Abstract Body

ABSTRACT BODY

Background and purpose:

Mesenteric panniculitis is a rare entity, with a prevalence of around 0.6-1%, characterized by nonspecific inflammation of the adipose tissue of the mesentery. Its etiology is unknown, although its associated with neoplasias and other pathologies such as previous abdominal surgeries, intestinal ischemia, cirrhosis, pancreatitis, rheumatological diseases, infections, inflammatory bowel disease and smoking, among others. Abdominal pain is the most common manifestation and the diagnosis is usually established with an abdominal CT scan, which is highly specific.

Case presentation:

We present the case of a 57-year-old man with a medical history of hepatic cirrhosis secondary to HCV, obesity, cholelithiasis, nephrolithiasis, chronic mesenteric vein thrombosis and active smoking habit, who attended the emergency department with severe generalized abdominal pain of 2 days of evolution. Physical examination, laboratory tests and abdominal radiography were unremarkable except for the increase in CPR. For pain control he required a continuous opioid infusion pump. In the absence of diagnosis, a CT scan was performed, which showed findings compatible with mesenteric panniculitis.

Conclusion:

Mesenteric panniculitis, although it is a rare disease, must be taken into account in the differential diagnosis of abdominal pain, as it requires adequate pharmacological or surgical management. In addition, its diagnosis forces us to rule out associated pathologies, and if they are not proven, it is advisable to carry out periodic monitoring of patients to achieve an early diagnosis in case they appear.

Abstract Body

Renal infarction in the differential diagnosis of renal colic

ABSTRACT:

Backgrounds and purpose:

Renal infarction, with an incidence of 1,4%, is a rare and an underdiagnosed phatology due to the clinical picture, which is very similar to renal colic or pyelonephritis.

When the blood supply to the kidney is no enough, it can lead to renal infarction. The most common causes are atrial fibrillation and hypercoagulable state. The most frequent symptoms are abdominal pain, nausea and vomiting, hematuria and sometimes fever.

Case presentation

We present the case of a 49-year-old woman with a medical history of hypertension and dyslipidaemia, who came to the Emergency Department for colic pain in the left hemiabdomen with lumbar radiation, without voiding syndrome and with vomiting, since three days, which did not dissapear with analgesia despite having consulted three times. On examination, positive left renal succussion, without other alterations.

The abdominal ultrasound was normal. Given the persistence of pain despite intensive analgesic treatment and the decreased renal function in blood tests, it was decided to perform CT angiography with the finding of left multifocal renal infarction, which allowed requesting interventional radiology for treatment for reperfusion.

Conclusion

Renal infarction is often mistake for more benign pathology and the diagnosis is often delayed or missed, with the result of permanent loss of renal function.

Although it is a rare pathology, the early diagnosis can prevent the permanent loss of renal function, so it must be consider in the differential diagnosis of renal colic.

Abstract Body

Backgrounds and purpose

Poststreptococcal glomerulonephritis is prototypical for postinfectious glomerulonephritis (PIGN) and represents the most common cause of nephritic syndrome in childhood and young adults. The overall incidence has decreased, but PIGN is a significant problem in disadvantaged populations, where it is epidemic. In developed countries, it is typical in the elderly with comorbidities.

This entity is an immune-mediated glomerular inflammation triggered 1-6 weeks after throat or skin infection. Clinical presentation varies from an asymptomatic condition to rapidly progressive glomerulonephritis. Biopsy confirms the diagnosis but is rarely necessary. Clinical features and hypocomplementemia are essentially confirmatory. Treatment is supportive and prognosis is usually excellent, although long-term follow-up may be needed.

Case presentation

A 20-year-old woman, with no relevant medical history, was referred to the Emergency Department presenting hematuria, oliguria and generalized swelling for two days. She described a fully recovered pharyngotonsillitis treated with antibiotic 15 days ago.

Physical examination showed BP 168/92mmHg and eyelid and bilateral lower-leg edema. Laboratory test: SCr 7.12mg/dl, GFR 8ml/min, hypocomplementemia-C3, increased ASO titers and negative serologies. Urinalysis: hematuria and mild proteinuria.

Supportive treatment, including loop diuretics and restrictions of fluids and sodium, was initiated with good response. Based on clinical and laboratory findings, PIGN diagnosis was established. Biopsy was not necessary.

