amoxicillin-potassium-clavulanate-combination and Abdominal-Pain

Acute pancreatitis is an acute inflammation of the pancreas that varies in severity from mild to life threatening usually requiring hospitalization. The true incidence of drug-induced pancreatitis (DIP) is indeterminate due to the inadequate documentation of case reports of DIP. Here we present the case of amoxicillin/clavulanic acid-induced pancreatitis in a previously healthy male after excluding all other causes of pancreatitis.. A 58-year-old Caucasian man presenting for acute sharp abdominal pain with associated nausea and heaves. Pain was non-radiating and worsening with movement. Patient had no constitutional symptoms. The only medication he received prior to presentation was amoxicillin/clavulanic acid as prophylaxis for a dental procedure with his symptoms starting on day 9th of therapy. Laboratory studies revealed mild leukocytosis, increased levels of serum lipase, amylase, and C-reactive protein (CRP). Abdominal computed tomography (CT) was notable for acute pancreatitis with no pseudocyst formation. Hence, patient was diagnosed with mild acute pancreatitis that was treated with aggressive intravenous (IV) hydration and pain management with bowel rest of 2 days duration and significant improvement being noticed within 72 h. On further questioning, patient recalled that several years ago he had similar abdominal pain that developed after taking amoxicillin/clavulanic acid but did not seek medical attention at that time and the pain resolved within few days while abstaining from food intake. All other causes of pancreatitis were ruled out in this patient who is non-alcoholic, non-smoker, and never had gallstones. Abdominal ultrasound and magnetic resonance cholangiopancreatography (MRCP) eliminated out the possibility of gallstones, biliary ductal dilatation, or choledocholithiasis. Patient had no hypertriglyceridemia nor hypercalcemia, never had endoscopic retrograde cholangiopancreatography (ERCP), never took steroids, has no known malignancy, infection, trauma, or exposure to scorpions.. This case describes a patient with DIP after the intake of amoxicillin/clavulanic acid and when all other common causes of acute pancreatitis were excluded. Only two other case reports were available through literature review regarding amoxicillin/clavulanic acid- induced pancreatitis. We again stress on the importance of identifying and reporting cases of DIP to raise awareness among physicians and clinicians.

Topics: Abdominal Pain; Amoxicillin-Potassium Clavulanate Combination; beta-Lactamase Inhibitors; Cholangiopancreatography, Magnetic Resonance; Humans; Male; Middle Aged; Nausea; Pancreatitis; Tomography, X-Ray Computed; Ultrasonography; Vomiting

A 41-years-old female, with ulcerative colitis, presented to the emergency department with 7-days history of abdominal pain, bloody stools (> 10/day). The patient referred the appearance of a cutaneous lesion, on her left thigh, with subsequent appearance of similar lesions on the lower limbs. No improvement after amoxicillin/clavulanic acid. On admission, she was febrile (38.2 ºC) and tachycardic. She had three cutaneous lesions, the largest one with 8cm in the left thigh - a deep and painful lesion, with extensive ulceration, necrosis, exudative edges and with marked pathergia, compatible with pyoderma gangrenosum.

Topics: Abdominal Pain; Adult; Amoxicillin-Potassium Clavulanate Combination; Colitis, Ulcerative; Female; Humans; Pyoderma Gangrenosum

Topics: Abdominal Pain; Amoxicillin-Potassium Clavulanate Combination; Azithromycin; Chlamydia Infections; Chlamydia trachomatis; Female; Hepatitis; Humans; Pelvic Inflammatory Disease; Peritonitis; Tomography, X-Ray Computed; Young Adult

