Ileítis terminal por Yersinia enterocolitica: diagnóstico diferencial con la enfermedad de Crohn en un varón de 12 años / Terminal ileitis due to Yersinia enterocolitica: differential diagnosis with Crohn ́s disease in a 12-year-old male

Yersinia enterocolitica es un bacilo Gram-negativo causante de infección intestinal en los humanos. Se presenta con diferentes cuadros clínicos que obligan a descartar una variedad de etiologías, lo cual, a veces, hace difícil alcanzar un diagnóstico correcto en forma oportuna.Se expone el caso de un varón adolescente con dolor en la fosa ilíaca derecha a partir de una ileítis terminal con hallazgos similares a la enfermedad de Crohn, que se diagnosticó, finalmente, como infección por Yersinia enterocolitica. Se destaca la utilidad de los diferentes métodos auxiliares empleados.

Yersinia enterocolitica is a gram-negative rod causing intestinal infection in humans. It shows different clinical pictures with many different etiologies to be ruled-out, which sometimes makes it difficult to reach a timely and correct diagnosis. We report the case of an adolescent boy presenting with right lower quadrant pain from terminal ileitis with endoscopic findings akin to Crohn ́s disease finally diagnosed as Yersinia enterocolitica, highlighting the usefulness of the different ancillary methods employed.

Coexistencia de colitis linfocítica y enteritis microscópica en pacientes con diarrea crónica / Concurrent lymphocytic colitis and microscopic enteritis in patients with chronic diarrhea

Introducción: Colitis linfocítica y enteritis microscópica son causas relativamente comunes de diarrea crónica y ambas se caracterizan por un infiltrado linfocitico intraepitelial. No existen reportes previos de la coexistencia de ambas entidades. Objetivo: Describir las características clínicas e histológicas de los pacientes que presentan este diagnóstico simultáneamente. Material y métodos: Se seleccionaron pacientes adultos con diarrea crónica que tuvieran biopsia simultánea de colon y duodeno tomados el mismo día, durante los años 2010-2016, en el Servicio de Gastroenterología del Hospital Nacional Daniel Alcides Carrión. Se recopiló información clínica del archivo de historias. Las láminas fueron reevaluadas histológicamente por 3 patólogos. Se realizó estudio inmunohistoquímico de linfocitos intraepiteliales para CD8 y CD3 en 6 casos. Resultados: De 63 pacientes con diarrea crónica y biopsia simultánea de duodeno y colon, se identificó un total de 35 pacientes (55,5%) con diagnóstico simultáneo de enteritis microscópica y colitis linfocítica, 80% fueron mujeres. Se identificó anemia en 28,5% de los pacientes e infestación por Blastocystis hominis en el 31,8.%. En enteritis microscópica, el promedio de linfocitos intraepiteliales con CD8 y CD3 fue 40%, mientras que, en colitis linfocítica, el promedio fue de 37,2% para CD3 y 29,2% para CD8. En 11 de los 35 casos, se pudo obtener biopsias de íleon que fueron diagnosticadas como ileitis linfocítica. En 9 casos se diagnosticó colitis eosinofílica asociada a colitis linfocítica. Conclusión: Se encontró coexistencia de colitis linfocítica, enteritis microscópica y en algunos de ileitis linfocítica en un 55,5% pacientes con diarrea crónica con biopsia duodenal y colónica. Estos resultados abren la interrogante sobre si colitis linfocítica y enteritis microscópica son entidades diferentes o constituyen una sola patología que en algunos pacientes afecta varios segmentos del tubo digestivo.

Introduction: Lymphocytic colitis and microscopic enteritis are relatively common causes of chronic diarrhea and it is characterized by an intraepithelial lymphocytic infiltrate. There have been no previous reports of coexistence between these 2 pathologies. Objective: To describe histological and clinical characteristic in patients with coexistence of lymphocytic colitis and microscopic enteritis. Material and methods: All cases with simultaneous diagnosis of lymphocytic duodenosis and lymphocytic colitis were reevaluated during lapse time 2010-2016 in hospital Daniel Carrion. The slides were reviewed by 3 pathologists and clinical information was obtained from clinical records. Expression of CD3 and CD8 was detected in 6 cases by immunohistochemical assays. Results: A total of 35 patients with coexistence of lymphocytic duodenitis and lymphocytic colitis were selected of the pathology archives, 80% were females, Anemia was identified in 28.5% of patients. Blastocysitis hominis infestation was identified in 31.8%. The mean intraepithelial lymphocyte CD8 and CD3 positive was 40% in microscopic enteritis, while the mean intraepithelial lymphocyte CD3 positive was 37.2% and CD8 positive was 29.2% Additionally, lymphocytic ileitis was diagnosed in 11 of our cases. Eosinophilic colitis was diagnosed in 9 cases of lymphocytic colitis Conclusion: We found that lymphocytic colitis, microscopic enteritis and even lymphocytic ileitis can coexist in a group of patients with chronic diarrhea. These findings bring the question if this concurrence of both pathologies constituted a more generalized gastrointestinal disorder, involving both the large and the small intestines.

