Pub Date : 2024-09-12eCollection Date: 2024-09-01DOI: 10.14309/crj.0000000000001498
Meagan Alvarado, Darrick K Li
Acquired hemophilia A (AHA) is a rare bleeding disorder caused by the development of antibodies against factor VIII. AHA has previously been reported in association with malignancy and autoimmune disorders, but rarely with liver disease. A prolonged activated partial thromboplastin time is the initial laboratory manifestation of this condition but may be challenging to interpret in the setting of abnormal markers of coagulation typically seen in cirrhosis. We present a case of AHA in a patient with decompensated cirrhosis resulting in refractory bleeding and highlight the complexities of interpreting abnormal coagulation factors in patients with cirrhosis.
获得性血友病 A(AHA)是一种罕见的出血性疾病,由第八因子抗体引起。以前曾有报道称 AHA 与恶性肿瘤和自身免疫性疾病有关,但很少与肝病有关。活化部分凝血活酶时间延长是这种疾病的最初实验室表现,但在肝硬化患者通常出现凝血标志物异常的情况下,对其进行解释可能具有挑战性。我们介绍了一例肝硬化失代偿期患者因难治性出血而出现 AHA 的病例,并强调了解释肝硬化患者异常凝血因子的复杂性。
{"title":"An Unusual Cause of Refractory Bleeding in Cirrhosis.","authors":"Meagan Alvarado, Darrick K Li","doi":"10.14309/crj.0000000000001498","DOIUrl":"https://doi.org/10.14309/crj.0000000000001498","url":null,"abstract":"<p><p>Acquired hemophilia A (AHA) is a rare bleeding disorder caused by the development of antibodies against factor VIII. AHA has previously been reported in association with malignancy and autoimmune disorders, but rarely with liver disease. A prolonged activated partial thromboplastin time is the initial laboratory manifestation of this condition but may be challenging to interpret in the setting of abnormal markers of coagulation typically seen in cirrhosis. We present a case of AHA in a patient with decompensated cirrhosis resulting in refractory bleeding and highlight the complexities of interpreting abnormal coagulation factors in patients with cirrhosis.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11392490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142278841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-12eCollection Date: 2024-09-01DOI: 10.14309/crj.0000000000001514
Meghana Iyer, Stephen A Firkins, Roma Patel, Bailey Flora, Erika Staneff, Roberto Simons-Linares
Patients with hereditary polyposis syndromes (HPS) are among the highest risk of multiple types of cancer. This risk is further magnified by comorbid obesity; however, HPS present unique risks for bariatric surgery. The advent of endoscopic bariatric and metabolic therapies along with advancements in the realm of antiobesity medications provides potential weight loss alternatives in this vulnerable population. We present 2 cases of patients with obesity and HPS successfully treated with intragastric balloons in combination with antiobesity medications.
{"title":"Endoscopic and Pharmacologic Treatment of Obesity in Patients With Hereditary Polyposis Syndromes.","authors":"Meghana Iyer, Stephen A Firkins, Roma Patel, Bailey Flora, Erika Staneff, Roberto Simons-Linares","doi":"10.14309/crj.0000000000001514","DOIUrl":"https://doi.org/10.14309/crj.0000000000001514","url":null,"abstract":"<p><p>Patients with hereditary polyposis syndromes (HPS) are among the highest risk of multiple types of cancer. This risk is further magnified by comorbid obesity; however, HPS present unique risks for bariatric surgery. The advent of endoscopic bariatric and metabolic therapies along with advancements in the realm of antiobesity medications provides potential weight loss alternatives in this vulnerable population. We present 2 cases of patients with obesity and HPS successfully treated with intragastric balloons in combination with antiobesity medications.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11392469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142278900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-12eCollection Date: 2024-09-01DOI: 10.14309/crj.0000000000001515
Caleb J C McKinney, William Bigelow, Preethi G Venkat, Neeral L Shah
Hepatitis B virus (HBV) reactivation can occur in immunosuppressed patients. Specifically, HBV reactivation after chimeric antigen receptor T-cell (CAR T-cell) therapy is a known complication with few case reports and specific treatment guidelines. Our patient experienced HBV reactivation 27 months after CAR T-cell therapy even with 23 months of entecavir prophylaxis. This unique case highlights the need for further investigation into the risk of HBV reactivation after CAR T-cell therapy and the proper HBV prophylaxis during and after CAR T-cell therapy.
