History Of Intravenous Drug Abuse Research Articles

Abducens nerve palsy due to inferior petrosal sinus thrombosis

Isolated unilateral abducens nerve palsy is usually due to ischemia, trauma or neoplasm. Dorello’s canal is the space between the petrous apex and superolateral portion of the clivus, bound superiorly by Gruber’s ligament. The abducens nerve travels with inferior petrosal sinus (IPS) though the Dorello’s canal before entering the cavernous sinus. A 31-year-old man presented with neck pain, and binocular horizontal diplopia, worse looking towards left and at distance. He had a history of intravenous drug abuse but no history of hypertension or diabetes. On examination, he had complete left 6th nerve palsy with normal fundi, pupils, and other cranial nerves. Methicillin-resistant Staphylococcus aureus bacteremia was detected with naïve tricuspid valve endocarditis and multiple septic emboli to lungs with infarcts. His cerebrospinal fluid was normal. MRI of the brain was normal. MRV of head and neck showed thrombosis of the left internal jugular vein, left sigmoid sinus and left inferior petrosal sinus with normal cavernous sinus and no evidence of mastoiditis. He was treated with broad spectrum antibiotics. He was not anticoagulated for fear of pulmonary hemorrhage from pulmonary infarcts. Although cerebral venous sinus thrombosis commonly presents with elevated intracranial pressure, isolated ipsilateral 6th nerve palsy from its compression in Dorello’s canal due to thrombosis of the ipsilateral inferior petrosal sinus is extremely rare. To our knowledge, only two patients have been reported with isolated abducens palsy due to IPS thrombosis; one caused by septic emboli and the other developed it during IPS cortisol level sampling.

Infective endocarditis causing mitral valve stenosis \u2013 a rare but deadly complication: a case report

BackgroundInfective endocarditis rarely causes mitral valve stenosis. When present, it has the potential to cause severe hemodynamic decompensation and death. There are only 15 reported cases in the literature of mitral prosthetic valve bacterial endocarditis causing stenosis by obstruction. This case is even more unusual due to the mechanism by which functional mitral stenosis occurred.Case presentationWe report a case of a 23-year-old white woman with a history of intravenous drug abuse who presented with acute heart failure. Transthoracic echocardiography failed to show valvular vegetation, but high clinical suspicion led to transesophageal imaging that demonstrated infiltrative prosthetic valve endocarditis causing severe mitral stenosis. Despite extensive efforts from a multidisciplinary team, she died as a result of her critical illness.ConclusionsThe discussion of this case highlights endocarditis physiology, the notable absence of stenosis in modified Duke criteria, and the utility of transesophageal echocardiography in clinching a diagnosis. It advances our knowledge of how endocarditis manifests, and serves as a valuable lesson for clinicians treating similar patients who present with stenosis but no regurgitation on transthoracic imaging, as a decision to forego a transesophageal echocardiography could cause this serious complication of endocarditis to be missed.

Skurðaðgerðir við hjartaþelsbólgu á Íslandi 1997-2013

The aim of this study was to evaluate the outcomes of operations for endocarditis in Iceland, but such results have not been reported before. Retrospective nation-wide study of pa--tients that underwent open-heart surgery for infective endocarditis at Landspitali University Hospital in 1997-2013. Variables were collected from hospital charts. Long-term survival was analysed using Kaplan- Meier methods. Mean follow-up time was 7.2 years. Out of 179 patients diagnosed with endocarditis, 38 (21%) -underwent open heart surgery. Two patients were excluded due to missing information leaving 36 patients for analysis. The number of operations steadily increased, or from 8 to 21 during the first and last 5-years of the study period (OR: 1.12, 95% CI: 1.05-1.21, p=0.002). The most common pathogen was S. aureus and 81% (29/36) of the patients had positive blood cultures. Three patients had history of previous cardiac surgery and five had history of intravenous drug abuse. The aortic valve was most often infected (72%), followed by the mitral valve (28%). The infected valve was replaced in 35 cases 14 with a mechanical prosthesis and 20 with a bioprosthesis. In addition two mitral valves were repaired. Postoperative complications included perioperative myocardial infarction (35%), respiratory failure (44%) and reoperation for bleeding (25%). Thirty-day mortality was 11% (4 patients) with 5- and 10-year survival of 59% and 49%, respectively. One out of five patients with endocarditis underwent surgery, most commonly aortic or mitral valve replacement. Outcomes were comparable to other studies. In comparison to elective valve replace-ment surgery the rate of post-operative complications and 30-day mortality were higher and long-term survival was less favorable. Key words: Endocarditis, surgical treatment, valve replacement, complications, outcome. Correspondence: Arnar Geirsson, arnargeirsson@yahoo.com.