Curso terapêutica em gastroenterologia: aula 9: doença de crohn / Gastroenterology therapeutics course: class 9: crohn's disease

A doença de Crohn é uma doença intestinal inflamatória caracterizada por inflamação transmural e descontínua que pode acometer qualquer segmento do tubo digestivo, desde a boca até o ânus. Íleo terminal e cólon ascendente adjacente (ileocolite) são os principais locais acometidos, e os pacientes podem se apresentar com ulceração, estenose, formação de fístulas e abscesso. Em relação à terapêutica farmacológica, os aminossalicilatos e os corticosteróides são as drogas classicamente usadas, mas novos agentes farmacológicos estão sendo investigados e têm criado grande expectativa para um futuro bem próximo.

Ileítis y enteropatía perdedora de proteínas como manifestación de lupus eritematoso sistémico: caso clínico y revisión de la literatura / Ileitis and protein-losing enteropathy as manifestation of systemic lupus erythematosus

Son manifestaciones intestinales del lupus eritematoso sistémico, las trombosis (venosas o arteriales), vasculitis, pseudo-obstrucción intestinal crónica y las enteropatías perdedoras de proteínas. Describimos el caso de una paciente de 18 años, que ingresó por dolor abdominal y vómitos, con desarrollo posterior de hipoalbuminemia. El TAC abdominal mostró edema en diana de las asas desde duodeno hasta íleon, con escaso líquido libre perihepático. Los anticuerpos antinucleares y anti-DNA fueron positivos, con persistente hipocomplementemia. La terapia efectuada con corticoides, antibióticos y reposo intestinal fue efectiva, con normalización en el control a 4 semanas con TAC abdominal.

Necrotizing ileitis caused by cytomegalovirus in patient with systemic lupus erythematosus: case report.

We report a systemic lupus erythematosus (SLE) patient with necrotizing ileitis diagnosed at a tertially care centre in Thailand. The patient was surgically explored because peritonitis was suspected and segmental gangrenous and perforation of the terminal iliem were found. The pathological finding was necrotizing ileitis with appearance of cytomegalic intranuclear inclusion body. The presence of cytomegalovirus (CMV) infection in tissue was confirmed by CMV-DNA detection using polymerase chain reaction and ELISA probe hybridization method. The hemoculture and peritoneal fluid culture results revealed no pathogenic organisms. Postoperatively, the clinical course of the patient deteriorated and she developed hypotension. Vasopressive drugs were administered without clinical improvement. She expired on day 5 postoperation. Regarding CMV infection, the organism involves the small bowel in only 4.3 per cent of all CMV infections of the gastrointestinal tract. Isolated cases of ileal perforation due to CMV infection have never been reported in a SLE patient. Thus, chronic right lower abdominal pain, fever with or without diarrhea in immunocompromised patients should cause clinicians to consider CMV ileitis in the differential diagnosis. Immediate surgical resection and prompt antiviral therapy lead to successful treatment.

Cerebral thrombosis associated with active Crohn's disease

An increased incidence of cerebral thromboembolic events has been reported in young patients with inflammatory bowel disease (IBD). It has been suggested that a hypercoagulable state is associated with clinical activity of the disease, with elevation of factors V, VIII, fibrinogen and platelets and a lowering of anti-thrombin III. We present the case of a 35 y/o male with refractory Crohn's disease who complained of headaches, blurred vision and tonic-clonic seizures. The studies demonstrated an ischemic stroke of the left cerebral hemisphere, without vascular abnormalities. Elevation of factor VIII, platelets, and antithrombin III were found. The symptoms were relieved with medical treatment and the patient has continued in good health after resection of the diseased terminal ileum.

Reativaçäo da retocolite ulcerativa com o uso de droga antiinflamatória näo esteróide: relato de caso e revisäo da literatura / Reactivation of ulcerative rectocolitis with drug the use non-steroidal anti-inflammatory: report of a case and review of the literature

É relatado o caso de uma paciente portadora de retocolite ulcerativa idiopática e sacro-ileíte isolada que apresentou reagudizaçao da doença intestinal com o uso de diclofenac. A paciente, alérgica à sulfassalazina, estava em uso de ácidos graxos poliinsaturados omega(3), de óleo de peixe. Sao descritos os prováveis mecanismos envolvidos na reativaçao da doença inflamatória intestinal com uso de drogas antiinflamatórias nao esteróides e sugerido, quando necessário nestes pacientes, o uso dessas drogas, que inibem a lipoxigenase.