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Volume 79 - 2016 - Fasc.4 - Case reports

Acute temozolomide induced liver injury : Mixed type hepatocellular and cho- lestatic toxicity

Temozolomide (TMZ) is an oral imidazotetrazine methylating agent which is used for the treatment of glioblastoma multiforme (GBM). We report a case of acute hepatotoxicity in a 53-year old male patient after administration of TMZ for GBM. He had fatigue, nausea, anorexia and jaundice. His laboratory analysis showed alanine aminotransferase(ALT) : 632 IU/L (normal range 0-40) ; aspartate aminotransferase(AST) : 554 IU/L (normal range 5-34); alkaline phosphatase(ALP): 1143 IU/L (normal range 40-150); ?-glutamyl transpeptidase(GGT): 514 IU/L (normal range 9-64 IU/L) ; total bilirubin : 15.1 mg/dL (normal range 0-1.2) ; direct bilirubin : 13.2 mg/dL and prothrombin time(PT) : 13.5 s, with international normalized ratio (INR) : 1.1 (normal range 0.8-1.2). His liver biopsy specimen showed mixed-type (both hepatocellular and cholestatic) hepatic injury, compatible with a diagnosis of drug-induced hepatitis. An objective causality assessment using the Naranjo probability scale suggested that TMZ was the probable cause of the acute hepatitis. His liver function tests gradually normalized in 6 months after discontinuation of the drug. In susceptible individuals, TMZ use may lead to acute mixed type liver toxicity. Complete recovery may be possible if the drug is discontinued before severe liver injury is established. (Acta gastroenterol. belg., 2016, 79, 487-489).


A rare case of giant mesenteric cystic lymphangioma of the small bowel in an adult: A case presentation and literature review

Background : Lymphangiomas are tumours that are often found in the head and neck in children and, rarely, in adults. Among all lymphangiomas in adults, the small bowel mesentery type accounts for less than 1%. We aim to present a rare case of small bowel symptomatic cystic lymphangioma in an adult patient, as well as its diagnosis and subsequent treatment. Patient : An adult female who was admitted to the University Clinical Center Tuzla for surgery presented with abdominal pain, tenderness and swelling of the abdomen. A giant cystic small bowel mesentery lymphangioma, which was histopathologically confirmed, was enucleated during open surgery. Conclusion : Timely diagnosis and treatment of this rare condition are crucial. Although benign in nature, mesenteric lymphangiomas may cause significant morbidity or mortality due to their huge size and critical locations. (Acta gastroenterol. belg., 2016, 79, 491-493).


Bilateral inguinal hernia with an uncommon content : A case report

Here we present a sixty-two year old man with bilateral swellings palpated in inguinal areas on physical examination. Ultrasonography and abdominal multi-detector computed tomography revealed a bladder herniation through the right inguinal canal and a sigmoid colon herniation through the left inguinal canal. Radiologic imaging methods are important and can guide clinicians for preemptive or emergent surgery. (Acta gastroenterol. belg., 2016, 79, 495-496).


Prolonged course of hepatic granulomatous disease due to Bartonella henselae infection

Cat-scratch disease (CSD) is an emerging zoonosis caused by Bartonella henselae. The disease is usually self-limiting and typi- cally presents in about 90% of all cases as a subacute regional lymphadenopathy. We present a case report of an unusual CSD presentation, persistent hepatic granulomatous disease due to Bartonella henselae infection despite combination therapy with doxycycline and rifampicin. Furthermore, a review of literature was conducted. (Acta gastroenterol. belg., 2016, 79, 497-499).