Volume 84 - 2021 - Fasc.2 - Case reports
Hypercalcemia induced pancreatitis as a rare presentation of primary hyperparathyroidism
Acute pancreatitis (AP) is an inflammatory process of the
pancreas. It is a relatively common cause of acute upper abdominal
pain and is potentially associated with high morbidity and
mortality. Underlying hypercalcemia as a cause of AP is very rare.
We present a case of a hypercalcemia-induced acute pancreatitis
with an underlying parathyroid adenoma in an 81-year-old woman
with no previous symptoms of hypercalcemia. The parathyroid
adenoma was semi-urgently surgically resected with normalization
of calcium-levels. This case report summarizes the causes of
acute pancreatitis and hypercalcemia and its management.
Pemphigus vulgaris presenting as esophageal ulceration. Report of an underdiagnosed manifestation
Pemphigus vulgaris (PV) is a rare autoimmune blistering
disorder of the skin and mucous membranes. The true prevalence
of esophageal involvement is unknown; esophageal symptoms
almost always occur in the context of oral mucosa involvement.
We report the case of a 66-year-old man with cutaneous blisters
and esophageal symptoms that did not respond to acid suppression
therapy. Esophagogastroduodenoscopy showed esophageal ulcers
and mucosal desquamation. Biopsies were consistent with the
diagnosis of PV. The patient was started on immunosuppressive
therapy, achieving remission. This represents a rare case of
esophageal involvement of PV without mucosal involvement and
draws attention to a rare cause of dysphagia, which can be fatal if
left untreated
Complete response of a hepatocellular carcinoma with complex macrovascular invasion after combined treatment with chemoembolization and immunotherapy: a case report
Hepatocellular carcinoma accounts for 90% of primary liver
cancers and represents a growing health problem worldwide. We
report the complex case of a 71 year-old patient diagnosed with
a large hepatocellular carcinoma and presenting an extensive
vascular invasion of the middle hepatic vein and the inferior caval
vein ascending to the right atrium with no extrahepatic spread.
Due to several comorbidities, a systemic treatment by tyrosine
kinase inhibitors was contraindicated. After discussion at the
multidisciplinary hepatology tumor board, he was referred for
selective internal radiation therapy. Unfortunately, the work-up
showed an important lung shunt not allowing radioembolization. No
clear recommendations are available in this situation. The decision
was made to propose a combination treatment by transarterial
chemoembolization, that was performed using a new generation
of radio-opaque microspheres loaded with doxorubicin, followed
by immunotherapy. This allowed a complete response with a very
good quality of life.
An unexpected cause of persistent bacteraemia and portomesenteric venous gas
We report the case of a 59-year old man with portomesenteric
venous gas (PMVG) due to inferior mesenteric vein fistulization
caused by sigmoid diverticulitis with an unusual evolution.
The patient initially presented with classic symptoms of lower
abdominal pain and fever. Diagnosis of uncomplicated sigmoid
diverticulitis was confirmed on computed tomography (CT) for
which intravenous antibiotics were initiated. Hemocultures were
positive for omnisensitive Escherichia Coli, but despite adequate
intravenous antibiotic therapy, episodes of bacteraemia persisted
and hemocultures remained positive. Repeat CT scan demonstrated
regression of inflammation without signs of abcedation or
perforation consistent with clinical findings. Endocarditis was
excluded with a normal transoesophageal echocardiography.
Finally, positron emission tomography-computed tomography
(PET-CT) suspected a colovenous fistula and the presence of
PMVG. The patient was successfully treated with laparoscopic
sigmoidectomy. This case report summarises the diagnostic
pathway and aims for higher awareness of non-ischemic PMVG
causes.
