RESUMEN
Splenomegaly is a common finding in chronic hepatitis B infection. We present the case of a man with an acute flare of chronic hepatitis B infection, where splenomegaly in absence of portal hypertension led to the diagnosis of splenic marginal zone lymphoma (SMZL) with bone marrow involvement. Adequate suppression of the hepatitis B virus (HBV) viral load with tenofovir resulted in complete remission of the lymphoma.
Asunto(s)
Hepatitis B Crónica/complicaciones , Linfoma de Células B de la Zona Marginal/etiología , Neoplasias del Bazo/etiología , Adenina/análogos & derivados , Adenina/farmacología , Adenina/uso terapéutico , Médula Ósea/metabolismo , Médula Ósea/patología , Virus de la Hepatitis B , Hepatitis B Crónica/tratamiento farmacológico , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Organofosfonatos/farmacología , Organofosfonatos/uso terapéutico , Inducción de Remisión/métodos , Tenofovir , Carga Viral/efectos de los fármacosRESUMEN
OBJECTIVE AND DESIGN: Non-islet cell tumour induced hypoglycaemia (NICTH) is a paraneoplastic phenomenon that is associated with the formation of several isoforms of pro-insulin like growth factor 2 (pro-IGF-II), or so called "big" IGF-II. Disturbance of ternary complex formation by big IGF-II is assumed to be a crucial early event in the pathogenic cascade of hypoglycaemia. By size-exclusion chromatography, we investigated complex formation by adding different naturally occurring isoforms of pro-IGF-II to pooled normal adult serum. Results were compared with the analysis of the serum from a patient with NICTH. RESULTS: Gel filtration experiments with the serum of a patient with NICTH demonstrated that ternary complex formation was severely compromised. The various forms of pro-IGF-II did not induce a shift of IGF-binding protein 3 (IGFBP-3) from 150kD towards smaller binary complexes in the normal adult serum, suggesting that they did not interfere with the interaction between the acid labile subunit and IGFBP-3. Instead, unglycosylated recombinant pro-IGF-II[1-104] was capable of forming a 150kD complex. In contrast, predominantly glycosylated and unglycosylated pro-IGF-II[1-87] eluted in the free unbound form. We showed that mature IGF-II and isoforms of pro-IGF-II were able to phosphorylate the IGF-I receptors of MC7 cells, albeit to a markedly lesser extent than IGF-I. When the patient's serum was tested in this system, the IGF-I receptor phosphorylation activity was considerably less than that in sera from age matched healthy individuals. CONCLUSION: We postulate that, alongside the presence of big IGF-II in the circulation, additional steps are required to stimulate the release of IGF-II and pro-IGF-II isoforms from IGFBPs in vivo. These factors may be proteases, that are present in the local environment of the tumour and in insulin-sensitive tissues.
Asunto(s)
Carcinoma Hepatocelular/metabolismo , Cromatografía en Gel/métodos , Hipoglucemia/metabolismo , Proteínas de Unión a Factor de Crecimiento Similar a la Insulina/metabolismo , Factor II del Crecimiento Similar a la Insulina/metabolismo , Neoplasias Hepáticas/metabolismo , Síndromes Paraneoplásicos/metabolismo , Precursores de Proteínas/metabolismo , Adulto , Carcinoma Hepatocelular/complicaciones , Carcinoma Hepatocelular/patología , Humanos , Hipoglucemia/etiología , Hipoglucemia/patología , Neoplasias Hepáticas/complicaciones , Neoplasias Hepáticas/patología , Masculino , Síndromes Paraneoplásicos/complicaciones , Síndromes Paraneoplásicos/patología , Fosforilación , Isoformas de Proteínas , Tirosina/metabolismoAsunto(s)
Absceso Abdominal/diagnóstico , Dolor Abdominal/diagnóstico , Entomophthorales/aislamiento & purificación , Fiebre/diagnóstico , Cigomicosis/diagnóstico , Absceso Abdominal/tratamiento farmacológico , Absceso Abdominal/etiología , Absceso Abdominal/cirugía , Dolor Abdominal/tratamiento farmacológico , Dolor Abdominal/etiología , Dolor Abdominal/cirugía , Adulto , Antifúngicos/uso terapéutico , Fiebre/tratamiento farmacológico , Fiebre/etiología , Fiebre/cirugía , Humanos , Cetoconazol/uso terapéutico , Masculino , Resultado del Tratamiento , Indias Occidentales , Cigomicosis/complicaciones , Cigomicosis/tratamiento farmacológico , Cigomicosis/cirugíaAsunto(s)
Absceso/diagnóstico , Enfermedades de la Columna Vertebral/diagnóstico , Infecciones Estafilocócicas/complicaciones , Absceso/etiología , Absceso/cirugía , Humanos , Enfermedades de la Columna Vertebral/etiología , Enfermedades de la Columna Vertebral/cirugía , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/cirugíaRESUMEN
A 42-year-old woman presented with lowered consciousness, ataxia and ophthalmoplegia; MRI of the brain revealed abnormalities compatible with Wernicke encephalopathy (thiamine deficiency).
Asunto(s)
Trastornos de la Conciencia/etiología , Tiamina/uso terapéutico , Encefalopatía de Wernicke/diagnóstico , Adulto , Trastorno Amnésico Alcohólico/diagnóstico , Trastornos de la Conciencia/tratamiento farmacológico , Femenino , Humanos , Encefalopatía de Wernicke/complicaciones , Encefalopatía de Wernicke/tratamiento farmacológicoRESUMEN
A case of Lemierre's syndrome is reported. Although Fusobacterium species are commonly associated with this presentation, Prevotella bivia was the causative micro-organism identified in this case. The finding that disseminated anaerobic sepsis followed primary EBV infection led to the construction of a hypothetical model of infection.