Clopidogrel-induced hepatotoxicity after percutaneous coronary stenting

ABSTRACT

Hong Kong Med J 2005;11:414-6 | Number 5, October 2005
CASE REPORT
Clopidogrel-induced hepatotoxicity after percutaneous coronary stenting
TN Chau, KF Yim, NS Mok, WK Chan, VKS Leung, MF Leung, ST Lai
Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Hong Kong
 
 
Clopidogrel, an adenosine diphosphate receptor blocker, is widely used as an adjunctive antiplatelet therapy in acute coronary syndrome and percutaneous coronary stenting. The occurrence of hepatotoxicity is rare. We describe the occurrence of symptomatic liver disease in a 74-year-old man 5 weeks following commencement of therapy with clopidogrel. The reported cases of clopidogrel-induced hepatotoxicity are reviewed and the clinical significance of this event are discussed.
 
Key words: Adverse effects; Clopidogrel; Drug toxicity; Hepatitis
 
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A case of Streptococcus mitis endocarditis successfully treated by linezolid

ABSTRACT

Hong Kong Med J 2005;11:411-3 | Number 5, October 2005
CASE REPORT
A case of Streptococcus mitis endocarditis successfully treated by linezolid
KHL Ng, S Lee, SF Yip, TL Que
Department of Clinical Pathology, Tuen Mun Hospital, Tsing Chung Koon Road, Tuen Mun, Hong Kong
 
 
We report the successful treatment of infective endocarditis caused by Streptococcus mitis with linezolid in a patient with pre-existing valvular heart disease. The patient had multiple allergies to conventional antibiotics. Linezolid may provide an oral alternative in the treatment of infective endocarditis in patients with adverse drug reactions to traditional antibiotic regimens.
 
Key words: Endocarditis, bacterial; Oxazolidinones; Streptococcus mitis
 
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Fever, pulmonary haemorrhage, and acute renal failure in a young girl

ABSTRACT

Hong Kong Med J 2005;11:408-10 | Number 5, October 2005
CASE REPORT
Fever, pulmonary haemorrhage, and acute renal failure in a young girl
FWT Cheng, TF Leung, N Lee, F Yap, J Hui, TF Fok, PC Ng
Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
 
 
Leptospirosis is rarely reported in children. It is easily treated with antibiotics but can be fatal if treatment is delayed. A 12-year-old girl was diagnosed with Weil syndrome, a severe form of leptospirosis, 10 days after returning from Mainland China. She presented with fever, hypotension, jaundice, and acute renal failure. She had used well water for bathing and swum in freshwater.
 
Key words: Child; Leptospirosis; Weil disease
 
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A case of human brucellosis in Hong Kong

ABSTRACT

Hong Kong Med J 2005;11:403-6 | Number 5, October 2005
CASE REPORT
A case of human brucellosis in Hong Kong
MKP Lee, KSC Fung
Department of Pathology, United Christian Hospital, Kwun Tong, Hong Kong
 
 
Brucellosis is an infectious disease of humans and animals caused by Brucella species. We report on a 34-year-old housewife who presented with recurrent headache, fever, and malaise. Blood cultures yielded slow-growing gram-negative coccobacilli that were later identified as Brucella melitensis. The patient recalled handling goat placenta in China. She was prescribed a 6-week course of doxycycline and rifampicin. Laboratory staff who had been exposed to the isolate remained asymptomatic. The epidemiology, diagnosis, and treatment of brucellosis are discussed.
 
Key words: Brucella melitensis; Brucellosis
 
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Herpetic shoulder paresis in a Chinese elderly patient

ABSTRACT

Hong Kong Med J 2005;11:399-402 | Number 5, October 2005
CASE REPORT
Herpetic shoulder paresis in a Chinese elderly patient
TCC Tam, KY Chan, SL Ho, JKH Luk, LW Chu
Acute Geriatrics Unit, Grantham Hospital, Wong Chuk Hang, Hong Kong
 
 
A patient with left shoulder girdle weakness secondary to herpetic myotomal paresis is reported. Needle electromyography revealed denervational discharge from the left supraspinatus, deltoid, and brachioradialis muscles, compatible with a radiculopathy that was relevant to his myotomes affected by zoster infection. The patient was managed with range-of-movement and strengthening exercises as well as pain relief for post-herpetic neuralgia. Further studies are required to determine whether antiviral treatment can limit the extent of motor deficit and hasten recovery. Zoster paresis should be one of the differential diagnoses of girdle muscle weakness.
 
