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RISS 인기검색어
- 검색키워드
- 저자 : ( Annamarie Borja ) (검색결과 2 건)
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( Annamarie Borja ),( Ivan Declarador ),( Veerendra Chadachan ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Neutropenia is a recognized, although a rare side effect of ceftriaxone. In clinical trials of ceftriaxone, neutropenia was mostly observed with prolonged (more than 4 weeks) treatment. We report here a patient who developed neutropenia and transaminitis within 3 days of starting ceftriaxone. We will also review here the literature on ceftriaxone-induced neutropenia and discuss the various mecha Methods: A 48-year old Chinese female was admitted for intermittent abdominal pain associated with fever and vomiting of nonbilous and nonbloody content. Her past medical history included that of a previous episode of UTI, which was treated with ceftriaxone. Physical examination was unremarkable except for mild epigastric tenderness. Results: Investigations revealed she had neutrophilic leucocytosis and the urine microscopy revealed pyuria. She was treated for UTI with intravenous Ceftriaxone. Serial laboratory showed the development of neutropenia and transaminitis after starting Ceftriaxone. Ceftriaxone was then withheld and marked improvement of the total white cell count and transaminases was noted. Conclusions: In the case presented, looking at the temporal profi le of the patient`s results, her neutropenia and transaminitis are likely ceftriaxone-induced. The development of transaminitis and neutropenia within 3 days of ceftriaxone use is likely due to the fact that the patient has already been sensitized from prior exposure to ceftriaxone during her previous admission for UTI. This case illustrates that the treating physicians should be aware of this rare but a serious potential idiosyncratic complication arising from the use of parenteral ceftriaxone in the community.
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( Aissa Althea Flavier Hundal ),( Ashish Anil Sule ),( Annamarie Borja ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Systemic lupus with antiphospholipid syndrome is associated with thrombotic manifestations. There is little literature on lupus with anitiphospholipid syndrome patients presenting with splenic infarctions. Case Presentation: This is a case of a 28-year-old Chinese Female who presented with fever, night sweats and splenomegaly and lymphadenopathies. Investigations showed Hemoglobin of 6. 1g/dL, total white cell 8. 1x109/L, Platelets 300x109/L, Absolute Reticulocyte count 182. 5, Direct coombs positive, Bilirubin 12, Lactate Dehydrogenase 1264, Haptoglobin 15, ANA-IFA 640, homogenous pattern, Anti-ds-DNA >200, Lupus anti -coagulant and anti-cardiolipin positive. CT abdomen and pelvis showed splenomegaly with multiple hypodense lesions as well as abdominal and retroperitoneal adenopathy. CT neck was also done which showed polypoidal soft tissue in the nasopharynx. She underwent post-nasal space biopsy, which was negative of malignancy. She had bone marrow aspiration, which revealed hypercellular marrow with increase erythropoesis consistent with peripheral destruction. She also went for biopsy of the spleen, which was negative for tuberculosis and malignancy or lymphoma. Patient was then started on steroids for treatment of systemic lupus erythematosus with autoimmune phospholipid syndrome and showed clinical improvement. Discussion: Splenic hypodensities are usually benign and differential diagnoses include cysts, infarction, metastases, lymphomas, hamartomas, haemangiomas and tuberculosis. In a large, multicenter study, involving 1,000 adult patients with antiphospholipidsyndrome, spleen infarct was present in only 1. 1% of patients. Given the history of fever, splenomegaly and elevated serum lactate dehydrogenase, this case illustrates apossibility of splenic infarctions on the background of a hypercoagulable state, specifi - cally antiphospholipid syndrome. Conclusion: Hypodensities in the spleen in a patient with lupus can be associated with antiphospholipid syndrome with splenic infarctions. It would be necessary to rule out metastases, tuberculosis and lymphoma as differential diagnoses in such cases.
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