SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2022 | VOLUME 20 | ISSUE 2 | 41 SAGES CONGRESS 2022 ABSTRACTS patients and are associated with foci of infection in the lung and or gastrointestinal tract. We describe a case of focal TLA in a patient with type 2 diabetes mellitus (DM). Case presentation A 57 year-old male known with type 2 DM, hypertension presented with 2 month history of right upper quadrant (RUQ) pain, vomiting, fever, chills and rigors. Physical examination revealed point tenderness of the liver and right pleural effusion. Investigations revealed a WBC 12.42x 109/L, ESR >140mm/hr, liver function tests were normal except for raised ALP 419 U/L and GGT 207 U/L. Human immunodeficiency virus, amoebic and hydatid serology were negative. Ultrasound abdomen showed a large cystic mass (7.5cm x 8.2cm x 9.6cm) with ill-defined border and internal hypoechoic components in segment VI of the liver. Percutaneous drainage of the liver abscess was done. Cytology showed multiple acid fast bacilli on Ziehl-Neelsen staining. Polymerase chain reaction testing (GeneXpert) and culture were negative for TB. Standard intensive phase anti-tuberculous treatment was commenced. Review after two months confirmed resolution of symptoms, the pleural effusion and the focal liver lesion. Conclusion The conventional methods for diagnosis of TB have a low sensitivity in liver TB. Although TLA is very rare, it should be considered in the differential diagnosis of mass or cystic lesions of the liver especially in a high TB prevalence country. The prognosis is good if diagnosis is made early and treatment is commenced timeously. IMMUNE RECONSTITUTION INFLAMMATORY SYNDROME PRESENTING WITH UPPER AND LOWER GASTROINTESTINAL KAPOSI’S SARCOMA - CASE REPORT. Author Dr Mussagy Tarmamade 1 , Dr Muhammad Ismail 1 , Dra. Michela Loforte 1 , Dra. Luzmira Dimande 2 , Dra. Sheila Machatine 3 , Dra. Ema Nassone 1 , Dra. Regina Victor 1 , Dr Abdul Mussagi 1 , Dra. Liana Mondlane 1 1 Maputo Central Hospital, 2 Matola Provincial Hospital, 3 Mavalane Geral Hospital A 30-year-old female patient, black, with a history of HIV diagnosis and antiretroviral treatment with tenofovir, lamivudine and dolutegravir 3 months ago. She came with history of 1-month watery diarrhea, occasional hematochezia, persistent vomiting and generalized edema, on examination she was prostrate, anasarca, pale mucous membranes, generalized lymphadenomegaly. Analytically with moderate normocytic anemia, CD4 for past 3 months of 151 cells/mm3 and current of 351 cells/mm3, total proteins of 40g/dl, albumin of 25g/l, stool examination with 3-cross proteins and fecal hidden blood test positive. An upper digestive endoscopy was performed, where several raised and flat erythematous-violaceous lesions from 5 mm to 10 mm were observed in the gastric and duodenal mucosa, the histology was suggestive of chronic erythematous gastritis. Capsule Endoscopy revealed from the stomach to the transverse colon, mucosa with multiple lesions of varying sizes from 5mm-4cm, erythematous, violaceous, polypoid, flat, pseudotumor with a central ulcer and the presence of lesions that occupied the total circumference of the small intestine. The patient evolved with the presence of violaceous flat lesions on the upper limb, biopsies were performed with histology compatible with Kaposi’s sarcoma. Antibody and PCR-DNA test for Human Herpes Virus type 8 was positive. It was concluded to be a patient with diffuse intestinal Kaposi’s Sarcoma secondary to an exacerbated immune response after initiation of antiretroviral treatment for HIV. Referred for chemotherapy treatment with doxorubicin, bleomycin and vincristine, also received blood transfusion and continued antiretroviral therapy. Good clinical evolution was recorded. HEPATIC WILSON’S DISEASE - A CASE REPORT. Author Dr Shaun Temmers 1 , Dr Vasudevan G Naidoo 1 , Dr Catherine Gounden 1 1 Inkosi Albert Luthuli Central Hospital; University of Kwazulu-Natal Introduction Wilson’s disease (WD) is a rare disease globally, with an estimated prevalence of 1/10,000 – 1/30,000. There is a paucity of literature on the condition in Sub-Saharan Africa. Herein we describe a case of a young female with cirrhosis due to WD. Case report A 13yr old female presented with ascites, lower limb oedema, jaundice and no neurocognitive abnormalities. Her past medical and surgical history was unremarkable. There was no history of any drug use. On examination there was mild jaundice and conjunctival pallor. Her abdominal exam revealed a 12cm liver and 3cm splenomegaly. Ascites had resolved with diuretic treatment. Neurological evaluation was unremarkable. Laboratory findings revealed a prolonged INR of 1.98; total bilirubin 59 umol/l (5-21); alanine transferase (ALT) 145U/L (5 – 20); alkaline phosphatase (ALP) 139U/L (50 – 169); platelet count 88 x 109/L (150-400). A peripheral smear showed red cell fragments with a negative Coombs test. Tests for viral and autoimmune hepatitis were negative. Further investigations revealed the following: Ceruloplasmin 0.04g/L (0.2 – 0.6); 24hr urine copper 8.29 (range 0.2 – 0.8). Slit lamp evaluation revealed the presence of Kayser-Fleischer rings. Magnetic resonance imaging of the brain showed features compatible with WD but not classical. Following discussion with her parent’s, liver biopsy was declined. In light of the clinical and laboratory findings a diagnosis of WD was made and chelation therapy commenced. The diagnosis was supported by using the Leipzig score. Family screening was also advised. Conclusion This case highlights the value of considering and testing for WD especially in younger patients with cirrhosis with no apparent aetiology. The Leipzig score can be used as an effective tool in the diagnosis of WD. Furthermore, no single investigation can unequivocally confirm or exclude the disease.