Search

The article describes the case of a 78-year-old woman who was diagnosed with chronic lymphocytic leukemia (CLL) four years prior presentation when she was found to have lymphadenopathy on positron-emission tomography (PET) scan obtained for follow-up of her breast and bladder cancer. Topics discussed include treatment she received for CLL, finding on a full body computed tomography (CT) scan, and efficacy of ibrutinib on disease outside of a lymph node.

Drug-induced liver injury (DILI) is the most common cause of acute liver failure in the Unites States and accounts for 10% of acute hepatitis cases. We report the only known case of diphenhydramine-induced acute liver injury in the absence of concomitant medications. A 28-year-old man with history of 13/14-chromosomal translocation presented with fevers, vomiting, and jaundice. Aspartate-aminotransferase and alanine-aminotransferase levels peaked above 20,000 IU/L and 5,000 IU/L, respectively. He developed coagulopathy but without altered mental status. Patient reported taking up to 400 mg diphenhydramine nightly, without concomitant acetaminophen, for insomnia. He denied taking other medications, supplements, antibiotics, and herbals. A thorough workup of liver injury ruled out viral hepatitis (including A, B, C, and E), autoimmune, toxic, ischemic, and metabolic etiologies including Wilson’s disease. A liver biopsy was consistent with DILI without evidence of iron or copper deposition. Diphenhydramine was determined to be the likely culprit. This is the first reported case of diphenhydramine-induced liver injury without concomitant use of acetaminophen. [ABSTRACT FROM AUTHOR]

Hydatid cyst embolization to the pulmonary arteries is rare especially in the Western regions of the world. However, it can be mistaken for pulmonary embolism based on the similar clinical manifestations of cough, hemoptysis, and acute onset of chest pain. We report a case of a 32-year-old man presenting with these symptoms who was initially suspected of having pulmonary embolism. Subsequent imaging with CT and MR revealed hepatic hydatid cyst embolization to the pulmonary arteries. The significance of this case lies in the recognition of the unique radiologic features of pulmonary hydatid cyst embolization on CT and MR imaging to differentiate this entity from bland pulmonary thromboembolic disease. [ABSTRACT FROM AUTHOR]