A 44-year-old man, a known alcoholic and heavy smoker, was hospitalized with high fever and respiratory failure which a few hours later required intubation and artificial ventilation, although the chest x-ray had been unremarkable. Later serial chest x-ray films showed intrapulmonary infiltrations, while Legionella Bozemanii was demonstrated by direct immunofluorescence. Cranial computed tomography was unremarkable, despite the onset of tetraparesis and a severe midbrain syndrome. Cerebrospinal fluid contained merely mild lymphocytic pleocytosis. However, magnetic resonance imaging revealed symmetrical demyelinization foci in the brainstem as a sign of encephalitis. The neurological deficits regressed almost completely after several weeks of antibiotic treatment and rehabilitation measures over several months.

Adult↗

PubMed1990

[A rare mesentericocaval shunt in a case of alpha 1-antitrypsin deficiency].

We report the rare case of a 27-year-old man with decompensated cirrhosis of the liver caused by a deficiency of alpha-1-antitrypsin. The patient was scheduled for liver transplantation. Diagnostic procedures prior to surgery revealed an unusual hepatofugal collateral channel with a marked mesenterico-, lieno-, and renocaval shunt. Since the liver cirrhosis had already been manifest during early infancy, this shunt had formed spontaneously without developing esophagogastric varices.

Adult↗