Cytomegalovirus infection associated with onset of ulcerative colitis.

BACKGROUND: In 2009, a trigger role of cytomegalovirus (CMV) was shown in the development of ulcerative colitis (UC) in mice. Fifteen cases of synchronous onset of CMV colitis and UC have been reported in literature. A careful prospective and retrospective survey identified CMV colitis in newly diagnosed UC patients at 4.5% (3/65 cases) and 8.2% (5/61 cases), respectively. This means that a majority of synchronous CMV colitis may be missed in newly diagnosed UC patients in routine practice. Such a case is presented. CASE PRESENTATION: A 50-year-old woman, with a history of right partial mastectomy two years ago, had a persistent high fever for 9 days, after which a thickness of the colonic wall was detected on abdominal ultrasonography. Laboratory data showed inflammation and 2% atypical lymphocytes with the normal number of white blood cells. Although there was no bloody stool, fecal occult blood was over 1000 ng/ml. Colonoscopy showed diffuse inflammation in the entire large bowel and pseudomembranes in the sigmoid colon. The diagnosis was UC with antibiotic-associated pseudomembranous colitis. Metronidazole followed by sulfasalazine resulted in defervescence and improvement in laboratory data of inflammation. It took one month for normalization of fecal occult blood. Endoscopic remission was simultaneously confirmed. Later, it was found that a report of positive CMV antigenaemia (2/150,000) had been missed. Reevaluation of biopsy specimens using a monoclonal antibody against CMV identified positive cells, although inclusion bodies were not found in hematoxylin and eosin sections. Finally, the case was concluded to be synchronous onset of CMV colitis and UC. CONCLUSION: Synchronous CMV colitis is not routinely investigated in newly diagnosed UC patients. Together with a recent observation in animal studies, it is plausible that a subset (a few to several per cent) of UC patients develop synchronous CMV infection. Further studies are needed to elucidate the plausibility.

Lifestyle-related disease in Crohn's disease: relapse prevention by a semi-vegetarian diet.

AIM: To investigate whether semi-vegetarian diet (SVD) has a preventive effect against relapse of Crohn's disease (CD) in patients who have achieved remission, who are a high-risk group for relapse. METHODS: A prospective, single center, 2-year clinical trial was conducted. Twenty-two adult CD patients who achieved clinical remission either medically (n = 17) or surgically (n = 5) and consumed an SVD during hospitalization were advised to continue with an SVD and avoid known high-risk foods for inflammatory bowel disease. The primary endpoint was clinical relapse defined as the appearance of active symptoms of CD. Kaplan-Meier survival analysis was used to calculate the cumulative proportion of patients who had a relapse. A 2-year analysis of relapse rates of patients who followed an SVD and those who did not (an omnivorous diet group) was undertaken. RESULTS: SVD was continued by 16 patients (compliance 73%). Remission was maintained in 15 of 16 patients (94%) in the SVD group vs two of six (33%) in the omnivorous group. Remission rate with SVD was 100% at 1 year and 92% at 2 years. SVD showed significant prevention in the time to relapse compared to that in the omnivorous group (P = 0.0003, log rank test). The concentration of C-reactive protein was normal at the final visit in more than half of the patients in remission who were taking an SVD, who maintained remission during the study (9/15; 60%), who terminated follow-up (8/12; 67%), and who completed 2 years follow-up (7/10; 70%). There was no untoward effect of SVD. CONCLUSION: SVD was highly effective in preventing relapse in CD.

Lansoprazole-associated collagenous colitis: diffuse mucosal cloudiness mimicking ulcerative colitis.

There have only been a few reports on lansoprazole-associated collagenous colitis. Colonic mucosa of collagenous colitis is known to be endoscopically normal. We present a case of collagenous colitis where the mucosa showed diffuse cloudiness mimicking ulcerative colitis. A 70-year-old woman developed watery diarrhea four to nine times a day. She had interstitial pneumonia at 67 and reflux esophagitis at 70 years. Lansoprazole 30 mg/d had been prescribed for reflux esophagitis for nearly 6 mo. Lansoprazole was withdrawn due to its possible side effect of diarrhea. Colonoscopy disclosed diffuse cloudiness of the mucosa which suggested ulcerative colitis. Consequently sulfasalazine 2 g/d was started. The patient's diarrhea dramatically disappeared on the following day. However, biopsy specimens showed subepithelial collagenous thickening and infiltration of inflammatory cells in the lamina propria, confirming the diagnosis of collagenous colitis. One month after sulfasalazine therapy was initiated, colonoscopic and histological abnormalities resolved completely. Five months later the diarrhea recurred. The findings on colonoscopy and histology were the same as before, confirming a diagnosis of collagenous colitis relapse. We found that the patient had begun to take lansoprazole again 3 mo ahead of the recent diarrhea. Withdrawal of lansoprazole promptly resolved the diarrhea. Endoscopic and histological abnormalities were also completely resolved, similar to the first episode. Retrospectively, the date of commencement of sulfasalazine and discontinuation of lansoprazole in the first episode was found to be the same. We conclude that this patient had lansoprazole-associated collagenous colitis.

