ACG Case Reports Journal最新文献

Hepatic malignancies in explanted livers are not uncommon; however, finding primary nonhepatic malignancies in explanted livers of any etiology is very rare. Given its rarity, we present a case of low-grade B-cell lymphoma in the liver explant of a patient with metabolic dysfunction-associated steatohepatitis cirrhosis after orthotopic liver transplantation. Preorthotopic liver transplantation workup was notable for periportal lymphadenopathy that was negative for malignancy per ultrasound-guided biopsy, so this finding was surprising. This unexpected diagnosis of lymphoma despite negative workup during pretransplant evaluation underscores the importance for liver transplant centers to conduct thorough investigations for malignancies before transplantation.

We present a case of a 49-year-old woman with diffuse cutaneous systemic sclerosis with refractory gastroesophageal reflux disease and dysphagia for pills and solid foods. Esophagogastroduodenoscopy revealed gastroesophageal intussusception. Despite several interventions including esophageal stent placement, dysphagia persisted. Owing to refractory severe symptoms, the patient underwent a laparoscopic hiatal hernia repair combined with endoscopic transoral incisionless fundoplication. The patient tolerated the intervention well and dysphagia resolved. Although an obscure persistent dysphagia in SSc patients, gastroesophageal intussusception should be considered. This case underscores the need for persistence in the diagnostic evaluation of gastrointestinal symptoms in patients with SSc and highlights the need for a multidisciplinary team care approach.

A unique case involving a 65-year-old woman with recurrent hormone-positive, HER-2-negative breast cancer stage IV (T2N2M1) with known metastases to the bone presented with worsening dysphagia and esophageal wall thickening on imaging masquerading as achalasia. However, endosonography (EUS)-guided biopsy of the esophagus wall demonstrated metastatic breast cancer to the esophagus causing pseudoachalasia.

Acinar cell carcinoma is a relatively rare pancreatic neoplasm, typically treated with surgical resection and adjuvant chemotherapy; however, definitive treatment protocols are not well established. We describe endoscopic ultrasound-guided chemoablation with fine needle injection of paclitaxel/gemcitabine in conjunction with chemotherapy in a 78-year-old man with a 3.0 × 2.7-cm acinar cell carcinoma who was not a surgical candidate. At 12 months, the mass had reduced in size to 0.9 × 0.9 cm, followed by steady growth to 6 × 4.5 cm at 24 months when the patient died secondary to unrelated causes.

Recurrent Clostridioides difficile infection (rCDI) remains a major clinical challenge, often requiring fecal microbiota transplantation (FMT) after conventional treatment fails. An 86-year-old woman with rCDI underwent FMT after failing multiple antibiotic therapies. Shortly after FMT, she experienced diarrhea and abdominal pain, alongside positive C. difficile stool tests. Antibiotics were withheld because of clinical improvement, and she achieved complete resolution of symptoms without further treatment. This case demonstrates the potential benefit of withholding antibiotics in rCDI patients soon after FMT to allow sufficient time for donor microbiota engraftment and underscores the need for further research to optimize post-FMT management.

One to 2% of patients undergoing immune checkpoint inhibitor (ICI) therapy develop ICI-induced pancreatitis (ICI-IP). A small subset of these patients develop recurrent pancreatitis, even after discontinuation of ICI therapy. This case series presents 2 patients with recurrent steroid-responsive ICI-IP who were managed with immunomodulators as steroid-sparing agents. Both patients were maintained on immunomodulators for approximately 2 years before discontinuation of the agents, with no further recurrence or complications of pancreatitis. This case series highlights the use of mycophenolate mofetil and azathioprine for the management of recurrent ICI-IP.

Presented is a 76-year-old man with metastatic melanoma that was successfully treated with pembrolizumab, an immune checkpoint inhibitor (ICI). He underwent 20 months of ICI treatment without dose limiting side effects. Nearly 18 months after ICI discontinuation, the patient developed intermittent epigastric pain and diarrhea. Owing to mild symptoms, he was not immediately evaluated. Three years after ICI cessation, he was diagnosed with stricturing, jejunal Crohn's disease. He was treated with vedolizumab and displayed clinical and radiographic response to treatment. This case serves as an example of potential gastrointestinal-related, long-term autoimmune implications of ICI therapy, even in patients without acute side effects.