Volume 71 - 2008 - Fasc.1 - Case reports
Necrotizing pancreatitis due to poisoning with organophosphate pesticides
Several complications have been reported in relation to organophosphate poisoning. Pancreatitis due to cholinergic hyper- secretion related to this type of poisoning, is however rare and has usually a subclinical course. Necrotizing pancreatitis has only been reported in 3 patients. We present a case of a young man who deliberately ingested the organophosphate dichlorvos and developed a necrotizing pancreatitis. A distal spleen and vessel preserving pancreatectomy was performed already 36 hours after ingestion. We believe that due to this very early surgery, this patient could be discharged as early as 12 days after surgery. (Acta gastroenterol. belg., 2008, 71, 27-29).
Lamivudine treatment for acute severe hepatitis B : report of a case and review of the literature
The oral nucleoside analogue lamivudine has been effectively used in the treatment of chronic hepatitis B. However, there is lim- ited data concerning the efficacy and safety of lamivudine in patients with severe acute or fulminant hepatitis B. We report the use of lamivudine in a young woman with acute HBV infection and fulminant hepatic failure. Following lamivudine treatment, we noticed a prompt clinical, biochemical, serological and virological response as it was seen in the vast majority of, previously report- ed, cases. Lamivudine treatment was continued until HBsAg was cleared. Our case, as well as previously reported ones, suggests that lamivudine may have a beneficial effect in selected patients with acute severe or fulminant HBV infection. (Acta gastroenterol. belg., 2008, 71, 30-32).
Epstein-Barr virus related lymphoma in inflammatory bowel disease
Epstein-Barr virus (EBV) induced lymphoproliferative disease is a well-known, feared complication of EBV primo-infection in children treated with immunomodulators or immunosuppressive drugs, eg after transplantation. As the incidence of inflammatory bowel disease (IBD) in young children is rising, more young EBV naïve patients are treated with immunomodulatory agents. It is not yet clear whether these patients carry the same risk as trans- planted patients to develop lymphoproliferative disease and if sO. whether their evolution is comparable. We present the history of a young patient with Crohn's disease who developed an EBV related lymphoma shortly after the primo-infection while being treated with azathioprine. This case argues for a rigorous follow up of young IBD patients treated with immune suppressive drugs, also regarding EBV status. (Acta gastroenterol. belg., 2008, 71, 33-35).
Acute hepatitis with prolonged cholestasis and disappearance of interlobular bile ducts following tibolone and Hypericum perforatum (St. John's wort). Case of drug interaction ?
The case of a patient under tibolone therapy for two years who developed a mixed-type liver injury with prolonged cholestasis and features of the vanishing bile duct syndrome following a ten weeks treatment with St. John wort (Hypericum Perforatum) infu- sions is reported. In the absence of evidence of a potential role for concomitant medication i.e. hydroxychloroquine sulfate to play a role in the clinical, biochemical and morphological picture, an interaction between the herbal preparation and tibolone was sus- pected as the likely cause of liver damage. (Acta gastroenterol. belg., 2008, 71, 36-38).
Portal vein thrombosis as the first sign of a primary myeloproliferative disorder : diagnostic interest of the V617F JAK-2 mutation. A report of 2 cases
Portal vein thrombosis is, in some cases, related to a myelopro- liferative disorder but the diagnosis of the latent forms may be difficult in case of normal blood counts. We report two cases of patient with portal vein thrombosis of unknown origin in whom the presence of the V617F mutation of the Janus Kinase 2 gene lead to the diagnosis of primary myeloproliferative disorder, con- firmed on bone marrow examination. The search of the V617F mutation of the Janus Kinase 2 gene has to be performed in all cases of portal vein thrombosis of unknown origin. (Acta gastro- enterol. belg., 2008, 71, 39-41).