Toxic shock syndrome (TSS) was first described by Todd in 1978. The relevant Lancet publication reported 7 cases of children with fever, exanthema, hypotension and diarrhoea associated with multiple organ failure. An association between TSS and use of hyper-absorbent tampons in menstruating women was discovered in the 1980s. Following the market withdrawal of such tampons, TSS virtually disappeared. Herein we report a new case of TSS in a 15-year-old girl.. A 15-year-old patient was admitted to intensive care for severe sepsis and impaired consciousness associated with diffuse abdominal pain. Dermatological examination revealed diffuse macular exanthema. Laboratory tests showed hepatic cytolysis (ASAT 101 U/L, ALAT 167 U/L, total bilirubin 68μmol/L) and an inflammatory syndrome. Lumbar puncture and blood cultures were sterile while thoraco-abdomino-pelvic and brain scans were normal. The patient was menstruating and had been using a tampon over the previous 24hours. Vaginal sampling and tampon culture revealed TSST-1 toxin-producing S. aureus. Management consisted of intensive care measures and treatment with amoxicillin-clavulanic acid and clindamycin for 10 days.. In case of septic shock associated with diffuse macular exanthema a diagnosis of TSS must be envisaged, particularly in menstruating women.

Topics: Abdominal Pain; Adolescent; Amoxicillin-Potassium Clavulanate Combination; Bacterial Toxins; Clindamycin; Critical Care; Diagnosis, Differential; Drug Therapy, Combination; Enterotoxins; Erythema; Female; Fever of Unknown Origin; Humans; Menstrual Hygiene Products; Shock; Shock, Septic; Staphylococcus aureus; Superantigens

Topics: Abdominal Pain; Adult; Amoxicillin-Potassium Clavulanate Combination; Biopsy, Needle; Esomeprazole; Female; Fever; Gastritis; Gastroscopy; Humans; Immunohistochemistry; Infusions, Intravenous; Prognosis; Rare Diseases; Severity of Illness Index; Streptococcal Infections; Tomography, X-Ray Computed; Treatment Outcome; Vomiting

Topics: Abdominal Pain; Aged; Amoxicillin-Potassium Clavulanate Combination; Bacterial Infections; Capsule Endoscopy; Double-Balloon Enteroscopy; Enterococcus faecalis; Erythromycin; Escherichia coli; Female; History, 18th Century; Humans; Intestinal Diseases; Severity of Illness Index; Treatment Outcome

Antibiotic-associated colitis is a gastrointestinal complication of antibiotic use commonly seen in hospitalised patients, with

Topics: Abdominal Pain; Aged; Amoxicillin-Potassium Clavulanate Combination; Diagnosis, Differential; Diarrhea; Enterocolitis, Pseudomembranous; Female; Gastrointestinal Hemorrhage; Humans; Klebsiella Infections; Klebsiella oxytoca; Tomography, X-Ray Computed

An 86-year-old man presented with severe pain in the upper abdomen along with fever. On physical examination, we found an arterial blood pressure of 84/43 mm Hg, a heart rate of 80 bpm and a temperature of 38.3°C. The abdomen was painful and peristalsis was absent. Empiric antibiotic therapy for sepsis was started with amoxicillin/clavulanate and gentamicin. CT scan of the abdomen revealed an emphysematous cholecystitis. Percutaneous ultrasound-guided cholecystostomy was applied. Bile cultures revealed Clostridium perfringens. Emphysematous cholecystitis is a life-threatening form of acute cholecystitis that occurs as a consequence of ischaemic injury to the gallbladder, followed by translocation of gas-forming bacteria (ie, C. perfringens, Escherichia coli, Klebsiella and Streptococci). The mortality associated with emphysematous cholecystitis is higher than in non-emphysematous cholecystitis (15% vs 4%). Therefore, early diagnosis with radiological imaging is of vital importance.

Topics: Abdominal Pain; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bile; Cholecystostomy; Clostridium perfringens; Emphysematous Cholecystitis; Gallbladder; Gentamicins; Humans; Male; Radiography, Abdominal; Sepsis; Tomography, X-Ray Computed