Different distribution of Dukes' stage between proximal and distal colorectal cancer.

BACKGROUND/AIMS: As different features of colorectal cancer between proximal and distal sites are influenced mainly by proximal shift and diagnostic improvement, a comparison of proximal and distal cancer sites may provide clues as to appropriate strategy for colorectal cancer treatment. METHODOLOGY: The clinicopathological data on 676 patients with colorectal cancer was compared regarding the proximal and distal sites. RESULTS: In cases of cancer without metastasis (Dukes' A or B), the incidence of Dukes' A was higher in the distal than in the proximal site (11.2% vs. 24.3%), while the incidence of Dukes' B was lower in the distal than the proximal site. In cases of cancer with metastasis (Dukes' C or D), the incidence of Dukes' C and Dukes' D tumors was similar between proximal and distal sites. CONCLUSIONS: A large number of Dukes' A cancer in distal site may be slow growing with low metastatic potential.

Successful non-surgical treatment of brain abscess and necrotizing fasciitis caused by Bacillus cereus.

Musculoskeletal and central nervous system infections caused by Bacillus cereus are very rare. Only a few cases have been reported, whose clinical courses strongly suggested that surgical procedures combined with appropriate antimicrobial therapy are necessary to cure these infections. A 60-year-old man with severe neutropenia due to myelodysplastic syndrome, developing necrotizing fasciitis and brain abscess caused by Bacillus cereus is reported. Without performing any surgical procedures, the patient was successfully treated with systemic antimicrobial therapy combined with granulocyte colony stimulating factor, which contributed to the increase in the neutrophil count.

CD30 and the NPM-ALK fusion protein (p80) are differentially expressed between peripheral blood and bone marrow in primary small cell variant of anaplastic large cell lymphoma.

The t(2;5)(p23;q35) translocation results in the formation of a unique chimeric NPM-ALK protein (p80). Expression of this protein is considered to be one of the clinical features of anaplastic large cell lymphoma (ALCL). Recently recognized as one clinical subtype of ALCL, the small cell variant is prone to have a leukemic presentation. Although the small cell variant has been recognized as a subtype of ALCL, the clinical properties of this subtype, especially the immunophenotype of lymphoma cells in peripheral blood, have not yet been fully described. This report shows that neither CD30 nor p80 is detected by immunostaining in the predominant small cell malignant clone and also in large lymphoma cells in peripheral blood, while large cells and occasionally observed small cells in bone marrow were found to be positive for CD30 and p80. Our findings suggest that differential expression of CD30 and p80 between peripheral blood and bone marrow lymphoma cells is a property of the small cell variant of ALCL.

Estimation of angiogenesis with anti-CD105 immunostaining in the process of colorectal cancer development.

BACKGROUND: The expression of panendothelial markers (eg, CD34, CD31, and factor VIII) is not always observed in angiogenic vessels, and such markers are not useful for measuring angiogenesis. In contrast, CD105 is preferentially expressed in angiogenic vessels and thus may be valuable for measuring angiogenesis. We hypothesized that microvessel quantification by means of CD105 might be useful for measuring angiogenesis in the colorectal adenoma-carcinoma sequence. METHODS: We immunohistochemically investigated 54 cases of colorectal adenomas and 20 cases of carcinomas using monoclonal antibodies CD34 and CD105, and microvessel density (MVD) was counted at x200 magnification. RESULTS: Microvessels positive for CD34 were distributed almost uniformly in adenomas. In contrast, microvessels positive for CD105 were preferentially observed in the surface area of adenomas. In carcinomas, CD34 stained only a proportion of blood vessels that were positive for CD105. No significant difference of MVD for CD34 was observed in the colorectal adenoma-carcinoma sequence. In contrast, an increment of MVD for CD105 from low-grade to high-grade dysplasia (P <.0001) and that from high-grade dysplasia to carcinomas (P <.05) was statistically significant. CONCLUSIONS: Assessing neovascularization with CD105 in the process of colorectal cancer development may thus be a valuable marker for predicting the risk of colorectal cancer development.