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Pruritus is a major symptom of primary biliary cirrhosis, cholestatic autoimmune disease which affects mostly middle-age women. Often, it can be severe and refractory to multiple treatments, and mostly affecting the patient’s health-related quality of life. Intense pruritus can be itself an indication to liver transplantation, in extreme cases leading to suicide. Its physiopathology has not yet been fully elucidated, but recent studies added the elevation of autotaxin and lysophosphatidic acid to the group of classic mechanisms already linked to cholestatic pruritus. In this case report we illustrate how ultraviolet B phototherapy appears to successfully control severe pruritus and contribute to the healing of pruritic skin lesions caused by intense scratching. There is limited medical literature concerning this therapeutic approach on cholestatic pruritus, but we hope that further randomised controlled trials will successfully establish it as an effective treatment in the near future.

An 85-year-old man with type 2 diabetes presented to a secondary hospital emergency room with a 2-day course of vomiting and epigastric pain, which started after a snapper fish meal. The patient was alert, tachycardic, tachypneic and with intense abdominal pain. He had leukocytosis and a C reactive protein of 23.3 mg/dL. There was no evidence of organ failure. Both abdominal and chest roentgenograms showed a small amount of intraperitoneal gas which was confirmed by an abdominal CT scan. Exploratory laparotomy was negative for an abdominal visceral perforation. It did however raise …

A male patient in his mid-30s with end stage alcoholic cirrhosis (Child-Pugh C, MELD 21) was referred to our hospital due to refractory ascites. He had had several hospital admissions for spontaneous bacterial peritonitis, encephalopathy and sepsis. He was submitted to an emergency herniorraphy due to a strangulated umbilical hernia. Suddenly the surgical suture did not …