Melioidosis caused by Burkholderia pseudomellei is an infection with protean clinical manifestations. Guillain-Barré syndrome [GBS] associated with melioidosis is very rare.. A 42-year-old woman with diabetes presented with abdominal pain, vomiting and intermittent fever for one month. Six months before presentation she had recurrent skin abscesses. Three months before presentation she had multiple liver abscesses which were aspirated in a local hospital. The aspirate grew "coliforms" resistant to gentamicin and sensitive to ceftazidime. On presentation she had high fever and tender hepatomegaly. Ultra Sound Scan of abdomen showed multiple liver and splenic abscesses. Based on the suggestive history and sensitivity pattern of the previous growth melioidosis was suspected and high dose meropenem was started. Antibodies to melioidin were raised at a titre of 1:10240. The growth from the aspirate of liver abscess was confirmed as Burkholderia pseudomellei by polymerase chain reaction [PCR]. After a week of treatment, patient developed bilateral lower limb weakness. Deep tendon reflexes were absent. There was no sensory loss or bladder/bowel involvement. Analysis of the cerebro-spinal fluid showed elevated proteins with no cells. There was severe peripheral neuropathy with axonal degeneration. A diagnosis of GBS was made and she was treated with plasmapharesis with marked improvement of neurological deficit. Continuation of intravenous antibiotics lead to further clinical improvement with normalization of inflammatory markers and resolution of liver and splenic abscess. Eradication therapy with oral co-trimoxazole and co-amoxyclav was started on the seventh week. Patient was discharged to outpatient clinic with a plan to continue combination of oral antibiotics for 12 weeks. At the end of 12 weeks she was well with complete neurological resolution and no evidence of a relapse.. Guillaine Barre syndrome is a rare complication of melioidosis and should be suspected in a patient with melioidosis who develop lower limb weakness. Plasmapharesis can be successfully used to treat GBS associated with active melioidosis.

Topics: Abdominal Pain; Administration, Oral; Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Burkholderia pseudomallei; Ceftazidime; Drug Resistance, Bacterial; Female; Gentamicins; Guillain-Barre Syndrome; Humans; Injections, Intravenous; Liver Abscess; Melioidosis; Meropenem; Peripheral Nervous System Diseases; Polymerase Chain Reaction; Splenic Diseases; Thienamycins; Trimethoprim, Sulfamethoxazole Drug Combination

Acute porphyria is historically known as "the little imitator" in reference to its reputation as a notoriously difficult diagnosis. Variegate porphyria is one of the four acute porphyrias, and can present with both blistering cutaneous lesions and acute neurovisceral attacks involving abdominal pain, neuropsychiatric features, neuropathy, hyponatremia, and a vast array of other nonspecific clinical features.. A 40-year-old man presented to the Emergency Department (ED) as a major trauma call, having been found in an "acutely confused state" surrounded by broken glass. Primary survey revealed: hypertension, tachycardia, abdominal pain, severe agitation, and confusion with an encephalopathy consistent with acute delirium, a Glasgow Coma Scale score of 13, and head-to-toe "burn-like" abrasions. Computed tomography was unremarkable, and blood tests demonstrated hyponatremia, acute kidney injury, and a neutrophilic leukocytosis. The next of kin eventually revealed a past medical history of variegate porphyria. The patient was experiencing an acute attack and received supportive management prior to transfer to intensive care, subsequently making a full recovery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case highlights the importance of recognizing acute medical conditions in patients thought to be suffering from major trauma. Acute porphyria should be considered in any patient with abdominal pain in combination with neuropsychiatric features, motor neuropathy, or hyponatremia. Patients often present to the ED without any medical history, and accurate diagnosis can be essential in the acute setting to minimize morbidity and mortality. The label of the major trauma call must be taken with great caution, and a broad differential diagnosis must be maintained throughout a diligent and thorough primary survey.

Topics: Abdominal Pain; Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Diagnosis, Differential; Emergency Service, Hospital; Humans; Male; Porphyria, Variegate; Rhabdomyolysis; Vomiting; Wounds and Injuries

This is a case of a 75-year-old man being admitted to the on-call surgical department with acute abdominal pain. On arrival he was clinically dehydrated and shocked with localised pain over McBurney's point and examination findings were suggestive of appendiceal or other colonic pathology. Full blood testing revealed a white cell count of 38×10(9)/L and a C reactive protein (CRP) of 278 mg/L. A CT scan revealed a gallbladder empyema that extended into the right iliac fossa. This case highlights the potential for a hyperdistended gallbladder empyema to present as acute right iliac fossa pain with blood tests suggestive of complicated disease. Further analysis confirmed Actinomyces infection as the underlying aetiology prior to a laparoscopic subtotal cholecystectomy. This case serves to remind clinicians of this as a rare potential cause of atypical gallbladder pathology.