免疫抑制患者可能出现乙型肝炎病毒(HBV)再活化。具体来说,嵌合抗原受体 T 细胞(CAR T 细胞)治疗后的 HBV 再激活是一种已知的并发症,但很少有病例报告和具体的治疗指南。我们的患者在接受 CAR T 细胞治疗 27 个月后,即使服用了 23 个月的恩替卡韦预防药物,仍出现了 HBV 再激活。这一独特的病例凸显了进一步研究 CAR T 细胞疗法后 HBV 再激活风险以及在 CAR T 细胞疗法期间和之后采取适当的 HBV 预防措施的必要性。
{"title":"Post-Chimeric Antigen Receptor T-Cell Therapy Hepatitis B Virus Reactivation After 23 Months of Entecavir Prophylaxis.","authors":"Caleb J C McKinney, William Bigelow, Preethi G Venkat, Neeral L Shah","doi":"10.14309/crj.0000000000001515","DOIUrl":"https://doi.org/10.14309/crj.0000000000001515","url":null,"abstract":"<p><p>Hepatitis B virus (HBV) reactivation can occur in immunosuppressed patients. Specifically, HBV reactivation after chimeric antigen receptor T-cell (CAR T-cell) therapy is a known complication with few case reports and specific treatment guidelines. Our patient experienced HBV reactivation 27 months after CAR T-cell therapy even with 23 months of entecavir prophylaxis. This unique case highlights the need for further investigation into the risk of HBV reactivation after CAR T-cell therapy and the proper HBV prophylaxis during and after CAR T-cell therapy.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11392473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142278912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-12eCollection Date: 2024-09-01DOI: 10.14309/crj.0000000000001513
Harishankar Gopakumar, Ankita C Nekkanti, Eugene N Annor, Imran L Balouch
{"title":"No Endoscope Free-Hand Polypectomy of a Large Rectal Polyp.","authors":"Harishankar Gopakumar, Ankita C Nekkanti, Eugene N Annor, Imran L Balouch","doi":"10.14309/crj.0000000000001513","DOIUrl":"https://doi.org/10.14309/crj.0000000000001513","url":null,"abstract":"","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11392478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142278909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-11eCollection Date: 2024-09-01DOI: 10.14309/crj.0000000000001483
Yuting Huang, Nicole M Loo, Alice Y Chang, Zachary Yu, Amanda L McKenna, Charles Ritchie, Allie M Metcalfe, Raouf E Nakhleh, Murli Krishna, C Burcin Taner, Liu Yang
The management of hepatic adenoma in transgender individuals undergoing gender-affirming hormone therapy remains unclear, especially whether treatment should be based on sex assigned at birth or therapy patient received. We presented a transgender man, female at birth, with hepatic adenomatosis with molecular profile differed from typical adenomas in cisgender males on testosterone. Discontinuing testosterone led to autoinfarction of the adenoma, allowing the avoidance of invasive treatments and resumption of gender-affirming hormone therapy. This case underscores the necessity for personalized care in the growing transgender population and challenges current consensus of treatment based on sex assigned at birth, emphasizing a tailored approach.
