Journal of Clinical Case Reports

A 24 years young male with no prior history of jaundice now presented with progressive jaundice and hepatomegaly. Autoimmune serology and liver biopsy revealed features of autoimmune hepatitis. He was started on oral prednisolone and azathioprine, following which he attained remission. However, he persisted in having hyperbilirubinemia with a predominant unconjugated fraction. Hemolytic causes of unconjugated hyperbilirubinemia were ruled out, and the diagnosis of Gilbert Syndrome was established.

Background: Splenectomy and hydatid cyst resection using either laparoscopy or laparotomy methods are frequently performed procedures. However, cases of patients suffering from both massive splenomegaly and hydatid cyst are rare.

Case presentation: Patient was a 62-year-old man who complained of upper abdominal pain and was diagnosed with massive splenomegaly. In a Computed Tomography (CT) scan performed prior to surgery, a hypodense lesion with the measurements of the (45 x 43) m m² was found in the sixth segment of the liver. Therefor we performed an open splenectomy and hydatid cyst resection through one incision.

Conclusion: Simultaneous surgical procedures on both massive splenomegaly and hydatid cysts are rare. We suggest a CT scan be performed and the best type of incision be chosen based on the pathology and site of lesion, before performing a midline incision.

A 62-year-old male with recently diagnosed stage IV pancreatic cancer was started on chenotherapy with 5-Fluourouracil. Shortly after initiation, he suffered cardiac arrest. We will review the proposed pathophysiology of 5-Fluourouracil cardiotoxicity, the reported incidence, treatment, and the antidote for 5-Fluorouracil overdose or toxicity. Myocardial infarction is an adverse cardiac reaction associated with 5-fluorouracil (5-FU). Data on the incidence, risk, and prognosis of 5-FU-related myocardial infarction are limited. Fluorouracil (5-FU) is the most commonly proposed chemotherapy drug for colorectal cancer. Cardiogenic side effects such as autopsy arterial vessels seizures, ventricular arrhythmias, and cardiac ischemia are also rare.

Immune Thrombocytopenic Purpura (ITP) is a heterogeneous disease with unpredictable treatment responses. This unpredictability is attributed in part to different pathogenic mechanisms including oxidative stress. The anti-oxidant effect of ascorbic acid in treatment of ITP has been described but evidence on its efficacy is contentious.

We describe a patient with refractory ITP in whom ascorbic acid was used as a useful adjuvant treatment. A 60-year old man with diabetes and hypertension presented with myocardial infarction and underwent primary coronary intervention. He had steroid dependent ITP, with a poor response to azathioprine, rituximab and splenectomy. He had drug induced cholestasis with dapsone. Therefore high doses of steroids were required to maintain safe platelet counts for antiplatelet drugs, which lead to poor glycemic control. High dose ascorbic acid was started, following which his platelet count remained above 100 x 109/L, permitting tailing off of prednisolone while continuing dual antiplatelet therapy.