Novembre 2007 - Volume XXVI - numero 9
Pagine elettroniche ; Caso Contributivo
1SC di Pediatria, Ospedale di San Vito al Tagliamento (PN), ASS6 “Friuli Occidentale”;
2Laboratorio di Analisi e Microbiologia, Ospedale di San Vito al Tagliamento (PN), ASS6 “Friuli Occidentale”
Indirizzo per corrispondenza: pediatria.sanvito@ass6.sanita.fvg.it
Key words: Yersinia enterocolitica, Enteritis, Pseudo-appendicular syndrome, IIeitis
We report a case of a 11-year old boy with Yersinia enterocolitica (YE) enteritis mimicking initially acute appendicitis. The following clinical course was characterized by persistent periciecal adenitis associated with elevated levels of inflammatory indices, leading to consider the diagnosis of chronic inflammatory bowel disease. The diagnosis of YE infection was made by positive stool culture. The patient’s clinical situation spontaneously improved and antibiotic treatment was not necessary. YE infection is thought to be relatively infrequent in general population. The clinical spectrum of YE may range from a self limited enteritis, mesenteric adenitis, pseudoappendicitis, ileocolitis, to extraintestinal manifestations and post-infectious reactions, such as nodosum erythema. This case-report suggests to consider the diagnosis of YE infection in case of persistent mesenteric adenitis or terminal ileitis.
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Pagine elettroniche ; Caso Contributivo
Prima Clinica Pediatrica, Ospedale Meyer, Firenze
Indirizzo per corrispondenza: paolo.lionetti@unifi.it
Key words: Autoimmune hemolytic anemia, Ulcerative colitis, Cyclosporine, Azathioprine, Mesalazine
We report a case of a 7 year-old patient with a 4-year history of severe steroid-refractory Ulcerative Colitis (UC) which had been controlled with cyclosporine and azathioprine, who was admitted to our Clinic because of jaundice. At time of admission mild intestinal bleeding was occasionally present on azathioprine and mesalazine. Investigations revealed hyperbilirubinemia, Coombs-positive haemolytic anemia (AIHA) (Hb 7.5 g/dl). IVIG (1 g/kg/day for 3 days) and oral prednisone (2 mg/kg/day) were prescribed with clinical improvement. Four weeks later, while on oral steroids (1 mg/kg/day) and azathioprine, a new haemolytic crisis occurred (Hb 6.7 g/dl) refractory to IVIG (1 g/kg/day for 3 days) and metylprednisolone pulses. Colonoscopy showed active mucosal lesions. Oral cyclosporine was then introduced with complete remission of GI bleeding and partial improvement of AIHA; after 6 months, controlled chronic haemolisis and positive Coombs test persist with mild anaemia.
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