Case Reports in Gastrointestinal Medicine最新文献

Background: Pyogenic liver abscesses (PLAs) commonly result from hematogenous spread or biliary tract infections, most often due to cholecystitis or cholangitis. Klebsiella pneumoniae is a recognized pathogen in PLA and has been associated with underlying gastrointestinal malignancies, particularly colorectal cancer. While screening for malignancy is well established in cryptogenic K. pneumoniae liver abscess, its role when a clear biliary source is present is less well described.

Case presentation: We report a 76-year-old man with a history of untreated hepatitis C and prior renal cell carcinoma who presented with right upper quadrant pain, weight loss, and leukocytosis. Imaging revealed a pericholecystic liver abscess with acute cholecystitis. The abscess was drained percutaneously, and cultures grew K. pneumoniae. Although imaging suggested a biliary source, colonoscopy was performed given the pathogen's known association with colorectal neoplasia. This revealed multiple large laterally spreading tumors, including a 30-mm ascending colon lesion confirmed as well-differentiated invasive adenocarcinoma on biopsy.

Conclusion: This case underscores the importance of considering colorectal cancer screening in patients with K. pneumoniae PLA, even when a biliary source is identified. Early endoscopic evaluation in such patients may facilitate timely diagnosis of occult malignancy and alter clinical management.

Coronavirus disease 2019 (COVID-19) is known to induce gastrointestinal symptoms as well as respiratory symptoms. There have been instances where diarrhea persists after the acute phase of COVID-19, suggesting an extension of the disease's symptoms. It is not typical to recall the onset of inflammatory bowel disease (IBD) with such symptoms, much less with reports on Crohn's disease (CD). It is important to collect such cases in order to lead to appropriate diagnosis and treatment. This report presents a case of a young man in which diarrhea, initially manifesting during the acute phase of COVID-19, persisted for two months, ultimately leading to a CD diagnosis. At the onset of COVID-19, the patient had fever, abdominal pain, and diarrhea, but respiratory symptoms were not prominent. An ileocolonoscopy was performed to further investigate the cause of persistent diarrhea, leading to an appropriate diagnosis of CD. It is hypothesized that aberrations in the immune system triggered by severe acute respiratory syndrome coronavirus 2's impact on the intestinal tract might contribute to the onset of CD. The patient's condition gradually improved after the initiation of treatment with prednisolone. By the following treatment with azathioprine, the patient has maintained clinical remission. Clinicians should consider performing ileocolonoscopy for patients with persistent diarrhea after COVID-19, given the possibility of IBD. Gastrointestinal symptoms are relatively common with COVID-19. COVID-19 infection may trigger CD through immunological mechanisms. It is important to consider that cases of prolonged diarrhea after COVID-19 may include the induction of CD and to perform an ileocolonoscopy.

Eosinophilic colitis (EC) is a rare subtype of eosinophilic gastrointestinal disorders, marked by dense eosinophilic infiltration of the colon in the absence of secondary causes. We report the case of a 48-year-old Ethiopian man with a history of atopic disease who presented with chronic nonbloody diarrhea, intermittent abdominal pain, and fatigue. Diagnostic colonoscopy with biopsy confirmed EC, supported by peripheral eosinophilia and histological findings. The patient was treated with oral prednisolone, leading to complete symptom resolution.

Approximately 50% of patients with inflammatory bowel disease (IBD) exhibit extraintestinal manifestations, among which skin and mucosal lesions are common. However, pyoderma gangrenosum occurs in only 1%-2% of IBD patients. We report the case of a 23-year-old male patient who was admitted to the hospital with pyoderma gangrenosum that was unresponsive to conventional treatments. The patient did not exhibit any gastrointestinal symptoms. We conducted diagnostic investigations, excluding causes such as infections, vascular occlusions, and systemic diseases. The patient did not respond to systemic antibiotic therapy and local care. With mild thickening of the colon wall observed on a CT scan, we decided to perform a colonoscopy, which revealed lesions suggestive of chronic ulcerative colitis. Histopathological examination of the colon tissue confirmed the diagnosis. With the diagnosis of early onset chronic ulcerative colitis presenting with extraintestinal manifestations, we decided to treat the patient with the biological drug infliximab. After 3 months of treatment, the pyoderma gangrenosum lesions healed. In summary, this clinical case indicates that pyoderma gangrenosum can be an initial and rare manifestation of IBD.