Conclusion

The previous case fits perfectly as the typical presentation of PIGN. Signs of acute kidney injury such as oliguria, edema and hypertension after an infection should be identified early in Primary Healthcare to refer these patients to the Emergency Department for further tests and treatment if necessary.

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Brain tumour as a cause of balance disorders

Background and purpose

Balance disorders and motion sickness are one of the most frequent reasons for consultation in Primary Care (almost 2% of the population at least once a year). Causes for these two symptoms are so numerous that it is difficult to list them all (benign paroxysmal positional vertigo, hypotension, arrhythmias…). This issue often makes us forget about some of the less frequent ones (and usually more dangerous), like brain tumours.

Case presentation

We present the case of a 40-year-old patient, with a medical history of multiple vertigos, migraine and cervical herniae, who comes to the Emergencies Service with a new episode of instability and motion sickness. After a thorough physical exploration and without manifesting any different symptom, it was sent home with the same treatment as always. Three days later, the patient consults again, this time suffering an episode of convulsions, syncope and loss of sphincter control. At his arrival, almost identical physical exploration as the last episode, but this time a CT Scan was requested, founding a cystic tumour on the sylvian aqueduct, causing obstructive hydrocephaly and so on, the balance disorder (after a quick surgical intervention the patient recovered without issues).

Conclusion

Even though the most frequent causes are the ones we have to think first, we can not forget about other possibilities, especially those ones who can put our patients at risk if we let them develop.

Abstract Body

Metamizole agranulocytosis

ABSTRACT:

Backgrounds and purpose:

Agranulocytosis, defined as severe neutropenia, is often related to taking medications. It is an underestimated differencial diagnosis, and can be suspected with a simple clinical interview.

Case presentation

A 27 years old male with a history of Crohn´s disease. He went to the emergency room for abdominal pain and fever of 39º of two days of evolution. He has been on amoxicillin and metamizole treatment for dentalphlegmon up to three days ago. He denies nausea, vomiting or alteration of the stool habit. Normal stools. The pain does not remind him of the previous outbreak of his autoinmune disease. Anodyne physical examination, highlighting a CRP of 8.67 and 100 neutrophils in the analysis. Blood cultures, urine cultures and stool cultures are collected that are normal. Empirical antibiotic treatment is started and colony stimulators are administered.

During admission, he remained clinically stable, with good evolution after the antibiotec. Due to the patient’s history, it was decided to perform a colonoscopy, in which an outbreak of Crohn’s disease was ruled out. A definitive diagnosis of agranulocytosis due to metamizole is established.

Conclusion

Agranulocytosis due to metamizole is a common disease that should not be underestimated in primary care consultations or in the emergency services, since a suspected diagnosis and early empirical antibiotic treatment can prevent undesirable outcomes, such as septic shock or sepsis.

Abstract Body

ABSTRACT BODY

Background and purpose:

Mesenteric panniculitis is a rare entity, with a prevalence of around 0.6-1%, characterized by nonspecific inflammation of the adipose tissue of the mesentery. Its etiology is unknown, although its associated with neoplasias and other pathologies such as previous abdominal surgeries, intestinal ischemia, cirrhosis, pancreatitis, rheumatological diseases, infections, inflammatory bowel disease and smoking, among others. Abdominal pain is the most common manifestation and the diagnosis is usually established with an abdominal CT scan, which is highly specific.

Case presentation:

We present the case of a 57-year-old man with a medical history of hepatic cirrhosis secondary to HCV, obesity, cholelithiasis, nephrolithiasis, chronic mesenteric vein thrombosis and active smoking habit, who attended the emergency department with severe generalized abdominal pain of 2 days of evolution. Physical examination, laboratory tests and abdominal radiography were unremarkable except for the increase in CPR. For pain control he required a continuous opioid infusion pump. In the absence of diagnosis, a CT scan was performed, which showed findings compatible with mesenteric panniculitis.

Conclusion:

Mesenteric panniculitis, although it is a rare disease, must be taken into account in the differential diagnosis of abdominal pain, as it requires adequate pharmacological or surgical management. In addition, its diagnosis forces us to rule out associated pathologies, and if they are not proven, it is advisable to carry out periodic monitoring of patients to achieve an early diagnosis in case they appear.