesion was histopathologically documented and showed apparently non-viable parasitic cysts by biopsy. These find- ings suggest the long-term albendazole therapy being parasitocidal.
Conclusions : Palliative or mass reduction surgery combined with long-term albendazole therapy is the standard therapy for advanced disease, especially when curative resection might result in significant morbidity and mortality. (Acta gastroenterol. belg., 2003, 66, 255-257).
Cystic fibrosis : an unusual cause of chronic pancreatitis
Chronic pancreatitis is most frequently associated with alcohol abuse.
This should however not always automatically be accepted as the presumed cause. When the history is doubtful, uncommon etiologies must be considered as is illustrated by the present case. A 38 years old man was in the past 20 years treated for chronic pancreatitis ascribed to ethylisme although he always denied this. When the diagnosis was eventually questioned, new investigations showed slightly elevated sweat electrolyte concentrations and a ???? F508/R117H genotype compatible with cystic fibrosis (CF). Demonstration of mild respiratory abnormalities, obstructive azoospermia and CF in his brother supported this diagnosis.
Although rarely, pancreatitis typically develops in the kind of CF patients with milder genotypes and less severe symptoms. Systematic analysis for genetic mutations in patients with idio- pathic chronic pancreatitis (ICP) revealed however that this mild form of CF is a less exceptional cause than thought. As CF patients increasingly survive into adulthood this disease should be consid- ered as a possible etiology in the differential diagnosis of pancre- atitis at all ages. (Acta gastroenterol. belg., 2003, 66, 260-262).