Daily Archives: September 4, 2017

Question: A 63-year-old man with a past medical history of hypertension presented with increasing lower extremity edema, persistent hypokalemia, and back pain for >2 months. Despite administration of spironolactone together with intravenous and oral potassium supplement, his clinical symptoms progressed, prompting admission to our institution. Physical examination showed prominent bilateral pitting lower extremity edema up to his knees. Laboratory results showed potassium 2.9 mmol/L (normal, 3.5–5.3), Na+ 150 mmol/L (normal, 137–147), Ca2+ 1.89 mmol/L (normal, 2.1–2.6), alanine transaminase 145U/L, blood sugar 7.5 mmol/L, and lipase 110.8 U/L. Continue reading →

Question: A 64-year-old, obese women with a history of schizophrenia and multiple bariatric surgeries had been attending clinics for 4 years for assessment and adjustment of her gastric band. The patient had largely been unsuccessful in losing weight a… Continue reading →

Question: A 31-year-old woman, born in Pakistan, presented with dysphagia and severe anemia. She had a 10-year history of iron deficiency anemia secondary to chronic menorrhagia. She initially received a red blood cell transfusion, but had no gynecologic explorations or follow-up. The patient complained of dysphagia for solids that had been worsening for the last 5 years associated with a weight loss of 10 kg, but not with odynophagia or dysphonia. At admission, her hemoglobin level was 55 g/L, with a low mean corpuscular volume (70 fL) and ferritin level (<10 μg/L). Continue reading →

Question: A 73-year-old man presented with a 7-day history of fever. He also had a history of follicular lymphoma originating from the spleen and underwent splenectomy 12 years ago. In addition, he underwent transurethral resection of a bladder tumor 8 months ago, followed by 2 rounds of bacillus Calmette-Guérin (BCG) therapy. The last course was administered 7 days before presentation. Results of laboratory analysis showed increased levels of alanine transaminase (254 IU/L; normal, <40), aspartate aminotransferase (240 IU/L; normal, <40), γ-glutamyl transpeptidase (386 IU/L; normal, <70), and alkaline phosphatase (1704 IU/L; normal, 115-359). Continue reading →

Question: A 60-year-old man presented with substernal chest pain and dysphagia lasting 1 month. The intensity of substernal chest pain increased when swallowing food without chills and fever. He had lost about 4.0 kg in the past 2 months. Continue reading →

Question: A 67-year-old man with a past medical history of well-controlled diabetes mellitus type 2, a recent episode of acute kidney injury owing to bilateral distal ureteral strictures of unknown etiology treated with bilateral ureteral stenting and … Continue reading →

In their recent paper, Moreland et al1 showed that obese patients after Roux-en-Y gastric bypass surgery have steatorrhea and hyperoxaluria that were quantitatively correlated. They appropriately explained that hyperoxaluria was due to excess fatty ac… Continue reading →

We report a case series of 5 patients with quantifiable viral loads at the end of treatment who subsequently achieved sustained virologic response (SVR) with recommended hepatitis C virus (HCV) direct-acting antiviral (DAA) regimens. All 5 patients had… Continue reading →

Question: A 20-year-old man presented to our clinic with a 3-year history of intermittent hematochezia, in addition to developmental delay. Laboratory analysis and physical examination were otherwise normal. Colonoscopy to investigate the cause of hematochezia revealed >100 tubular, tubulovillous, and villous adenomas throughout the colon, up to 2 cm in size (Figure A). Restorative proctocolectomy was performed and numerous polyps were found, but no evidence of invasive carcinoma was identified. The parents and the patient’s sibling were phenotypically normal, with no developmental delay and no family history of gastrointestinal cancer. Continue reading →

Thiopurines have been mainly used to maintain remission in patients with inflammatory bowel disease (IBD) for decades, especially since the landmark placebo-controlled double blind randomized study by Markowitz et al.1 However, adverse events, especia… Continue reading →