Evaluation of hepatitis C virus intrafamilial transmission among families with one index case, a pilot study from Fars province, Iran.

Our aim was to survey the rate and risk factors for Hepatitis C virus interfamilial transmission among families with one index case. The role of intrafamilial transmission in Hepatitis C virus epidemiology is still debated. A cross-sectional study was conducted on 34 families (236 members) of HCV infected patients from Fars province, spring to summer 2013. All subjects were first evaluated for the risk factors of exposure and then their serum was checked for the presence of HCV antibody and the genome, using ELISA and PCR. The genotype of all PCR positive cases was also determined by a commercial assay. Two independent sample t test and Chi-Square test were used to compare groups together. In 18 out of 34 families, HCV antibody was detected (52.9%) in new members. Among them, HCV transmission in 11 families (32%) was also confirmed by PCR. Having a history of intravenous drug abuse (P=0.006) and incarceration (P=0.01) showed to be important risk factors for interfamilial transmission. Hence, blade/needle sharing (P=0.016) just following molecular assay and sex (P=036) only in the serologic analysis were also determined as significant risk factors. Furthermore, based on serologic results, medium socioeconomic state was further associated with this manner of transmission (P=0.019 and P=0.328). Interestingly, among relatives, 13 cases were brothers while just 5 cases were couples. The genotypes 3a and 1a were more prevalent among the population. In conclusion, our finding highlighted a noticeable role of interfamilial transmission for HCV spread and supports the significant role of close relatives, especially brother relationship in this spread. Hence, the socioeconomic state was associated with the transmission rate of virus in the family.

56-Year-Old-Man With Fever, Altered Mental Status, and Abdominal Pain

56-Year-Old-Man With Fever, Altered Mental Status, and Abdominal Pain

Human T-lymphotropic Virus Co-infections in Adults Infected With Human Immunodeficiency Virus

IntroductionHuman T-lymphotropic virus type 1 or 2 (HTLV-1/2) co-infection in patients infected with the human immunodeficiency virus (HIV) can lead to increased morbidity. Because HTLV-1/2 shares a similar transmission route with HIV, HTLV-1/2 infection may be more prevalent in HIV-infected individuals. However, rates of HTLV-1/2 co-infection among HIV-infected individuals have not been studied recently in the United States. Materials and MethodsWe conducted a cross-sectional study using serum from 292 HIV-infected subjects from one clinic in Virginia. Serum samples were tested for co-infection with HTLV-1/2 by commercial ELISA; positive results were then confirmed via western blot, which also differentiated between HTLV-1 and -2. ResultsSeven (2.4%) of the subjects were co-infected with HTLV-2. One subject (among the seven co-infected with HTLV-2) was co-infected with HTLV-1 (0.3%). The only demographic factor significantly associated with HTLV-2 infection was history of intravenous drug abuse (p=0.002). ConclusionsWhile our results are limited to a single city, our low rates of co-infection do not support routine screening for HTLV-1/2 co-infection among HIV-infected individuals in the United States.