{"title":"Hepatic Adenomatosis in a Transgender Man on Gender-Affirming Testosterone Therapy.","authors":"Yuting Huang, Nicole M Loo, Alice Y Chang, Zachary Yu, Amanda L McKenna, Charles Ritchie, Allie M Metcalfe, Raouf E Nakhleh, Murli Krishna, C Burcin Taner, Liu Yang","doi":"10.14309/crj.0000000000001483","DOIUrl":"https://doi.org/10.14309/crj.0000000000001483","url":null,"abstract":"<p><p>The management of hepatic adenoma in transgender individuals undergoing gender-affirming hormone therapy remains unclear, especially whether treatment should be based on sex assigned at birth or therapy patient received. We presented a transgender man, female at birth, with hepatic adenomatosis with molecular profile differed from typical adenomas in cisgender males on testosterone. Discontinuing testosterone led to autoinfarction of the adenoma, allowing the avoidance of invasive treatments and resumption of gender-affirming hormone therapy. This case underscores the necessity for personalized care in the growing transgender population and challenges current consensus of treatment based on sex assigned at birth, emphasizing a tailored approach.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11390042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142278906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-11eCollection Date: 2024-09-01DOI: 10.14309/crj.0000000000001489
Jonathan K Lin, Lafaine Grant
Existing on the spectrum of post-transplant lymphoproliferative disorders (PTLD), plasmablastic lymphoma (PBL) is a highly aggressive form of B-cell non-Hodgkin lymphoma. Since its discovery in 1997, fewer than 5 cases of postliver transplantation-associated PBL have been recorded. Despite increased awareness of PTLD and improvement in imaging, PBL often presents with disseminated disease at the time of diagnosis. Treatment usually involves immunosuppression reduction and the use of chemo/immunotherapy, but the prognosis remains poor, with median survival being less than 12 months. We present to you a case of Epstein-Barr virus-negative PBL occurring more than 6 years postliver transplantation.
{"title":"Epstein-Barr Virus-Negative Plasmablastic Lymphoma Post-liver Transplantation.","authors":"Jonathan K Lin, Lafaine Grant","doi":"10.14309/crj.0000000000001489","DOIUrl":"https://doi.org/10.14309/crj.0000000000001489","url":null,"abstract":"<p><p>Existing on the spectrum of post-transplant lymphoproliferative disorders (PTLD), plasmablastic lymphoma (PBL) is a highly aggressive form of B-cell non-Hodgkin lymphoma. Since its discovery in 1997, fewer than 5 cases of postliver transplantation-associated PBL have been recorded. Despite increased awareness of PTLD and improvement in imaging, PBL often presents with disseminated disease at the time of diagnosis. Treatment usually involves immunosuppression reduction and the use of chemo/immunotherapy, but the prognosis remains poor, with median survival being less than 12 months. We present to you a case of Epstein-Barr virus-negative PBL occurring more than 6 years postliver transplantation.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11390050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142278903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-11eCollection Date: 2024-09-01DOI: 10.14309/crj.0000000000001486
Zaid Ansari, Akram Ahmad, Pablo A Bejarano, Antonio Pinna, Xaralambos Zervos
Malakoplakia is a rare acquired histiocytic disorder first described in the urinary bladder. There have been 8 cases reported involving the liver, and this is the first reported case of malakoplakia involving an adult transplanted liver. We report a 63-year-old man with a medical history of orthotopic liver transplantation who presented with fever, chills, and abdominal pain. Imaging found confluent microabscesses in the right lobe of the liver that persisted despite prolonged antibiotics. He was taken to the operating room for a segment 6 hepatectomy of the abscess. Histologically, the inflammatory process showed malakoplakia.
{"title":"Malakoplakia in a Transplanted Liver.","authors":"Zaid Ansari, Akram Ahmad, Pablo A Bejarano, Antonio Pinna, Xaralambos Zervos","doi":"10.14309/crj.0000000000001486","DOIUrl":"https://doi.org/10.14309/crj.0000000000001486","url":null,"abstract":"<p><p>Malakoplakia is a rare acquired histiocytic disorder first described in the urinary bladder. There have been 8 cases reported involving the liver, and this is the first reported case of malakoplakia involving an adult transplanted liver. We report a 63-year-old man with a medical history of orthotopic liver transplantation who presented with fever, chills, and abdominal pain. Imaging found confluent microabscesses in the right lobe of the liver that persisted despite prolonged antibiotics. He was taken to the operating room for a segment 6 hepatectomy of the abscess. Histologically, the inflammatory process showed malakoplakia.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11390046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142278908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-11eCollection Date: 2024-09-01DOI: 10.14309/crj.0000000000001493
Sharifeh Almasaid, Fathima Keshia Suhail, Hafiz M Khan
Gastric perforation is considered a surgical emergency managed operatively; however, endoscopic repair techniques have gained popularity as they are cost-effective, improve mortality, and decrease hospital stay and recurrence. With increased prevalence of gastric defects postoperatively and after invasive endoscopic procedures, various endoscopic techniques were developed over the years, but special consideration should be given to the defect type, size, and location. Our case highlights the use of X-Tack through-the-scope suturing for closing a large, full-thickness gastric perforation in a difficult location where OverStitch is not feasible.
