ro13-9904 and Hepatitis

A 23-year-old Japanese woman, previously a commercial sex worker, presented with a 2-day history of right upper quadrant (RUQ) abdominal pain, worse on deep inspiration. She had noticed increased vaginal discharge 2 months earlier and had developed dull, lower abdominal pain 3 weeks prior to presentation. Although pelvic examination and transvaginal ultrasonography revealed neither a tubal nor ovarian pathology, abdominal CT scan with contrast demonstrated early enhancement of the hepatic capsule, a finding pathognomonic for Fitz-Hugh-Curtis syndrome (FHCS). Cervical discharge PCR assay confirmed Chlamydia trachomatis infection. This case highlights that normal gynaecological evaluation may be insufficient to rule out FHCS, for which physicians should have a high index of suspicion when seeing any woman of reproductive age with RUQ pain.

Topics: Abdominal Pain; Adult; Anti-Bacterial Agents; Ceftriaxone; Chlamydia Infections; Chlamydia trachomatis; Contact Tracing; Directive Counseling; Doxycycline; Drug Therapy, Combination; Female; Hepatitis; Humans; Pelvic Inflammatory Disease; Peritonitis; Sex Work; Tomography, X-Ray Computed; Treatment Outcome

Topics: Abdominal Pain; Adult; Anti-Bacterial Agents; Ceftriaxone; Chlamydia Infections; Chlamydia trachomatis; DNA, Bacterial; Doxycycline; Drug Therapy, Combination; Female; Hepatitis; Humans; Laparoscopy; Pelvic Inflammatory Disease; Peritonitis; Polymerase Chain Reaction; Treatment Outcome

We report an unusual presentation of sacroiliitis and hepatitis secondary to Salmonella systemic infection. A high index of suspicion, early blood cultures, prompt investigations and treatment with parenteral antibiotics can result in complete resolution of symptoms and prevent long-term sequelae of either condition.

Topics: Adolescent; Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Hepatitis; Hepatomegaly; Humans; Liver Function Tests; Magnetic Resonance Imaging; Male; Sacroiliitis; Salmonella enteritidis; Salmonella Infections; Tomography, X-Ray Computed

Here we describe a case of viral sepsis beyond the neonatal period caused by human parechovirus subtype 3 (HPeV-3), which manifested as cardio-respiratory failure, hepatitis, and necrotizing enterocolitis (NEC). HPeV-1 and 2 were originally classified as enteroviruses but the advent of sequence analysis led to them being recognized as a new genus in the picornavirus family. Subsequently, nine additional HPeV strains have been reported including HPeV-3 in 1999.(1) The spectrum of disease that these viruses may cause is still unknown, and they are rarely screened for in clinical practice.

Topics: Anti-Bacterial Agents; Blood Coagulation Disorders; Ceftriaxone; Enterocolitis, Necrotizing; Enzyme Inhibitors; Fever; Heart Failure; Hepatitis; Humans; Infant; Male; Parechovirus; Penicillanic Acid; Picornaviridae Infections; Piperacillin; Respiratory Insufficiency; Reverse Transcriptase Polymerase Chain Reaction; RNA, Viral; Sepsis; Sequence Analysis, RNA; Tazobactam

Hepatitis is a rare clinical manifestation of syphilis. In this report a 50 years old male patient who was diagnosed as secondary syphilis presenting with hepatitis has been discussed. The patient was admitted to the hospital with high fever and skin rash, and his history revealed a suspected sexual contact. He indicated that he had been admitted to a health center eight months ago because of the presence of a penile wound, however VDRL (Venereal Disease Research Laboratory) test was negative at that time. Fever (39.5 degrees C), jaundice in skin and sclera, generalized macular and maculopapular skin rash including palms and soles, lymphadenopathy and hepatosplenomegaly were detected in physical examination. Laboratory tests yielded elevated erythrocyte sedimantation rate, high CRP levels and elevated liver enzyme levels, however viral hepatitis markers together with VDRL and TPHA (Treponema pallidum hemagglutination) tests were found negative. Ceftriaxone therapy was initiated because of the presence of high fever (40 degrees C) and 30 leukocyte/mm3 in urine, and the absence of bacteria in Gram staining of urine sample. However, the antibiotic therapy was discontinued since fever persisted. As the clinical signs and symptoms strongly indicated syphilis, the serological tests were repeated and VDRL positivity at 1/8 and TPHA positivity at 1/1280 titers were detected. Ceftriaxone therapy was restarted and continued for 14 days with complete cure. Since the spouse of the patient was also found VDRL and TPHA positive, she was treated with penicilin. The presentation of this case emphasized the importance of repeating the serological tests for syphilis since they might be negative in the early stages of infection. The case also indicates that syphilis should be considered in the differential diagnosis of hepatitis.

Topics: Anti-Bacterial Agents; Cardiolipins; Ceftriaxone; Cholesterol; Diagnosis, Differential; Exanthema; Female; Fever; Hemagglutination Tests; Hepatitis; Hepatomegaly; Humans; Jaundice; Lymphatic Diseases; Male; Middle Aged; Phosphatidylcholines; Splenomegaly; Syphilis; Syphilis Serodiagnosis

Though typhoid fever is quite common, typhoid hepatitis is a very rare entity which may have a variety of presenting features similar to other more common conditions. One case of typhoid hepatitis is reported here because of its ratity.

Topics: Adolescent; Ceftriaxone; Cephalosporins; Female; Hepatitis; Humans; Jaundice; Liver; Typhoid Fever

An elderly woman presented with very high levels of transaminases and lactic dehydrogenase in her liver function tests. Viral and drug-induced hepatitis were considered unlikely because of the absence of risk factors. Sepsis was suspected and antibiotic treatment was started with clinical improvement. A retrospective diagnosis of ischaemic hepatitis due to septicaemia was made. Markedly raised liver transaminases need not always be drug-induced or viral-related, especially in the elderly. It could be ischaemic in origin and the serious underlying condition needs to be sought and treated urgently.

Topics: Aged; Alanine Transaminase; Aspartate Aminotransferases; Bacteremia; Ceftriaxone; Cephalosporins; Female; Hepatitis; Humans; Ischemia; L-Lactate Dehydrogenase; Liver; Sepsis; Staphylococcal Infections