Intravenous drug use is associated with alloimmunization in pregnancy

Anecdotal evidence has suggested an association of intravenous drug abuse with alloimmunization; however, published data are limited to case reports. The purpose of this study was to determine whether women with a history of intravenous drug abuse have an increased risk of alloimmunization. A retrospective cohort study was performed with the use of data from a single-center blood bank and perinatal database from 2008-2014. Blood bank data were used to identify women with alloimmunization, which was defined as a positive antibody screen in pregnancy not due to naturally occurring antibodies, agglutinins, autoantibodies, or Rh immunoglobulin administration. Intravenous drug abuse was ascertained from a comprehensive database that has captured all drug abuse in pregnancy since 2008. For women who contributed >1 pregnancy to the database, only the most recent pregnancy was included. The rates of alloimmunization among women with a history of intravenous drug abuse and general obstetric populations were calculated and compared. The distribution of alloantibody types, proportion of Rh-group alloantibodies, and patient Rh status were assessed for intravenous andnon-intravenous drug abuse-associated alloimmunization. Characteristics and outcomes between intravenous and non-intravenous drug abuse-associated alloimmunization were assessed for women with clinically significant alloantibodies. Alloimmunization was more common in women with a history of intravenous drug abuse (11/305 women; 3.6%) compared towomen without a history of intravenous drug abuse (288/16,022 women; 1.8%; relative risk, 2.00; 95% confidence interval, 1.11-3.62). Needle-sharing was present in 7 and suspected in 4 women with an intravenous drug abuse history. Among women with a history of intravenous drug abuse, none had a history of transfusion ortraditional risk factor for alloimmunization. The distribution of alloantibodies was different between intravenous drug abuse- and non-intravenous drug abuse-associated alloimmunization. Rh group alloantibodies and Rh-negative status were more common in women with a history of intravenous drug abuse. Among Rh-negative women with a history of intravenous drug abuse, 50% of RhD alloimmunization cases occurred in nulliparous women. The rate of multiple alloantibodies was not different between intravenous drug abuse- and non-intravenous drug abuse-associated alloimmunization. Maternal history of intravenous drug abuse is associated with an increased risk of alloimmunization. Approximately 1in 30 intravenous drug abuse women may be diagnosed with an alloantibody in pregnancy. Given the current US opioid epidemic, increased vigilance in screening is required. Needle-sharing represents a possible mechanism for intravenous drug abuse-associated alloimmunization; however, limited obstetric care, failure to obtain Rh immunoglobulin, or failure to identify early pregnancy loss cannot be excluded.

Polycystic Liver Disease

Panel A: CT abdomen and pelvis. Pelvis B: CT abdomen and pelvis with arrows. A 77-year-old African American male presented with intermittent abdominal pain for one week. He denied nausea, vomiting, diarrhea, constipation, fevers, anorexia, or weight loss. He denied a family history of liver disease, recent travel, or history of intravenous drug abuse. His vital signs were normal. Labs revealed total bilirubin of 1.5 mg/dl, hypoalbuminaemia 3.0 gm/dl and prolonged prothrombin time of 14.8 sec. Computed Tomography of the abdomen and pelvis with contrast showed multiple hepatic cysts with the largest cyst occupying the right abdomen, measuring 20.6 cm (Panel A and Pelvis B). This cyst had predominantly fluid attenuation, but also contained several septations. The patient underwent laparoscopic fenestration of the large hepatic cyst with hepatic cyst wall biopsy. Pathology revealed blood without malignant cells. The patient tolerated the procedure well with improvement of his abdominal pain and normalization of his liver function tests and coagulation profile.

Infective Endocarditis Causing Complete Occlusion of Internal Carotid Artery and Presenting as Acute Ischemic Stroke

Image 1: Carotid ultrasound showing complete occlusion of internal carotid artery. Image 2: Carotid ultrasound showing complete occlusion of internal carotid artery. Image 3a: Magnetic resonance angiogram showing complete occlusion of internal carotid artery on left side (panel A); compare to right side (panel B). Image 3b: Magnetic resonance angiogram showing complete occlusion of internal carotid artery on left side (panel A); compare to right side (panel B) This is a 24-year-old Caucasian male with past medical history of intravenous drug abuse, hypertension, cardiomyopathy, endstage renal disease on hemodialysis 3 times a week (through AV fistula) was brought by the EMS after he was found by his mother lying on the floor drowsy. After further questioning in ER he complained of weakness in the right side of his body including the right upper limb and lower limb, he denied having any headaches, nausea or vomiting. On examination he was young cachectic male in moderate distress and febrile with a temperature of 102.3; Pupils were equal, round, reactive to light and accommodation. Neurologic exam showed strength was 1/5 right upper and lower extremity and normal strength on left side. He also had a facial droop to the left side. On cardiovascular examination S1, S2 were heard with 3/4 diastolic murmur in the left parasternal region and decreased breath sounds in the bilateral lower lung bases. Neurology team was called and patient was taken for CT head which did not show any acute hemorrhage. Given the history physical findings and preliminary labs patient was admitted for Infective endocarditis causing septic emboli and stroke. Tran’s esophageal echocardiography confirmed the diagnosis with aortic

Intravenous Drug Abuse by Patients Inside the Hospital: A Cause for Sustained Bacteremia.

