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Case presentation: A 32-year-old man from Congo presented with high-grade fever, confusion

and headache. He developed tachycardia and hypotension followed by electrocardiogram
changes and elevation of troponin I levels suggesting myocarditis. A physical examination
revealed conjunctival suffusion, polyarthritis of his lower extremities and cutaneous necrosis

of his feet due to vasculitis. Laboratory findings included amylase levels 10-fold the upper

normal serum levels and thrombocytopenia. The diagnosis was confirmed by a positive
leptospira immunoglobulin M, negative immunoglobulin G and a positive rapid agglutination
test. Our patient recovered progressively with antimicrobials and supportive care.

Conclusions: Because the clinical features and diagnostic findings of leptospirosis are not

specific, a high index of suspicion must be maintained for the diagnosis. Serology is the most
important tool for accurate and quick diagnosis in order to administer the appropriate therapy.

29. V.D.Souftas, M. Kosmidou, M. Karanikas, D. Souftas, G. Menexes, P. Prassopoulos.
Symptomatic Abdominal Simple Cysts: Is Percutaneous Sclerotherapy with Hypertonic Saline
and Bleomycin a Treatment Option? Gastroenterology Research and Practice

2015;2015:489363

doi: 10.1155/2015/489363. Epub 2015 Mar 23. PMID: 25878660 [PubMed] [Scopus]

Abstract: Aim. To evaluate the feasibility of percutaneous sclerotherapy of symptomatic
simple abdominal cysts, using hypertonic saline and bleomycin, as an alternative to surgery.
Materials and Methods. This study involved fourteen consecutive patients (ten women, four

men, mean age: 59.2 y) with nineteen symptomatic simple cysts (liver n = 14, kidney n = 3, and

adrenal n = 2) treated percutaneously using a modified method. Initially CT-guided drainage
was performed; the next day the integrity of the cyst/exclusion of extravasation or
communications was evaluated under fluoroscopy, followed by two injections/reabsorptions

of the same quantity of hypertonic NaCl 15% solution and three-time repetition of the same
procedure with the addition of bleomycin. The catheter was then removed; the patients were

hospitalized for 12 hours and underwent follow-ups on 1st, 3rd, 6th, and 12th months. Cyst’s
volumes and the reduction rate (%) were calculated in each evaluation. Results. No pain or

complications were noted. A significant cyst’s volume reduction was documented over time (P
< 0.001). On the 12th month 17 cysts disappeared and two displayed a 98.7% and 68.9%

reduction, respectively. Conclusion. This percutaneous approach constitutes a very promising
nonsurgical alternative for patients with symptomatic simple cyst, without complications

under proper precautions, leading to eliminating the majority of cysts.

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