Wilsons 疾病作为尖锐胰腺炎，胆管炎，和黄疸介绍的诊断挑战

Wilson’s disease is a rare disorder of copper transport in hepatic cells,and may present as cholestatic liver disease;pancreatitis and cholangitis are rarely associated with Wilsons’s disease.Moreover,cases of Wilson s disease presenting as pigmented gallstone pancreatitis have not been reported in the literature.In the present report,we describe a case of a 37-year-old man who was admitted with jaundice and abdomina pain.The patient was diagnosed with acute pancreatitis,cholangitis,and obstructive jaundice caused by pigmented gallstones that were detected during retrograde cholangiopancreatography.However,because of his long-term jaundice and the presence of pigmented gallstones,the patient underwent further evaluation for Wilson’s disease,which was subsequently confirmed.This patient’s unique presentation exemplifies the overlap in the clinical and laboratory parameters of Wilson’s disease and cholestasis,and the difficulties associated with their differentiation.It suggests thatWilson’s disease should be considered in patients with pancreatitis,cholangitis,and severe protracted jaundice caused by pigmented gallstones.

Retrospective study of the associations between hepatitis C virus infection and metabolic factors

AIM To evaluate the bidirectional association between metabolic syndrome(MS) components and antiviral treatment response for chronic hepatitis C virus(HCV) infection. METHODS This retrospective cohort study included 119 HCV + patients treated with pegylated-interferon-α and ribavirin. Metabolic characteristics and laboratory data were collected from medical records. Differences in baseline clinical and demographic risk factors between responders and non-responders were assessed using independent samples t-tests or χ~2 tests. The effects of sustained viral response(SVR) to antiviral treatment on de novo impairments in MS components, including impaired fasting glucose(IFG) and type 2 diabetes mellitus(T2DM), were assessed using univariable and multivariable logistic regression analysis, while the effect of MS components on SVR was assessed using univariable logistic regression analysis. RESULTS Of the 119 patients, 80(67%) developed SVR over the average 54 ± 13 mo follow-up. The cumulative risks for de novo T2DM and IFG were 5.07-(95%CI: 1.261-20.4, P = 0.022) and 3.87-fold higher(95%CI: 1.484-10.15, P = 0.006), respectively for non-responders than responders, when adjusted for the baseline risk factors age, sex, HCV genotype, high viral load, and steatosis. Post-treatment triglyceride levels were significantly lower in non-responders than in responders(OR = 0.27; 95%CI: 0.069-0.962, P = 0.044). Age and HCV genotype 3 were significantly different between responders and non-responders, and MS components were not significantly associated with SVR. Steatosis tended to attenuate SVR(OR = 0.596; 95%CI: 0.331-1.073, P = 0.08).CONCLUSION SVR was associated with lower de novo T2DM and IFG incidence and higher triglyceride levels. Patients infected with HCV should undergo T2DM screening and antidiabetic treatment.

Primary effusion lymphoma-like lymphoma in a patient with inflammatory bowel disease

A 77-year-old man with inflammatory bowel disease(IBD)and who was treated with anti-tumor necrosis factor(TNF),6-mercaptopurine and corticosteroids,presented with primary effusion lymphoma-like lymphoma(PEL-like lymphoma)with massive ascites.The patient’s clinical course was complicated by acute renal insufficiency and hypotension,which led to death within 2 wk.In general,patients with IBD may have an increased risk for development of lymphoma,which is frequently associated with immunosuppressive and/or anti-TNF antibody therapies.PEL is a rare subset of lymphoma localized to serous body cavities,lacks tumor mass or nodal involvement,and is associated with infection by human herpes virus 8(HHV-8).Primary neoplastic effusion may also be present in patients with large B-cell lymphoma without evidence of human immunodeficiency virus or HHV-8 infections.This type of lymphoma is classified as PEL-like lymphoma.Both PEL and PEL-like lymphoma types have been reported in patients undergoing immunosuppressive therapy,but to the best of our knowledge,the case described herein represents the first PEL-like lymphoma occurring in a patient with IBD.