RESUMO
A 69-year-old man with a history of pulmonary tuberculosis presented with fever. He tested positive for the QuantiFERON TB-2G and human T-cell lymphotropic virus type 1 antibodies. Imaging revealed a mass in the neck of the gallbladder, with periportal lymph node enlargement and penetration into the duodenum. A definite diagnosis could not be made, even with a subsequent detailed examination. Finally, cholecystectomy and a lymph node biopsy were performed. Histopathology revealed a caseating granuloma in the lymph nodes and in the serosa of the gallbladder, and polymerase chain reaction was positive for tuberculosis. Therefore, the patient was diagnosed with abdominal tuberculosis lymphadenitis extending into the gallbladder and duodenum.
Assuntos
Abdome/virologia , Duodenopatias/virologia , Doenças da Vesícula Biliar/virologia , Infecções por HTLV-I/complicações , Vírus Linfotrópico T Tipo 1 Humano , Tuberculose dos Linfonodos/virologia , Idoso , Doenças da Vesícula Biliar/patologia , Doenças da Vesícula Biliar/cirurgia , Humanos , Masculino , Resultado do Tratamento , Tuberculose dos Linfonodos/cirurgiaAssuntos
Adenocarcinoma/sangue , Antígeno CA-19-9/sangue , Neoplasias do Colo/sangue , Colonoscopia/métodos , Mucosa Intestinal/cirurgia , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Biomarcadores Tumorais/sangue , Neoplasias do Colo/patologia , Neoplasias do Colo/cirurgia , Seguimentos , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Índice de Gravidade de Doença , Fatores de TempoRESUMO
A 52-year-old man presented with diarrhea and 20 kg weight loss in one year. Enteroscopy showed diffuse yellow-white shaggy mucosa in the duodenum and jejunum. Biopsies of the duodenal mucosa revealed massive infiltration within the lamina propria by foamy macrophages strongly positive for periodic acid-Schiff stain. Electron microscopy demonstrated numerous bacilli within macrophages of the lamina propria. Tropheryma whipplei DNA was detected by polymerase chain reaction. The definitive diagnosis of Whipple's disease was made. Antibiotic therapy dramatically improved his clinical picture. This is the first Japanese case with Whipple's disease diagnosed by electron microscopy and polymerase chain reaction.
Assuntos
Ceftriaxona/administração & dosagem , Doença de Whipple/diagnóstico , Doença de Whipple/tratamento farmacológico , Biópsia por Agulha , DNA Bacteriano/análise , Seguimentos , Humanos , Imuno-Histoquímica , Infusões Intravenosas , Mucosa Intestinal/patologia , Mucosa Intestinal/ultraestrutura , Japão , Masculino , Microscopia Eletrônica , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase/métodos , Medição de Risco , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
Protein-losing gastroenteropathy (PLG) can occur as a manifestation of various diseases including autoimmune disorders, and optimal therapy of these underlying diseases may be the only effective remedy for PLG. In the present report, we describe a case of a 54-year-old woman with PLG associated with an autoimmune disease, presumably CREST syndrome. She failed to respond to steroid treatment. Subsequently, cyclosporine was initiated, which resulted in a rapid recovery. The patient was successfully treated with low-dose cyclosporine for five years. There has not been, to our knowledge, any report of PLG successfully treated with cyclosporine. Cyclosporine therapy may be effective not only in inducing but also in maintaining complete remission in patients with autoimmune-associated PLG, especially refractory or intolerable to steroids and/or immunosuppressive therapies.