Vol 2, No 4 (2015)

Table of Contents

Cover Page
Bruno Marmelo, Telma Pereiro, Paula Sousa, Joana Capelo, Adelino Carragoso

Objectives: To report a case of Brucella peritonitis.

Patient and methods: We describe the case of a patient and present a brief review of the few published reports.

Results: The patient had alcoholic cirrhosis of the liver and was diagnosed with Brucella non-neutrocytic bacterascites.

Conclusion: Brucellosis is a common zoonosis with worldwide distribution. It is a systemic disease with the potential to predominantly affect one organ or a specific system (focal brucellosis). However, peritoneal focalization of this disease is a very rare presentation.

Renata Baronaite Hansen, Ulla Feldt Rasmussen, Åse Krogh Rasmussen, Carsten Palnaes Hansen, Ulrich Knigge

Objectives: The authors describe 2 atypical cases of patients with hypoglycaemia, suspected for insulinoma.

Methods: The 2 reports are accompanied by a concise review of the literature.

Results: Patient 1 had a distal pancreatectomy performed for suspected insulinoma, and was diagnosed with a glucagonoma and beta-cell hyperplasia (nesidioblastosis). To the authors’s knowledge, co-existing glucagonoma and nesidioblastosis had not been previously reported.
Patient 2 was diagnosed with a benign insulinoma and 5 years later with metastatic disease.

Conclusion: The authors conclude that insulinomas are rare entities which often present a diagnostic and therapeutic challenge. In such cases, patient referral to tertiary multidisciplinary centers is recommended.

Maria Paparoupa, Frank Schuppert, Huy Ngoc Anh Ho

Objectives: We present an atypical case of chronic mesenteric ischemia with weight loss as only clinical manifestation and endoscopic findings imitating Crohn´s disease.

Materials and Methods: A CT Angiography of abdomen confirmed the diagnosis of mesenteric ischemia after total occlusion of celiac trunk and superior mesenteric artery.

Results: The patient died due to severe sepsis, as a result of extended bowel infarction.

Conclusions: The diagnosis of chronic mesenteric ischemia requires a high degree of clinical suspicion and can be life-saving if early conducted.

Meenal Sharma, Chris Anthony, Charlie Chia-Tsong Hsu, Catriona Maclean, Niki Martens

Disseminated nocardiosis of the central nervous system (CNS) has been rarely reported, especially in the immunocompetent patient. We report a case of cerebral and cervical intradural extramedullary nocardiosis likely to have been the result of disseminated spread from a pulmonary infective focus. Attempts at tissue biopsy and culture of the initial cerebral and pulmonary lesions both failed to yield the diagnosis.
Interval development of a symptomatic intradural extramedullary cervical lesion resulted in open biopsy and an eventual diagnosis of nocardiosis was made.

We highlight the diagnostic dilemma and rarity of spinal nocardial dissemination in an immunocompetent individual.

Paola Finocchietto, Damián Contardo, Tatiana Uehara, Claudia Papini, Natalia Deligiannis, Enrique Darderes, Augusto Castroagudin, Cecilia Cabral, Horacio di Fonzo

A 31-year-old Caucasian woman of South-American descent was diagnosed with a variant of multicentric Castleman disease (MCD) that has been reported in Japan as Castleman-Kojima disease. This is a systemic inflammatory disorder known as TAFRO Syndrome which includes thrombocytopenia, polyserositis (ascites/pleural effusion), microcytic anemia, myelofibrosis, fever, renal dysfunction and organomegaly, with immunologic disorder, polyclonal hypergammaglobulinemia, and elevated levels of interleukin-6 (IL-6) and the vascular endothelial growth factor present in serum and/or effusions. Optimal therapies are not well established. The patient was treated with methylprednisolone and rituximab. Following the start of treatment, the patient has been asymptomatic for over 8 months.

This is one of only a few reports of TAFRO Syndrome in a non-Japanese patient.

Vital Manuel Da Silva Domingues, Vital Da Silva Domingues, Isabel Neves, Susana Garrido, Inês Ferreira, Teresa Mendonça

The gastrointestinal system is commonly implicated in Systemic Lupus Erythematosus (SLE). Ascites, produced by several mechanisms has been reported as a systemic manifestation of lupus, but only rarely as an initial presentation of the disease. Its appearance is often insidious and without abdominal pain. Chylous ascites (such as chyle in the peritoneal cavity) has seldom been reported in SLE. We describe a case of chylous ascites in an SLE patient, reviewing the other published cases, its pathophysiology and its management.