Objectives: Despite cystic fibrosis transmembrane conductance regulator (CFTR) proteins being present throughout the entire body and organ systems, typical presentation of cystic fibrosis (CF) involves lung disease. We report a series of individuals that were referred to our CF clinic for evaluation following a diagnosis of chronic pancreatitis or acute recurrent pancreatitis. After evaluation, they were deemed to have CFTR dysfunction and started on highly effective modulator therapy (HEMT).

Methods: A retrospective chart review was completed for all individuals referred to the University of Iowa Health Care Cystic Fibrosis Clinic from January 1, 2012, through December 31, 2023, for follow-up evaluation of chronic or acute recurrent pancreatitis. Along with demographic data, we quantified emergency department encounters or hospitalizations due to pancreatitis pre- and post-HEMT as well as individual tolerability of therapy.

Results: Ten individuals met inclusion criteria. Four individuals were found to have sweat chlorides that confirmed a diagnosis of CF, and three individuals with sweat chloride values below the diagnostic threshold were further evaluated with nasal potential difference (NPD) testing and found to have results consistent with CFTR dysfunction. All 10 patients were initiated on HEMT. In the 2 years prior to HEMT initiation, there was an average of 0.33 pancreatic episodes per month (range: 0.00-1.38), compared with 0.09 pancreatic episodes per month (range: 0.00-0.50) after initiation. HEMT was generally well tolerated with one individual discontinuing due to liver function abnormalities.

Conclusions: Our study highlights a panel of individuals that may have been overlooked for CFTR dysfunction due to a nonpulmonary primary presentation, such as pancreatitis. However, our use of additional diagnostic tools followed by HEMT utilization was able to describe individual-reported improvements in symptoms and quality of life in individuals with CFTR dysfunction.

Background: Myelodysplastic syndromes (MDSs) are clonal hematopoietic disorders often associated with cytogenetic abnormalities, among which trisomy 8 is one of the most common abnormalities. Trisomy 8 is linked to autoimmune manifestations, including Behçet-like disease, especially with gastrointestinal involvement.

Case presentation: We report a rare and severe case of a 59-year-old male with MDS characterized by a complex abnormal karyotype, including trisomy 8, accompanied by multiple ileal perforations and intestinal ulcers resembling Behçet's disease. Despite surgical intervention and broad-spectrum antimicrobials, recurrent symptoms persisted. A combination of corticosteroids and thalidomide ultimately led to clinical and hematologic improvement.

Methods: Clinical, radiologic, histopathologic, and cytogenetic data were collected. Literature review was conducted to contextualize diagnostic criteria and treatment strategies.

Results: The patient showed hematologic and symptomatic improvement following immunosuppressive therapy. Chromosome karyotype analysis revealed chromosomal numerical abnormalities, including trisomy of chromosomes 8, 9, and 15 and the presence of an extra Y chromosome. Gastrointestinal involvement with recurrent perforations was attributed to Behçet-like intestinal disease.

Conclusion: This case underscores the aggressive clinical course and diagnostic challenges of Behçet-like disease associated with MDS and trisomy 8, highlighting the importance of early recognition and immune-targeted therapy.

Background: Crohn's disease, a chronic inflammatory bowel disease, commonly presents with abdominal pain, diarrhea, and weight loss, typically leading to diagnosis through endoscopic or imaging studies. Its incidental discovery during emergent trauma surgery is rare.

