Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0019209 (hepatomegaly)
 5,798 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 74-year-old housewife was admitted to the hospital with complaints of high fever and general fatigue. The physical examinations on admission showed no particular findings except for mild hepatomegaly, but laboratory findings showed severe liver dysfunction, active inflammation and negative tuberculine test. On the 4th day, she suddenly complained of severe respiratory distress. A chest X-ray film demonstrated surprising changes in comparison with that taken on admission. On suspicion of adult respiratory distress syndrome (ARDS) associated with military tuberculosis (Miliary TB), administration of Methylpredonisolone (1000 mg a day for 3 days) in addition to antituberculous drugs was immediately started. With this therapy she was recovered from such ill condition, but the general exhaustion and slight fever continued. We suspected that her condition might be due to adrenocortical involvement of Miliary TB and hormonal examinations were performed. Unexpectedly, Cushing's syndrome was suspected on the basis of the following; high level of plasma cortisol without normal daily variation, normal ACTH level, an absent response to the Dexamethasone suppression test. Computed tomography revealed left side adrenal mass. During these examinations, renal dysfunction probably due to Miliary TB grew gradually worse and she died of renal failure on the 56th day. Necropsy revealed disseminated tuberculosis involving the lungs and the liver, but the adrenal glands were not examined.
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PMID:[A case of miliary tuberculosis (miliary TB) accompanied with adult respiratory distress syndrome (ARDS) in a patient with Cushing's syndrome]. 140 68

Three patients with respiratory failure resulting from miliary tuberculosis had a characteristic clinical presentation that included a long history of a prominent cough, dyspnea, weight loss, tachycardia, tachypnea, pulmonary adventitious sounds, and hepatomegaly. Hematologic investigation showed a normal white cell count with marked left shift in the morphology of white cells in all three patients, and evidence of disseminated intravascular coagulation in one patient. In only one patient was the initial sputum positive for acid-fast bacilli; in the others, invasive diagnostic procedures including lumbar puncture, bone marrow trephine, and open-lung biopsy were necessary for diagnosis. Miliary tuberculosis should be suspected in patients with adult respiratory distress syndrome of unknown etiology. Simple diagnostic procedures such as sputum, bronchial brushings, and urine examination should be followed by bone marrow trephine, liver biopsy, transbronchial lung biopsy, and lumbar puncture if physical signs of meningitis are present.
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PMID:Adult respiratory distress syndrome associated with miliary tuberculosis. 396 42

In three cases of pulmonary tuberculosis associated with the adult respiratory distress syndrome the clinical features, which were similar to those of patients with miliary tuberculosis and adult respiratory distress syndrome, included a history of cough, fever, and dyspnoea on effort, and the physical signs of fever, tachypnoea, pulmonary adventitious sounds, tachycardia, and hepatomegaly. In these cases the radiological features, though suggestive of diffuse pulmonary oedema, were more prominent on the side in which the cavitatory lesion appeared. The diagnosis of tuberculosis was made easily from direct examination of sputum. Despite early ventilatory support and antituberculous therapy, two of the three patients died. Postmortem examination of the lungs in these cases showed evidence of acute alveolar damage (loss of type 1 pneumocytes and the presence of hyaline membranes within alveolar ducts) and of chronic alveolar damage (interstitial and alveolar fibrosis).
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PMID:The adult respiratory distress syndrome bronchogenic pulmonary tuberculosis. 674 May 41

An immigrant from India presented with a three months history of fever, weight loss, cough and hepatomegaly which were rapidly diagnosed as miliary tuberculosis when gastric lavage revealed acid-fast bacilli. One day after antituberculous therapy was commenced, the patient developed adult respiratory distress syndrome and disseminated intravascular coagulation which were successfully treated by corticosteroids, fresh frozen plasma and mechanical ventilation. Ten other survivors of miliary tuberculosis and adult respiratory distress syndrome were reviewed and the association of adult respiratory distress syndrome with the antimicrobial therapy is discussed.
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PMID:Survival in miliary tuberculosis complicated by respiratory distress. 793 45

A 40-year-old man with chronic myelogenous leukemia in chronic phase received an allogeneic marrow graft from his HLA identical brother. He was conditioned with busulfan (16 mg/kg) and cyclophosphamide (120 mg/kg). Graft-versus-host disease (GVHD) prophylaxis was attempted with cyclosporine A (CYA) and methotrexate. On day 30, weight gain, ascites and hepatomegaly developed in addition to an elevation of total bilirubin (TB). He was diagnosed as having veno-occlusive disease (VOD) and treated conservatively. The TB level increased up to 20.1 mg/dl on day 66, then reduced to 2.1 mg/dl on day 129. By that time ascites and hepatomegaly also had completely resolved. However, on day 134. The TB level started to increase again, when the lesions of chronic GVHD were observed in the eye, the mouth, and the skin. CYA was started on day 142, and FK506 was substituted for CYA on day 161. Despite the improvement of oral and skin lesions, TB level continued to rise, and he died of respiratory failure due to ARDS on day 186. Autopsy revealed both acute and old hepatic VOD lesions, suggesting the occurrence of late-onset VOD which probably contributed to the liver dysfunction observed after clinical resolution of the first episode of VOD.
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PMID:[Severe hepatic veno-occlusive disease (VOD) which was successfully treated with supportive therapy, but subsequently developed late-recurrence]. 954 27