{"title":"Endoscopic Through-the-Scope X-Tack Helix Suturing System for Complete Closure of a Large Full-Thickness After Surgical Gastric Perforation.","authors":"Sharifeh Almasaid, Fathima Keshia Suhail, Hafiz M Khan","doi":"10.14309/crj.0000000000001493","DOIUrl":"https://doi.org/10.14309/crj.0000000000001493","url":null,"abstract":"<p><p>Gastric perforation is considered a surgical emergency managed operatively; however, endoscopic repair techniques have gained popularity as they are cost-effective, improve mortality, and decrease hospital stay and recurrence. With increased prevalence of gastric defects postoperatively and after invasive endoscopic procedures, various endoscopic techniques were developed over the years, but special consideration should be given to the defect type, size, and location. Our case highlights the use of X-Tack through-the-scope suturing for closing a large, full-thickness gastric perforation in a difficult location where OverStitch is not feasible.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11390043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142278902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-11eCollection Date: 2024-09-01DOI: 10.14309/crj.0000000000001490
Emily Fellows, Daryl Ramai, Lara Patriquin, Christopher Ko
Intra-abdominal splenosis is a rare finding which most commonly occurs following traumatic splenectomy. We present a case report of a patient who presented with abdominal pain in which peripancreatic and intrapancreatic lesions were found in the setting of mediastinal lymphadenopathy. Owing to concerns for pancreatic malignancy, we explored these lesions using endoscopic ultrasound with fine-needle biopsy (with rapid on-site evaluation). Ultimately, surgical pathologies revealed the presence of splenic tissues and the diagnosis of pancreatic splenosis.
{"title":"Spontaneous Heterotopic Autotransplantation of Splenic Tissue: A Mimic of Pancreatic Malignancy.","authors":"Emily Fellows, Daryl Ramai, Lara Patriquin, Christopher Ko","doi":"10.14309/crj.0000000000001490","DOIUrl":"https://doi.org/10.14309/crj.0000000000001490","url":null,"abstract":"<p><p>Intra-abdominal splenosis is a rare finding which most commonly occurs following traumatic splenectomy. We present a case report of a patient who presented with abdominal pain in which peripancreatic and intrapancreatic lesions were found in the setting of mediastinal lymphadenopathy. Owing to concerns for pancreatic malignancy, we explored these lesions using endoscopic ultrasound with fine-needle biopsy (with rapid on-site evaluation). Ultimately, surgical pathologies revealed the presence of splenic tissues and the diagnosis of pancreatic splenosis.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11390039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142278914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-11eCollection Date: 2024-09-01DOI: 10.14309/crj.0000000000001495
Susie Min, Debra W Yen, Gail L Bongiovanni
Dermatomyositis (DM) is an inflammatory disease of the muscles and skin. Severe gastrointestinal (GI) involvement, characterized by GI bleeding and perforation secondary to underlying vasculopathy, is rarely seen. We describe a case of newly diagnosed DM in a 75-year-old woman who presented with a rash and muscle weakness. She then had sudden onset of hematemesis and was found to have duodenal ulcers due to leukocytoclastic vasculitis from her DM. Our aim was to highlight the need for recognition of GI involvement in adults with DM.
{"title":"Gastrointestinal Vasculitis in Adult Patient With Dermatomyositis Presenting as Hematemesis.","authors":"Susie Min, Debra W Yen, Gail L Bongiovanni","doi":"10.14309/crj.0000000000001495","DOIUrl":"https://doi.org/10.14309/crj.0000000000001495","url":null,"abstract":"<p><p>Dermatomyositis (DM) is an inflammatory disease of the muscles and skin. Severe gastrointestinal (GI) involvement, characterized by GI bleeding and perforation secondary to underlying vasculopathy, is rarely seen. We describe a case of newly diagnosed DM in a 75-year-old woman who presented with a rash and muscle weakness. She then had sudden onset of hematemesis and was found to have duodenal ulcers due to leukocytoclastic vasculitis from her DM. Our aim was to highlight the need for recognition of GI involvement in adults with DM.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11390040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142278904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}