Patients with history of intravenous drug abuse are noted to be at risk of several infections including HIV, endocarditis, and other opportunistic infections. We report the case of a patient with sustained Bacillus cereus bacteremia despite use of multiple antibiotic regimens during his inpatient stay. Our case highlights the importance of high suspicion for active drug use inside the hospital in such patients. This is important in order to minimize unnecessary diagnostic workup and provide adequate treatment and safe hospital stay for these patients.

763: Intravenous drug use is associated with alloimmunization in pregnancy

Anecdotal evidence has suggested an association of intravenous drug abuse (IVDU) with alloimmunization (AI), however published data are limited to case reports. The objective of this study is to determine if women with a history of IVDU have an increased risk of AI. A retrospective cohort study was performed using data from a single-center perinatal database from 2008-2014. IVDU was ascertained from a comprehensive database capturing all IVDU in pregnancy since 2008. Blood bank data was used to identify women with AI, defined as a positive antibody screen in pregnancy not due to a naturally occurring antibodies, agglutinins, or RhIG administration. Charts were abstracted for cases of AI with clinically significant antibodies. For women contributing more than one pregnancy to the database, only the most recent affected pregnancy was included. The rates of AI in the IVDU and general obstetric populations were compared using chi-squared. The distribution of alloantibody types, proportion of Rh-group alloantibodies, and patient Rh status were assessed for IVDU- and non-IVDU-associated AI. AI was more common in IVDU (11 of 305, 3.6%) compared with non-IVDU women (288 of 16,022, 1.8%, p=0.02). This finding persisted among women with clinically significant alloantibodies, (2.6% vs 0.8%, p<0.001). Needle sharing was documented in 7 and suspected in 3 IVDU women. No IVDU women had a history of transfusion. The distribution of alloantibodies was different between IVDU- and non-IVDU-associated AI (Figure). Rh group alloantibodies and Rh negative status were more common in IVDU women. Among Rh negative IVDU women, 50% of RhD AI cases were in nulliparas. The rate of multiple alloantibodies was not different between IVDU and non-IVDU AI. (Table) Maternal history of IVDU is associated with an increased risk of AI. Approximately 1 in 30 IVDU women will be sensitized in pregnancy. Given the current US opioid epidemic, increased vigilance in screening is required. Needle sharing represents a possible mechanism for IVDU-associated AI, however limited obstetric care, failure to obtain RhIG, or failure to identify early pregnancy loss cannot be excluded.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Tricuspid Valve Surgery in Patients with Isolated Tricuspid Valve Endocarditis: Analysis of Perioperative Parameters and Long-Term Outcomes.

Background The aim of this study was to evaluate the perioperative characteristics and the short- and mid-term outcomes in patients undergoing tricuspid valve (TV) surgery for isolated TV endocarditis. Patients and Methods A total of 56 patients with isolated TV endocarditis underwent TV surgery at a single center between June 1995 and February 2012. Mean age of patients was 53.8 ± 17.1 years, 39 (69.6%) being male. The mean left ventricular ejection fraction was 60.4 ± 13.6% and 13 (23.2%) patients had diabetes mellitus. Average logistic EuroSCORE was 19.4 ± 17.0%. Mean follow-up was 4.7 ± 3.8 years. Results Microbiological investigations revealed positive blood cultures in 89.1% of patients and positive intraoperative swabs in 51.9%. The most common pathogen (42.9%) isolated was Staphylococcus aureus, followed by coagulase-negative staphylococcus (17.9%). Discussion A history of intravenous drug abuse (IVDA) was recorded in 11 patients (19.6%), of which 8 patients additionally had hepatitis C. A total of 15 patients (26.8%) had a permanent pacemaker/implantable cardioverter-defibrillator in situ. TV replacement was performed in 22 patients (39.3%) and TV repair was performed in 34 patients (60.7%). Overall 30-day mortality was 12.5%. Five-year survival was 63.9 ± 7.2% (95% confidence interval [CI]: 64.0-137.5 months). Freedom from reoperation for recurrent TV endocarditis was 91.7 ± 4.0% (95% CI: 152.3-179.3 months) at 5 years. Conclusion Blood culture is the most important tool to detect the causative pathogen causing IE of TV. The high risk of hepatitis C in patients with IVDA and IE of the TV should be mentioned.

