Case of Familial clubbing 👆👆

Tricky case 💥

24 yrs old male patient with Hx of persistently elevated liver enzymes since 2020 .

No Hx of abdominal pain , jaundice or Weight changes 🤔.

No FHx of liver disease ✅

AST 540. , ALT 457. , ALP 168

Visited lot of hepatologist , but of no benefit..

Virology , wilson screen , ferritin , autoimmune hepatitis pannel ... all were neg .

On of hepatologist decide doing liver biopsy ❓..

Our assessment... mylagia and fatigue last months ..

So we decide sending S.CPK = horrible result 🙄

So its case of myositis with elevated liver enzymes due to muscle damage, no liver injury.

Patient referred to rheumatologist ✅

❌ Keep in mind that liver enzymes not specific to hepatocyte .. in also reflecting muscle status 💪.

مهمة جدااااا هاي الكيس

كل نسيج يستاصل من الجسم ، يجب ان يذهب للزرع النسيجي .

Young age female with Hx of acute abdomen, diagnosed as acute appendicitis, but histopathology revealed unexpected reason .. yes Carcinoid tumor involving appendicular base .

So PET scan is needed ...

✅ Ileum is not protected from NSAID use , not only stomach.

✅ This is nice case of ileal white based ulceration in patient with chronic use of NSAID ....

دمتم بخير 🌹