Case presentation: We report the case of a 25-year-old male who sustained blunt abdominal trauma in a dirt-bike accident, presenting to the emergency department the same day with progressive abdominal pain. Emergent exploratory laparotomy for a suspected bowel perforation revealed characteristic "creeping fat," inflammatory adhesions, and an enterocolonic fistula, suggesting undiagnosed Crohn's disease. The presence of acute inflammation necessitated extended small bowel resection and precluded primary anastomosis. Postoperatively, the patient developed recurrent intra-abdominal abscesses, including a subhepatic collection measuring 5.7 × 2.6 × 5 cm, as well as pleural effusions, necessitating multiple drainage procedures, targeted antibiotics, and nutritional optimization. A multidisciplinary team-including trauma surgeons, gastroenterologists, infectious disease specialists, and interventional radiologists-collaborated to manage both acute injuries and the newly recognized chronic inflammatory condition. Final pathology revealed multifocal colonic mucosal ulceration with acute inflammation, ileocolic fistula formation, and colonic perforation, consistent with a penetrating (fistulizing) phenotype, ileocolonic Crohn's disease.

Conclusion: This case illustrates the importance of maintaining a broad diagnostic perspective during trauma surgery and highlights how an unrecognized inflammatory bowel disease can complicate postoperative recovery. Early suspicion and tailored interventions are crucial for mitigating complications such as abscess formation and sepsis. A prompt gastroenterology consult and confirmatory investigations are recommended to guide long-term management of Crohn's disease. Ultimately, this report underscores that vigilance for atypical findings in emergent settings can significantly improve patient outcomes.

A temporal relationship between liver enzyme derangement and an herbal remedy warrants further assessment for herb-induced liver injury (HILI). Here, we describe the use of kava, a drink traditionally consumed in Pacific Island cultures, causing acute ALT and AST elevation as assessed by an updated RUCAM score of 7. The increasing use of kava in Western society should prompt clinicians to be more aware of this rare cause of HILI. A 46-year-old man was referred to the emergency department with a 3-week history of fatigue, right upper quadrant pain, and profound transaminitis. He commenced kava 10 g daily 5 weeks prior to aid sleep, which was ceased 2 weeks prior due to his biochemical derangement. Blood tests revealed an ALT of 1546 U/L and an AST of 920 U/L. An autoimmune screen, viral serology, and liver ultrasound showed no abnormalities. A liver biopsy revealed foci of hepatocellular necrosis with scattered ballooning degeneration and apoptotic bodies in the parenchyma, but normal underlying hepatic parenchyma without steatosis. Following cessation of kava, the liver enzymes improved without any other intervention. He was monitored as an outpatient and had no recurrence. The incidence of kava HILI may increase with its marketing; its exact mechanism is unknown. Ultimately, further research is needed to identify the pathogenesis of kava HILI. HILI is a significant cause of transaminitis, and clinicians should remain vigilant in patients presenting with nonspecific symptoms and a negative liver screen.

Malaria can be a life-threatening disease, but it rarely presents with acute hepatitis. This case reports the medical course of a 55-year-old African woman afflicted with P. falciparum malaria, recently treated in Cameroon, who presented with jaundice and transaminitis. Her liver biopsy indicated cholestatic hepatitis. Her diagnosis was complicated by the fact that only one of four follow-up thick and thin blood smears was positive for P. falciparum. After more than 17 months of follow-up, her liver enzymes and bilirubin returned to baseline without further malaria treatment, and her findings were attributed to drug-induced liver injury caused by antimalarial medications.

Necrotizing pancreatitis (NP) is characterized by severe pancreatic inflammation with necrosis and a systemic inflammatory response. We describe the case of a 32-year-old female with NP successfully treated with a modified protocol using hydrogen peroxide (H₂O₂) flushes performed through percutaneous drains (PCDs). She was deemed high risk for endoscopic necrosectomy due to her significant cardiorespiratory comorbidities. As such H₂O₂-assisted necrosectomy involving H₂O₂ instillation into the necrotic collections via the PCDs was performed. Sequential close clinical follow-up to 1 year showed a durable response without adverse effects. To our knowledge, an extended, durable clinical response has not been previously reported. Further research is required to define clear guidelines on dosing, administration regimen, and follow-up on PCD drainage.