A 38-year-old male presented with history of dysphagia, regurgitation, and 5-kg weight loss for 10 months. He also had a history of intermittent low-grade fever every 3–4 months associated with fatigue and generalized weakness for the same duration. One month before admission, he had a history of having right upper limb cellulitis that responded to antibiotics. Examination revealed severe pallor. An esophagoduodenoscopy revealed a dilated esophagus and resistance at the gastroesophageal junction (Fig. 1A, D). A timed barium esophagogram showed a hold-up of contrast with distal tapering (Fig. 1B). The diagnosis of type I achalasia was confirmed on high-resolution solid-state esophageal manometry (Sandhill Scientific, CO, USA) (basal lower esophageal sphincter [LES] pressure, 7.2 mmHg; integrated relaxation pressure [IRP], 25 and 27 mmHg, respectively, for liquid and viscous swallow; mean distal contractile integral [DCI], 1 and 9 mmHg/cm/s, respectively, for liquid and viscous swallow) (Fig. 1C). His Eckardt score on presentation was 6. Given the short duration of symptoms, rapid worsening, recurrent infections, and fatigue, he was evaluated to rule out secondary achalasia. On investigation, he was found to have bi-cytopenia (anemia and thrombocytopenia). Hemoglobin was 6 g/dL (normal, 11.6 to 15 g/dL) and platelet count was 100,000 per cubic millimeter (normal, 150000–400,000 per cubic millimeter). A peripheral blood smear showed pseudo-rouleaux formation, reduced red blood cells, and 4% blast cells. Bone marrow aspiration showed approximately 45% blasts and promonocytes and 20% of abnormal monocytes with reduction of other hematopoietic elements; blasts were positive for cytochemical staining with myeloperoxidase (MPO) stain suggestive of acute myeloid leukemia (AML) with monocytic differentiation. Bone marrow biopsy confirmed these findings. Esophageal biopsies revealed stratified squamous epithelium displaying mild mixed inflammatory cells comprising polymorphs and lymphocytes; occasional atypical hematopoietic cells were noted in the subepithelial region displaying medium-sized cells with round to oval nuclei, a high nuclear-cytoplasmic ratio, fine chromatin, occasional conspicuous nuclei, and a scant amount of cytoplasm (Fig. 2A–D). With a diagnosis of leukemic infiltration of the esophagus causing secondary achalasia cardia, he was started on chemotherapy for AML and feeding was ensured by nasogastric tube. He was successfully treated with cytarabine and an anthracycline-based induction chemotherapy regimen. His dysphagia was completely relieved post-chemotherapy, and he was tolerating both solids and liquids well. A repeat timed barium esophagogram (improved emptying with a reduction in the height of the barium column) (Fig. 1E) and esophageal manometry (basal LES pressure, 2.7 mmHg; IRP, 5 and 3 mmHg, respectively, for liquid and viscous swallow; mean DCI, 2 and 5 mmHg, respectively, for liquid and viscous swallow) showed improvement (Fig. 1F).
Fig. 1
A and D An esophagoduodenoscopy showing a dilated esophagus and the gastroesophageal junction in retroverted view, respectively. B A timed-barium esophagogram showing hold-up of contrast with distal tapering at the time of diagnosis. C A high-resolution solid-state manometry tracing showing high integrated relaxation pressure (IRP) with failed peristalsis diagnostic of type I achalasia cardia. E A timed-barium esophagogram showing improved emptying with a reduction in the height of the barium column post-chemotherapy for leukemia. F A high-resolution solid-state manometry tracing post-chemotherapy for leukemia showing improvement with decrease in IRP
Fig. 2
A–D Sections from esophageal biopsy showing mixed inflammatory cell infiltrate comprising polymorphs and lymphocytes along with a few atypical hematopoietic cells infiltrating fibromuscular tissue (A and B: H&E stain, × 200 original magnification; C and D: H&E stain, × 400 original magnification)
×
×
…
Anzeige
Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten
Die Leitlinie zur akuten infektiösen Gastroenteritis wurde 2024 umfassend überarbeitet. Cola und Saft zur oralen Hydratation und einige Antidiarrhoika sollten vermieden werden. Von einem standardmäßigen Erregerpanel wird abgeraten. Die Hintergründe zu diesen und weiteren Empfehlungen erläutert Leitlinienkoordinator Prof. Carsten Posovszky.
Krebspatienten, auch und vor allem solche in fortgeschrittenen Stadien, profitieren offenbar von guter körperlicher Verfassung. Hohe Muskelkraft und kardiorespiratorische Fitness sind laut Ergebnissen einer Metaanalyse mit geringerer Mortalität assoziiert.
Erleiden Menschen mit Vorhofflimmern einen ischämischen Schlaganfall, ist dieser weniger schwer, auch sind Infarktgröße und Blutungsrisiko geringer, wenn sie zuvor orale Antikoagulanzien erhalten haben. Die Art der Antikoagulation spielt dabei keine Rolle.
Eine bessere Blutzuckerkontrolle und weniger Fälle von hypoglykämischem Koma, dafür mehr diabetische Ketoazidosen. Dieses HCL-Insulin-Therapie-Profil zeigte sich in einem Vergleich von Hybrid-Closed-Loop(HCL)- und Open-Loop-Systemen bei Typ-I-Diabetes im DPV-Register.
In diesem CME-Kurs können Sie Ihr Wissen zur EKG-Befundung anhand von zwölf Video-Tutorials auffrischen und 10 CME-Punkte sammeln. Praxisnah, relevant und mit vielen Tipps & Tricks vom Profi.