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An unusual case of abdominal pain
Un caso peculiar de dolor abdominal
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"documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Gastroenterol Hepatol. 2023;46:633-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Image of the month</span>" "titulo" => "Spontaneous cutaneous fistula secondary to hepatic hydatidosis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "633" "paginaFinal" => "634" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Fístula cutánea secundaria a hidatidosis hepática" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1173 "Ancho" => 2508 "Tamanyo" => 356776 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cutaneous fistula (arrow) in the right upper quadrant of the abdominal wall (A) with draining grape-like bodies (B).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Miguel Sogbe, José Luis del Pozo" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Miguel" "apellidos" => "Sogbe" ] 1 => array:2 [ "nombre" => "José Luis" "apellidos" => "del Pozo" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S021057052200276X?idApp=UINPBA00004N" "url" => "/02105705/0000004600000008/v1_202309280830/S021057052200276X/v1_202309280830/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Image of the month</span>" "titulo" => "An unusual case of abdominal pain" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "635" "paginaFinal" => "636" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Marta García-Calonge, Pedro Pujante, Isabel Pérez-Martínez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Marta" "apellidos" => "García-Calonge" "email" => array:1 [ 0 => "martagcalonge@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Pedro" "apellidos" => "Pujante" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Isabel" "apellidos" => "Pérez-Martínez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Gastroenterology, Hospital Universitario Central de Asturias, Oviedo, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias, Oviedo, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Un caso peculiar de dolor abdominal" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1357 "Ancho" => 600 "Tamanyo" => 117578 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Ultrasound imaging of cecoileitis. (B) Hands hyperpigmentation at diagnosis. (C) Resolution of hyperpigmentation after treatment</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 16-year-old girl presented in various occasions with abdominal pain, vomiting and fever, being diagnosed with cecoileitis through abdominal ultrasound and CT scan (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). She underwent an ileocolonoscopy with normal results. As previous medical history she had been diagnosed of celiac disease in January 2020 based on epigastric pain, positive AntiTG2 antibodies and HLA DQ2.8, having Marsh 1 in duodenal biopsies.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">In her last admission she had a notably hyponatremia, hypoglycemia and a tendency to hypotension. A marked hyperpigmentation was noticed, especially in the back of the hands and knuckles (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). Joined to the unclarified abdominal pain, fatigue and a marked weight loss in the last months, a suspicion diagnosis of adrenal insufficiency was made.</p><p id="par0015" class="elsevierStylePara elsevierViewall">A basal cortisol of 4<span class="elsevierStyleHsp" style=""></span>μg/mL (normal range 6.24–18), ACTH of 821<span class="elsevierStyleHsp" style=""></span>pcg/ml (5.2–40.3) and positive anti 21 hydroxylase antibodies led to the diagnosis of autoimmune primary adrenal insufficiency (Addison disease).<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> No abnormalities were seen in the adrenal glands in CT scan performed during admission. Thyroid disorders and diabetes mellitus were discarded. When asked about family history, only her mother referred skin vitiligo. No other autoimmune diseases or polyglandular syndromes were found.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Followed up also from endocrinologists she started treatment with hydroaltesone at replacement dose, with a rapid disappearance of the abdominal clinic and normalization of natremia and blood pressure findings.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a> Her skin hyperpigmentation also disappeared (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). She was discharged and in medical checkups she nowadays refers a great improvement with no limitations in active life and no recurrence of abdominal pain attacks.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1357 "Ancho" => 600 "Tamanyo" => 117578 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Ultrasound imaging of cecoileitis. (B) Hands hyperpigmentation at diagnosis. (C) Resolution of hyperpigmentation after treatment</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Al-Toma" 1 => "U. Volta" 2 => "R. Auricchio" 3 => "G. Castillejo" 4 => "D.S. Sanders" 5 => "C. Cellier" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/2050640619844125" "Revista" => array:6 [ "tituloSerie" => "United European Gastroenterol J" "fecha" => "2019" "volumen" => "7" "paginaInicial" => "583" "paginaFinal" => "613" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31210940" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0025" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis and treatment of primary adrenal insufficiency: an Endocrine Society Clinical Practice Guideline" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.R. Bornstein" 1 => "B. Allolio" 2 => "W. Arlt" 3 => "A. Barthel" 4 => "A. Don-Wauchope" 5 => "G.D. Hammer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1210/jc.2015-1710" "Revista" => array:6 [ "tituloSerie" => "J Clin Endocrinol Metab" "fecha" => "2016" "volumen" => "101" "paginaInicial" => "364" "paginaFinal" => "389" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26760044" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0030" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Consensus statement on the diagnosis, treatment and follow-up of patients with primary adrenal insufficiency" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E.S. Husebye" 1 => "B. Allolio" 2 => "W. Arlt" 3 => "K. Badenhoop" 4 => "S. Bensing" 5 => "C. Betterle" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/joim.12162" "Revista" => array:6 [ "tituloSerie" => "J Intern Med" "fecha" => "2014" "volumen" => "275" "paginaInicial" => "104" "paginaFinal" => "115" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24330030" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/02105705/0000004600000008/v1_202309280830/S0210570522003156/v1_202309280830/en/main.assets" "Apartado" => array:4 [ "identificador" => "75365" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Imágenes del mes" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/02105705/0000004600000008/v1_202309280830/S0210570522003156/v1_202309280830/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210570522003156?idApp=UINPBA00004N" ]
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