Predictors of In-hospital Adverse Events in Patients with Prosthetic Valve Infective Endocarditis

We aimed to study patients with prosthetic valve endocarditis (PVE) and analyse factors associated with in-hospital adverse events. A review of all patients who underwent echocardiography at a local university hospital with definite PVE (modified Duke's criteria) was performed. Adverse events of in-hospital mortality and redo valve surgery were identified. There were 23 patients with PVE (median age 53 years (IQR:38-66), 12 males (52%)). Twelve adverse events occurred including seven (30%) in-hospital mortalities and five (21%) redo valve surgery. Factors associated with in-hospital mortality include Staphylococcus aureus-PVE (86% vs 31%, p=0.027), presence of shock (86% vs 19%, p=0.005) and intensive care unit admission (72% vs 19%, p=0.026). Factors associated with the need for redo valve surgery include a younger median age (37 vs 61 years, p=0.012), longer median length of stay (58 vs 17 days, p=0.004), history of intravenous drug abuse (IVDA) (60% vs 6%, p=0.021) and right-sided valvular involvement (40% vs 0%, p=0.040). Using a composite endpoint of both outcomes, factors associated with in-hospital adverse events were a history of IVDA (36% vs 0%, p=0.037) and presence of shock (64% vs 17%, p=0.036). PVE carries a high risk of poor clinical outcome in terms of in-hospital mortality and the need for redo surgery.

Epidural abscesses following chronic pain injections

This report will present two cases of epidural abscesses following pain interventions and review available evidence and provide preventive strategies for its avoidance. A 54-year-old man having chronic low back and leg pain with past history significant for alcohol dependence and lumbar spine surgeries received a caudal epidural steroid injection following multiple intravascular injection of contrast. Eleven days following the procedure he developed symptoms suggestive of epidural abscess. It was subsequently confirmed by magnetic resonance imaging (MRI) and underwent nonsurgical management of the abscess without any neurological deficit. A 50-year-old homeless man with history of intravenous drug abuse, alcohol abuse, hepatitis C positive, squamous cell carcinoma of the neck, and degenerative lumbar disc disease received trigger point injections to his lumbar paraspinal muscles for management of his myofascial pain syndrome. Fifteen days following the injection, he reported to the emergency (ER) room with complaints of worsening pain. An MRI revealed epidural; abscesses tracking from the paraspinal muscles. He was subsequently managed with intravenous antibiotics and recovered uneventfully. Following review of the literature, it is possible to come up with preventive strategies to mitigate the occurrence of epidural abscesses. One of the key factors is the presence of comorbid conditions including diabetes mellitus and prior spine surgery which may dictate technique for the management of pain.

Diagnosis and management of primary pyogenic spinal infections in intravenous recreational drug users.

Primary spine infection secondary to intravenous drug abuse (IVDA) is a difficult clinical entity encountered by spine surgeons and infectious disease specialists. Patients tend to be noncompliant with the treatment and follow-up, and some continue to use IV recreational drugs even after the diagnosis of spine infection. The authors undertook this study to analyze the presentation, etiology, demographic characteristics, treatment, and outcome of primary pyogenic spinal infection in patients with IVDA as the major risk factor. The medical records, radiology imaging, and laboratory results (white blood cell count, inflammatory markers, bacteriology cultures) of all patients with pyogenic spine infection and history of IVDA presenting to a tertiary care center from August 2005 through December 2013 were retrospectively reviewed. The department of neurosurgery database and the hospital electronic medical records of University Hospital in San Antonio were used to identify the cohort for our study. A total of 164 patients with spinal infection were evaluated during the study period; 102 of these patients had a history of IVDA. Their average age was 45.4 years, and only 14 (13.7%) were women. The mean laboratory values at presentation included a white blood cell count of 11.1 × 10(3) cells/μl (range 0.5-32 × 10(3) cells/μl), erythrocyte sedimentation rate (ESR) of 74 mm/hr (range 9.9-140 mm/hr), and C-reactive protein (CRP) level of 67 mg/L (range 0.1-327 mg/L). Twenty-six patients (25.4%) had an associated epidural abscess. The most common organism isolated from cultures of the bone and/or blood was methicillin-sensitive Staphylococcus aureus (MSSA), which was found in 37 cases. A close second was methicillin-resistant S. aureus (MRSA), found in 23 cases. The most commonly involved region was the lumbar spine (24 cases [57.8%]), and most patients (69.6%) had involvement of only a single level. Eighty patients were initially treated with long-term IV antibiotic therapy, and only 22 underwent surgical intervention (24 procedures). Of the latter group, 8 patients underwent laminectomy alone while 16 required some type of instrumented stabilization. Of the patients requiring stabilization procedures, 2 (12.5%) required reoperation with extension of their surgical constructs to other levels. The average follow-up was 29.7 weeks (range 6 weeks to 3 years). Diagnosis and management of spinal infection in patients with a history of IVDA is challenging. The data from this study show that initial laboratory values are difficult to interpret given that only a minority of these patients present with leukocytosis. Back pain was the only reliable predictor of spine infection. The authors' experience indicates that the majority of patients with spine infection and a history of IVDA can be successfully treated with IV antibiotic therapy alone.

