Volume 87 - 2024 - Fasc.1 - Case reports
STEC colitis mimicking acute severe colitis with life-threatening consequences: a case report
Acute colitis is a common feature of infection with Shiga-toxin
producing Escherichia coli (STEC) and can mimic acute severe
ulcerative colitis. Early recognition is important as there is a risk
of developing Shiga toxin-induced haemolytic uremic syndrome
(STEC-HUS), defined by the triad of microangiopathic haemolytic
anemia, thrombocytopenia and organ damage. In severe cases
STEC-HUS can cause severe neurological complications and can
be fatal.
Case: We present a patient with a medical history of refractory
ulcerative colitis, where making the diagnosis of STEC-HUS was
challenging since the initial clinical presentation was difficult to
differentiate from a flare of ulcerative colitis.
Conclusion: This case illustrates that STEC induced colitis
can mimic acute severe ulcerative colitis. This finding is of utmost
clinical importance because of the potential life-threatening
complications of STEC-HUS. Therefore it should be excluded
promptly in patients with acute severe ulcerative colitis by using
multiplex-PCR assay on a faecal sample.
Stauffer syndrome : a rare paraneoplastic complication of renal cell carcinoma to be kept in mind. Case report and literature survey
The authors report the case of a 74-years-old woman treated by immunotherapy for a metastatic renal cell carcinoma and having developed an important cholestasis with thrombocytosis, increased CRP, leucocytosis and hypoalbuminemia. Liver remained free of metastases at medical imaging. The diagnosis of a Stauffer syndrome was confirmed by the hepatic biopsy. A complete response of liver disorders was obtained after nephrectomy. From literature survey, Stauffer syndrome should be kept in mind in cancer patients, especially those suffering from a renal cell carcinoma, presenting with cholestasis with no underlying cause.
Acute grade IV toxic hepatitis due to the e-cigarette
A 46-year-old woman presented at the emergency department because of acute hepatitis with jaundice. After hepatological work-up including liver biopsy, drug induced liver disease (DILI) was suspected. Patient recovered completely within a few months.
One year later she presented again with jaundice due to acute hepatitis. Vaping was the only agent that could be identified as causative agent for DILI. After VAPING cessation, the hepatitis resolved completely. Calculated RUCAM score was 10, making the diagnosis of toxic hepatitis very likely. During follow-up liver tests remained normal.
This is the first report of severe DILI secondary to the use of e-cigarettes. In future vaping can be included in the differential diagnosis of DILI.
Fulminant ectopic Cushing’s syndrome caused by metastatic small intestine neuroendocrine tumour – a case report and review of the literature
Cushing’s syndrome (CS) secondary to adrenocorticotropic hormone (ACTH) producing tumours is a severe condition with a challenging diagnosis. Ectopic ACTH-secretion often involves neuroendocrine tumours (NET) in the respiratory tract. ACTH-secreting small intestine neuro-endocrine tumours (siNET) are extremely rare entities barely reported in literature.
This review is illustrated by the case of a 75-year old woman with fulminant ectopic CS caused by a ACTH-secreting metastatic siNET. Severe hypokalemia, fluid retention and refractory hypertension were the presenting symptoms. Basal and dynamic laboratory studies were diagnostic for ACTH-dependent CS. Extensive imaging studies of the pituitary and thorax-abdomen areas were normal, while [68Ga]Ga-DOTATATE PET-CT revealed increased small intestine uptake in the left iliac fossa. The hypercortisolism was well controlled with somatostatin analogues, after which a debulking resection of the tumour was performed. Pathological investigation confirmed a well-differentiated NET with sporadic ACTH immunostaining and post-operative treatment with somatostatin analogues was continued with favourable disease control.
