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Query: UMLS:C0019209 (hepatomegaly)
 5,798 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

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

In a prospective study, we investigated whether human immunodeficiency virus (HIV) infection alters the clinical presentation in patients with tuberculous pleuritis. One hundred twelve of 118 patients who presented with pleural effusion suffered from tuberculosis (TB); 65 patients (58%) were HIV seropositive. Evidence of disseminated TB was found more often in HIV-positive than in HIV-negative patients (30.8% vs 10.6%, p < 0.02). Dyspnea, fever, night sweat, fatigue, and diarrhea, severe tachypnea, hepatomegaly, splenomegaly, and lymphadenopathy were significantly more common in HIV-infected than in HIV-negative patients with TB. The same applied to a negative Mantoux reaction, lower hemoglobin, higher beta 2-microglobulin values, and in pleural fluid, lower albumin and higher gamma-globulin levels. Among HIV-infected patients, PPD skin test anergy was significantly associated with relative low albumin and gamma-globulin levels of pleural fluid. However, the radiographic features did not differ with respect to HIV status; they were predominantly those of primary pleuritis (78% in each group). We conclude that coexisting HIV infection affects clinical and laboratory features, but not the radiographic presentation of patients with TB pleuritis in Tanzania.
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PMID:Clinical features of HIV-seropositive and HIV-seronegative patients with tuberculous pleural effusion in Dar es Salaam, Tanzania. 795 5

Twenty-two abdominal tuberculosis patients seen at Abbassia Fever Hospital in Cairo, Egypt from January 1990 to August 1992 are described; their mean age was 21.5 years, range 9-54 years; 17 were female. Common symptoms were fever, malaise, abdominal pain (64%) and weight loss (82%). Chest X-rays were normal in 14 patients (64%), but ultrasonography/computerized tomography of the abdomen was abnormal in 20 patients (91%), with adenopathy the usual finding. Anaemia and a raised erythrocyte sedimentation rate were present in all patients, and purified protein derivative skin test (5 Tu) was positive in 82%. Predominant abnormal physical findings were abdominal (86%), including hepatomegaly/splenomegaly and abdominal mass. Diagnosis was made from biopsy material (caseating granulomas) in 6 patients by laparotomy, 1 by laparoscopy, and 3 by cervical or supraclavicular node biopsy; and from laboratory examination of excretions in only 4 patients (acid-fast bacilli in stools of 2, mycobacteria in urine and menstrual fluid). Eight patients required presumptive diagnosis after response to specific isoniazid (+ethambutol) antituberculous therapy.
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PMID:Abdominal tuberculosis in Cairo, Egypt. 777 63

The clinical and radiological features in 38 infants less than 3 months of age with tuberculosis proved by culture are described and may aid early diagnosis of this often fatal condition. Respiratory symptoms, cough in 33 (87%) and tachypnoea in 31 (82%), were the commonest presenting symptoms. Twenty five infants (66%) had hepatomegaly and 20 (53%) splenomegaly. Mantoux testing gave an induration of > 15 mm in three of 17 (18%) infants. In a further five a Tine test gave confluent response. Chest radiography in 27 infants showed miliary tuberculosis in seven (26%) and hilar or paratracheal adenopathy in 14 (52%) and 10 (37%) respectively. Compression of either the bronchi or trachea or both was noted in 15 (56%). Detection of this complication was aided by high kilovolt radiographs. A culture of Mycobacterium tuberculosis was obtained from gastric aspirate in 35 (92%) infants, but positive cultures were also obtained from cerebrospinal fluid, tracheal or bronchial aspirate and liver and lymph node biopsy. Of 30 mothers evaluated seven (23) had previously unsuspected pulmonary tuberculosis.
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PMID:Tuberculosis in infants less than 3 months of age. 821 48

We assessed the value of liver biopsy in the diagnosis of fever of unknown origin (FUO) in hospital-based patients by a retrospective analysis of all cases (24 cases) seen at the University of Michigan Medical Center over a 5-year period. Based on the findings of a liver biopsy performed in the course of the evaluation of FUO, patients were divided into two groups: a diagnostic group, in which an abnormal liver biopsy was helpful in determining the cause of the FUO, and a nondiagnostic group, which included those who had either normal biopsy results or abnormal biopsy results that did not lead to a final diagnosis. Four patients (16.7%) had diagnostic liver biopsy results (histoplasmosis in three and tuberculosis in one). Physical findings, such as hepatomegaly, and laboratory data, including routine liver chemistries, were not predictive of a diagnostic liver biopsy. Therefore, despite advances in diagnostic technology since this subject was last reviewed, liver biopsy continues to be useful in the diagnosis of FUO. Furthermore, in endemic or borderline endemic areas, histoplasmosis should be considered in the differential diagnosis of FUO, and liver biopsy can be helpful to confirm this diagnosis.
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PMID:Liver biopsy in fever of unknown origin. A reappraisal. 840 95