Topics: Abdominal Pain; Actinomycosis; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cholecystitis; Diagnosis, Differential; Drainage; Gentamicins; Humans; Male; Radiography, Abdominal; Tomography, X-Ray Computed

Topics: Abdominal Pain; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cardiopulmonary Resuscitation; Diagnosis, Differential; Drug Hypersensitivity; Dyspnea; Electrocardiography; Heart Arrest; Humans; Male; Physical Examination; Respiratory Insufficiency; Risk Factors

Septic arthritis in the elderly carries a high mortality. Underlying risk factors, such as diabetes, malignancy, chronic renal failure, rheumatoid arthritis, hepatobiliary disease and AIDS, should be assessed. Rare causative organisms are occasionally encountered. Here, we describe a case of an 80-year-old diabetic patient with liver cirrhosis who developed Klebsiella pneumoniae septic arthritis, which is a rare cause of joint infection. We postulate that this case supports the notion that the patient's knee effusion seeded during a primary K pneumoniae bacteraemia of intestinal origin and related to liver cirrhosis.

Topics: Abdominal Pain; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Arthritis, Infectious; Carcinoma, Hepatocellular; Clavulanic Acids; Fatal Outcome; Humans; Klebsiella Infections; Klebsiella pneumoniae; Knee Joint; Liver Cirrhosis; Liver Neoplasms; Male; Ticarcillin

The authors report a case of small bowel diverticulitis diagnosed by computed tomography. They describe the CT findings and review its advantages for diagnosis of this uncommon entity that is rarely suspected at physical examination.

Topics: Abdominal Pain; Aged; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Constipation; Diverticulitis; Drug Therapy, Combination; Fever; Humans; Jejunal Diseases; Male; Physical Examination; Sensitivity and Specificity; Tomography, X-Ray Computed

Primary peritonitis caused by Streptococcus pneumoniae is a rare but serious complication of childbirth. We present here three cases of young women who developed abdominal pain after childbirth. All of the patients had fever with abdominal pain, diarrhea and clinical signs of peritonitis. In two cases a laparotomy was performed to remove pus. Cultures taken were positive for Streptococcus pneumoniae. Culture of vaginal swabs and blood cultures were also positive for the same pathogen. For the third patient, both vaginal swabs and blood cultures were positive for Streptococcus pneumoniae, antibiotic therapy only was administered. Outcome was favorable for all. We discuss the pathogenesis, clinical presentation, management and the usefulness for systematic search "for" Streptococcus pneumoniae in vaginal swabs.

Topics: Abdominal Pain; Adult; Amikacin; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteremia; Cilastatin; Diarrhea; Drug Therapy, Combination; Female; Fever; Humans; Imipenem; Laparotomy; Penicillins; Peritonitis; Pneumococcal Infections; Protease Inhibitors; Puerperal Infection; Thienamycins; Treatment Outcome; Vagina

Four days after beginning a perioperative antibiotic prophylaxis with amoxicillin and clavulanic acid a 33-year-old patient developed an acute haemorrhagic diarrhoea with cramp-like lower abdominal pain. Coloscopy revealed diffuse mucosal oedema with map-like ulcerations, increased susceptibility to trauma and submucous haemorrhages extending from the middle of the ascending to the middle of the descending colon. Granulocytic inflammation with cryptal atrophy was seen histologically. Stool cultures, including tests for Clostridium difficile toxin, were normal. All symptoms disappeared within three days of discontinuing the medication. Coloscopy after one week revealed marked improvement, after three months nothing abnormal. Acute segmental haemorrhagic penicillin-associated colitis is rare and must be distinguished from antibiotic-associated pseudomembranous colitis.

Topics: Abdominal Pain; Acute Disease; Adult; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Bacterial Proteins; Bacterial Toxins; Clavulanic Acids; Clostridioides difficile; Colitis; Colon; Colonoscopy; Cytotoxins; Diagnosis, Differential; Diarrhea; Drug Therapy, Combination; Feces; Gastrointestinal Hemorrhage; Humans; Male