RESUMEN
We describe the clinical features, liver histology, and ultrastructure in reversible diclofenac-induced hepatitis and review previous reports of this entity. Although rarely reported, diclofenac hepatitis may be severe, and even fatal. Symptoms, which develop from 1 week to 11 months after starting the drug, include jaundice, pruritus, fever, abdominal pain, nausea, vomiting, and rash. Bilirubin and alkaline phosphatase are mildly elevated, transaminases often markedly so. The nature of the idiosyncratic injury appears variable, some cases having features of a hypersensitivity reaction, most being more suggestive of a toxic metabolic effect. Light microscopy shows a nonspecific hepatitis with portal and lobular activity, and focal hepatocellular injury that may progress to zonal or massive necrosis. The ultrastructural features in our case are typical of drug or toxin injury. This may be of value in distinguishing this entity from other forms of hepatitis, which is important in view of the frequent reversibility of this potentially lethal form of injury.
Asunto(s)
Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Diclofenaco/efectos adversos , Anciano , Biopsia , Enfermedad Hepática Inducida por Sustancias y Drogas/patología , Diclofenaco/uso terapéutico , Femenino , Humanos , Hígado/ultraestructura , Microscopía Electrónica , Osteoartritis/tratamiento farmacológicoRESUMEN
Complications arising from Meckel's diverticulum are uncommon in adults and are seldom, if ever, seen in the elderly. When they do occur in adults, intestinal obstruction or inflammation is the usual mode of presentation, hemorrhage being much less common. The patient described in this case report was 78 yr old, presented initially with iron deficiency anemia and, later, developed severe acute hemorrhage. The cause of the hemorrhage was ulceration at the tip of an invaginated Meckel's diverticulum. The ulceration was not peptic in origin, as is usually the case in similar presentations in children, no ectopic oxyntic mucosa being detected in the diverticulum of our patient. In previous reports, invaginated Meckel's diverticula have always been accompanied by intussusception, and abdominal pain has been an important part of the symptom complex in such patients. Our patient had no abdominal pain, and no intussusception was noted at surgery. This case emphasizes the need for considering a Meckel's diverticulum as the source of acute or chronic hemorrhage, irrespective of the patient's age. The utility of radionuclide blood pool imaging in arriving at a diagnosis in these cases is discussed.