Adenovirus infections occur commonly in infants and children but are rarely fatal. Although immunosuppression has been associated recently with fatal outcome of adenovirus infections, reports of major morbidity or mortality caused by adenovirus infection in HIV positive patients are infrequent. This is the first report on fatal adenovirus infections in presumably HIV-positive infants in Thailand. Three infants, aged 4, 8 and 5 months, were hospitalized with diagnoses of pneumonia and ARDS, pneumonia with hepatomegaly and ARDS, and pediatric AIDS with pneumonia, respectively. All the infants died within a few weeks after hospitalization. Serologic tests revealed positive anti-HIV in all three infants. Unfortunately, no additional investigation for definite diagnosis of HIV infection was employed. Pathological findings from autopsy and post mortem needle biopsies revealed adenovirus pneumonia in the first two infants, and massive adenovirus infection of the liver in the third infant. Diagnoses were based on characteristic light microscopic pathological findings, and demonstration of viral particles arranged in crystalline arrays in the nucleus of the infected cells by electron microscopy.
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PMID:Fatal adenovirus infections in infants probably infected with HIV. 962 14

Actinomycin-D (Act-D) is a rare cause of veno-occlusive disease (VOD). Between 1993 and 1998, we managed 6 patients, all male, median age 19 months (range 6-48 months) who received Act-D for Wilms' tumour (n=4), clear cell sarcoma (n=1) or rhabdomyosarcoma (n=1). VOD presented with a median platelet count of 12 x 10(9)/l, INR 3.8, fibrinogen 16 mg/l, fibrinogen degradation products (FDPs) > or =80 microg/l, aspartate aminotransferase (AST) 6922 IU/l, bilirubin 47 micromol/l. In 3 cases, transient liver dysfunction and thrombocytopenia without neutropenia had been observed after a previous course of Act-D. All six children developed encephalopathy, hepatomegaly, ascites, reversed portal flow and renal impairment. All received mechanical ventilation and two required haemofiltration. The treatment was supportive. Severe Adult Respiratory Distress Syndrome developed in 3 patients, all of whom died. 3 patients recovered. The outcome of VOD with multi-organ failure is poor. Intravascular coagulopathy precedes and characterises severe VOD during Act-D treatment.
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PMID:Veno-occlusive disease with multi-organ involvement following actinomycin-D. 1137 45

A young trauma patient developed severe adult respiratory distress syndrome (ARDS), right heart failure, hepatic congestion and an extreme hepatomegaly but no hepatic failure. The patient needed 100% oxygen during ventilatory support for 80 days and was weaned from the ventilator after more than 100 days. The hepatomegaly gradually disappeared. Four months after the injury, the anatomical shape of the lungs, heart and liver were normalized. This case illustrates that severe ARDS may cause right heart failure and extreme hepatomegaly due to venous congestion in the liver and spleen, but without hepatic failure.
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PMID:Severe ARDS may cause right heart failure with extreme hepatomegaly but without hepatic failure. 1213 50

A 47-year-old man was admitted with four months history of pain upper central abdomen associated with passage of 3-4 loose watery stools per day. Abdominal examination revealed soft abdomen with mild tenderness in the para-umbilical region. There was associated hepatomegaly. His Hb% was low, liver and renal functions were deranged. Upper GI endoscopy revealed antral ulcer, and colonoscopy revealed a caecal ulcer, which were biopsied. Liver biopsy was also done. Histopathology report showed evidence of inflammatory colitis and chronic hepatitis, so a diagnosis of inflammatory bowel disease with autoimmune hepatitis was made. He was negative for HIV and hepatitis serology. He was given long list of medicine including steroids but the symptoms did not improve. Two months after admission he developed severe abdominal pain associated with distension. The X-Ray chest revealed pneumoperitoneum and laparotomy was carried out which revealed a small perforation in terminal ileum associated with multiple circular indurated areas ranging from few mm to 1.5 Cm in size with central thinning spread over distal half of small gut and enlarged mesenteric lymph nodes. The biopsy of perforated area revealed cytomegaloviral enteritis. Postoperatively patient developed ARDS and died on 13th postoperative day.
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PMID:Cytomegaloviral enteritis: a rare cause of small gut perforation. 2347 36