Management of COVID-19 Infection in a Small Bowel Transplant Recipient: A Case Report.

The COVID-19 pandemic has caused millions of people to become infected worldwide. Some patients may have disease progression and may need treatment with an anti-COVID-19 agent, hospitalization, and even intensive care. The risk factors for disease progression include old age, diabetes mellitus, pulmonary disease, cardiac disease, immunodeficiency, and immunosuppressant treatment. Therefore, managing COVID-19 infection in transplant patients under immunosuppressant treatments needs specific consideration, especially the side effects of anti-COVID-19 agents and the interaction between immunosuppressants and anti-COVID-19 agents. In this report, we present the case of a small bowel transplant patient who had a COVID-19 infection. The patient was initially treated for paxlovid, and she developed bloody stools and dizziness. The treatment was then changed to molnupiravir without discontinuation of tacrolimus. The patient recovered smoothly after a 5-day treatment with molnupiravir. Here, we discuss the management experience of such patients and review the relevant literature.

Cellular neurothekeoma of the upper lip in an infant.

Cellular neurothekeoma is an uncommon benign skin neoplasm and also a variant of neurothekeoma. Cellular neurothekeomas usually occur in the skin of the upper trunk, head, or neck of children and young adults; however, they rarely occur in infants or involve the lip. A 6-month-old male infant was incidentally found to have a tumor in the upper lip. The tumor was elastic, nontender, and movable, and the overlying mucosa and skin were normal without discoloration. The tumor was excised from the mucosal side of the upper lip, and a pathological examination revealed cellular neurothekeoma. Cellular neurothekeoma in the lip of an infant without overlying skin discoloration might delay the diagnosis and lead to wrong preoperative diagnosis. No similar case has been reported in the literature.

Congenital membrane causing duodenal obstruction and malpositioning of the descending colon.

A congenital membrane without intestinal malrotation is a rare cause of duodenal obstruction. Here we present an 11-year-old girl who had suffered from intermittent abdominal cramping pain and vomiting for more than 5 years. The image studies, including a plain abdomen roentgenogram and sonogram, showed no definite diagnosis. The upper gastrointestinal series and small bowel series showed the contrast was static over the third portion of the duodenum and the descending colon pulled up toward the epigastric area. Laparoscopic exploration revealed a congenital membrane extending from the right-side paraduodenal peritoneum through the third portion of the duodenum to the descending colon, which had caused obstruction of the third portion of the duodenum and malpositioning of the descending colon. To the best of our knowledge, this is the first case report in the literature where a congenital membrane caused both duodenal obstruction and malpositioning of the descending colon.

Congenital ectopic fistula of a minor salivary gland.

A rare case of congenital salivary gland fistula is reported. A 3-year-old girl presented with clear discharge from a dimple on the left cheek. An ectopic salivary gland fistula was unexpectedly diagnosed during operation. This is the first case of congenital salivary fistula draining from a minor salivary gland to a cutaneous pit. We completely excised the lesion, and the patient remains complication free.