Citrobacter koseri native valve endocarditis: A case report and review of the literature

We report a case of a 43-year-old man, with history of intravenous drug abuse and hepatitis C, admitted for infective tricuspid and aortic valve endocarditis due to Citrobacter koseri (C. koseri). C. koseri is a motile gram-negative bacillus that usually causes various infections in humans involving the urinary, gastrointestinal, and respiratory tracts. Infections are commonly reported in neonates, the elderly, and immunocompromised or debilitated hosts. It rarely causes infection in immunocompetent patients.

ENDOGENOUS ENDOPHTHALMITIS ASSOCIATED WITH INTRAVENOUS DRUG ABUSE

To describe demographics, characteristics, and management of eyes with endogenous endophthalmitis (EE) in intravenous drug abusers. Retrospective chart review of patients with EE who presented to University Hospital, New Jersey Medical School between January 2005 and October 2012. Thirty-four patients presented with a clinical diagnosis of EE during this time period. Eighteen patients (53%) had a history of intravenous drug abuse with at least 15 of the 18 patients reporting intravenous heroin abuse. Average age was 43 years (24-61 years), 13 were men. Three patients had bilateral involvement. Mean time from the onset of symptoms to presentation was 10 days (range, 1-42 days). Presenting vision in the affected eye ranged from 20/100 to no light perception; the majority of patients had vision of counting fingers or worse. All patients were admitted to the hospital for intravenous antimicrobials and further workup. Final best-corrected visual acuity at the last follow-up ranged from 20/20 to no light perception, with most patients having final vision of 20/400 or worse. We reviewed 21 eyes of 18 patients with EE and concurrent intravenous drug abuse over an 8-year period; our study shows extremely poor visual prognosis associated with EE in this setting.

Inaccuracy of transthoracic echocardiography for the identification of right‐sided vegetation in patients with no history of intravenous drug abuse or cardiac device insertion

The use of transthoracic echocardiography (TTE) to identify right-sided infective endocarditis (RSIE) vegetation is controversial. Data are scarce for patients with no history of intravenous drug abuse (IVDA) or cardiac device insertion. This study analysed the consistency of presurgical echocardiographic results with surgical findings for vegetation identification, and the factors that influence accuracy of echocardiography. This retrospective trial divided infective endocarditis (IE) patients into three subgroups according to the results of their presurgical TTE: left-sided native IE (LSNIE), left-sided prosthetic valve IE (LSPIE) and RSIE. The accuracy of TTE was tested by comparing vegetation (number and location), detected presurgery by TTE, with actual findings during surgery. In total, 416 patients were analysed, 322 with LSNIE, 31 with LSPIE and 63 with RSIE. Consistency between TTE findings and surgical results was lower in the RSIE group compared with the LSPIE and LSNIE groups. Consistency was lowered by the presence of vegetation in multiple locations and atypical distribution--both of which were increased in the RSIE group. The chance of vegetation in both sides of the heart rose with increased numbers of vegetation locations in RSIE patients. A high proportion of RSIE patients had congenital heart defects, mostly ventricular septal defects. TTE may be unsuitable for RSIE patients with no history of IVDA or cardiac device insertion, because multifocal and atypically distributed vegetation may influence detection accuracy.

Acute Mesenteric Ischemia Caused by T-cell Lymphoma in a Young Man With Hepatitis C Virus Infection

A 24-year-old man with a history of intravenous drug abuse and recently diagnosed hepatitis C virus (HCV) presented to the emergency department with 1 month of progressive abdominal pain. His pain was associated with nausea, vomiting, and bright blood streaked in his bowel movements.

Mitigation and Education

Mitigation and Education