The clinical and epidemiologic characteristics of the acquired immunodeficiency syndrome (AIDS) were studied in a tropical area of Brazil. During an 18-month period (July 1989-January 1991), 111 consecutive AIDS patients (102 men and nine women) were evaluated. Patients reported homosexual/bisexual activities (60%), intravenous drug use (19%), or both (6%), heterosexual activities (11%), blood transfusions (2%), and 2% belonged to an undetermined category. Weight loss, fever, oral thrush, and diarrhea were present in > or = 70% of the patients at presentation. An unexpected high frequency of hepatomegaly (49%) was detected, and found to be significantly associated with tuberculosis (P < 0.0001). Although the epidemiologic features of human immunodeficiency virus transmission were comparable to the United States/European pattern, the clinical spectrum of opportunistic infections more closely resembled that reported in Africa and Haiti, with a greater frequency of fungal and mycobacterial infections than Pneumocystis carinii pneumonia and viral infections.
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PMID:Characteristics of the acquired immunodeficiency syndrome in Brazil. 851 87

Patients infected with human immunodeficiency virus (HIV) are at risk for a variety of liver diseases. We undertook a retrospective study of 501 HIV-seropositive patients to assess the yield of percutaneous liver biopsy. The most common indications for liver biopsy were liver test abnormalities (89.5%), fever for 2 weeks (71.9%), and hepatomegaly (52.0%). The most common biopsy-derived diagnosis was Mycobacterium avium complex (MAC), seen in 87 (17.4%) biopsies. Mycobacterium tuberculosis was found in 13 biopsies (2.6%). In 28 biopsies (5.6%) mycobacteria was seen, but speciation of the organism was not possible. Chronic active viral hepatitis was seen in 60 biopsies (12.0%). Opportunistic hepatic infection from other organisms was found in 14 biopsies (2.8%). The most common neoplasm was lymphoma, which was seen in 12 biopsies (2.4%). MAC infection of the liver was associated with elevated alkaline phosphatase (p = 0.01). Among patients with fever for 2 weeks after an extensive negative workup including bone marrow biopsy, 58.2% had a diagnosis by liver biopsy. Overall, 64.3% of liver biopsies yielded a histopathological diagnosis, 45.7% of which were potentially treatable. We could not evaluate whether liver biopsy had a positive effect on patient outcome and survival, nor did we attempt to prove that liver biopsy resulted in a change in treatment or a change in preprocedure clinical diagnosis. Thus, questions about the efficacy of liver biopsy cannot be answered. Liver biopsy may be a helpful diagnostic tool in HIV-positive patients with fever, liver test abnormalities or hepatomegaly.
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PMID:Liver biopsy findings in 501 patients infected with human immunodeficiency virus (HIV). 855 99

The authors report 5 cases of pseudotumoral tuberculosis of the liver. They essentially involved young men from disadvantaged socio-economic backgrounds. Clinically, poor general condition with massive weight loss was constant, while pyrexia and hepatomegaly were sometimes absent. Hepatobiliary ultrasonography revealed hypoechogenic or even anechogenic lesions between 1.5 and 3.5 cm in diameter. Diagnostic confirmation was histological after needle biopsy. The outcome after antibiotic treatment with or without drainage, was recovery, with ultrasonographic normalization of the liver, in all patients, with a mean follow-up of 22 months.
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PMID:[The pseudo-tumoral form of hepatic tuberculosis. Five case reports]. 857 61

Peliosis hepatis is an uncommon entity characterized by multiple oval and irregularly shaped blood-filled cystic cavities in the liver parenchyma. The spaces are lined by either hepatocytes or endothelial cells. They communicate with the sinusoids, many of which are dilated. The condition has been associated with cirrhosis, malignancy, infection with tuberculosis and HIV, and medication such as anabolic or androgenic steroids. The etiology is uncertain, but toxic injury to the sinusoidal wall is postulated. The condition may present with hepatomegaly, cirrhosis and portal hypertension, hepatic failure, or shock from hepatic or splenic rupture. The authors report the case of a patient who developed peliosis hepatis while taking oral contraceptives. Abdominal ultrasound performed upon the 35-year-old woman presenting with right upper quadrant abdominal pain identified multiple, well-circumscribed liver lesions of varying size and echogenicity. No blood flow was detected on color duplex ultrasound and the rest of the abdominal examination was normal. Her condition was attributed to oral contraceptive use. Such use was therefore discontinued, and 6 months later the lesions were found to have reduced in size. The patient's pain had reduced considerably and she was clinically well. Follow-up is mandatory in such cases following diagnosis and treatment.
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PMID:Peliosis hepatis associated with oral contraceptive use. 868 55

We present an unusual hematologic manifestation of tuberculosis in a hemodialysis patient. A 37-year-old man was admitted because of fever, anorexia, and weight loss which developed 3 months earlier. He previously received a renal transplant and commenced hemodialysis 1 year ago. Physical examination revealed hepatomegaly, and peripheral blood counts revealed pancytopenia. The delayed bone marrow biopsy demonstrated marked hemophagocytosis, granuloma and tubercle bacilli by the acid-fast stain. The clinical course was fatal and he died without definite treatment. Through this case, we would like to recommend early bone marrow biopsy and antituberculosis therapy if fever of unknown origin, anorexia, weight loss, hepatomegaly and pancytopenia develop in patients undergoing dialysis.
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PMID:Tuberculosis-associated hemophagocytic syndrome in a hemodialysis patient: case report and review of the literature. 873 Apr 45


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