Key words: Aged; Herpes zoster; Paresis
 
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Diarrhoea and rash in a retired farmer

ABSTRACT

Hong Kong Med J 2005;11:397-8 | Number 5, October 2005
CASE REPORT
Diarrhoea and rash in a retired farmer
VWS Wong, WK Leung, KF To, JJY Sung
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
 
 
An 83-year-old retired farmer developed invasive strongyloidiasis after using potent topical corticosteroids. Initial colonoscopy features mimicked ulcerative colitis, and the clinical course was complicated by bacterial septicaemia with Serratia and Enterococcus. He was treated successfully with oral ivermectin and antibiotics.
 
Key words: Colitis, ulcerative; Inflammatory bowel disease; Strongyloides stercoralis; Strongyloidiasis; Ulcerative colitis
 
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Necrotic cardiac haemangioma masquerading as sepsis with disseminated intravascular coagulation

ABSTRACT

Hong Kong Med J 2005;11:308-10 | Number 4, August 2005
CASE REPORT
Necrotic cardiac haemangioma masquerading as sepsis with disseminated intravascular coagulation
TS Tse, KL Tsui, LC Ling, WH Chui, MC Choi, SK Li, CSW Chiu
Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
 
 
Cardiac haemangiomas are exceptionally rare benign vascular tumours. We report a case of cardiac haemangioma presenting with pyrexia of unknown origin and clinical features simulating sepsis with disseminated intravascular coagulation. The clinical course was complicated by systemic embolism.
 
Key words: Disseminated intravascular coagulation; Heart neoplasms; Hemangioma; Sepsis
 
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Benign metastasising leiomyoma: a rare but possible cause of bilateral pulmonary nodules in Chinese patients

ABSTRACT

Hong Kong Med J 2005;11:303-6 | Number 4, August 2005
CASE REPORT
Benign metastasising leiomyoma: a rare but possible cause of bilateral pulmonary nodules in Chinese patients
JWM Chan, WL Law, SOY Cheung, MP Lee, CK Ng, S Lee, KM Ko, CC Ma, JYS Liu, TM Chan, TYW Mok
Department of Medicine, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong
 
 
We report three cases of benign metastasising leiomyoma, which is a rare cause of multiple lung nodules, in three Hong Kong Chinese females. One patient presented with pleuritic chest pain, another was asymptomatic, while the last presented with haemoptysis. All three patients had previously undergone surgical resection of uterine leiomyomas. Multiple lung nodules mimicking lung metastases were demonstrated on chest radiographs, and all three diagnoses were obtained from lung biopsies. Hormonal therapy was given to two patients with variable responses. To the best of our knowledge, this is the first report of benign metastasising leiomyoma in Hong Kong Chinese population. It highlights the importance of considering this rare and benign disease in premenopausal females presenting with multiple lung nodules.
 
Key words: Hormone replacement therapy; Leiomyoma; Lung neoplasms; Neoplasms metastasis; Uterine neoplasms
 
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Partial rhombencephalosynapsis and Chiari II malformation

ABSTRACT

Hong Kong Med J 2005;11:299-302 | Number 4, August 2005
CASE REPORT
Partial rhombencephalosynapsis and Chiari II malformation
SMY Wan, PL Khong, P Ip, GC Ooi
Department of Diagnostic Radiology, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
 
 
We report a rare case of partial rhombencephalosynapsis coexistent with Chiari II malformation in a 6-year-old girl and discuss the features of these entities on magnetic resonance imaging.
 
Key words: Arnold-Chiari malformation; Cerebellum; Child; Magnetic resonance imaging; Rhombencephalon
 
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Recurrent variceal bleeding in a young woman

ABSTRACT

Hong Kong Med J 2005;11:295-8 | Number 4, August 2005
CASE REPORT
Recurrent variceal bleeding in a young woman
VKS Leung, TKL Loke, ISC Luk, PCW Lui, NNS Kung, SH Lam
Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Hong Kong
 
 
Congenital hepatic fibrosis is an uncommon fibrocystic disorder affecting the intrahepatic bile ducts. It has autosomal recessive inheritance. The main consequence of this condition is portal hypertension and it is often misdiagnosed as cirrhosis. Patients with congenital hepatic fibrosis usually present during childhood or early adolescence with oesophageal variceal bleeding. Portosystemic shunt surgery is the treatment of choice for these patients as the risk of postoperative hepatic encephalopathy is low. We report a patient with congenital hepatic fibrosis who presented with oesophageal variceal bleeding at the age of 16 years, initially misdiagnosed as having cryptogenic liver cirrhosis. The patient experienced two further episodes of oesophageal variceal bleeding in subsequent years. She eventually underwent portosystemic shunt surgery. One year after the operation, the shunt remained patent on Doppler ultrasonography, and there had been no further episodes of variceal bleeding post-surgery.
 
Key words: Cholangiography; Hypertension, portal; Liver cirrhosis; Liver diseases
 
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