Epstein-Barr virus-positive mucocutaneous ulcer in a patient with ulcerative colitis: a recently described entity to take into account.

Epstein-Barr virus-positive mucocutaneous ulcer (EBVMCU) is a new entity recently included in the classification of B-cell lymphoproliferative disorders associated with Epstein-Barr virus (EBV). It is related to immunosuppression and it usually appears in the oropharynx or the skin, being the colon an uncommon location. We present the case of a 31-year-old man with ulcerative proctitis being treated with azathioprine (AZA) and adalimumab (ADA), who was admitted to the hospital due to suspicion of a moderate-severe flare of ulcerative proctitis. Microbiological stool analyses were negative, with a positive fecal calprotectin test (2700 mg/kg). Rectoscopy showed severe endoscopic activity, taking multiple biopsies. Intravenous steroids were started at a dose of 60 mg/day. He presented a favorable clinical and analytical evolution, being discharged from the hospital. The histological results were received at gastroenterology consultation, being compatible with EBVMCU. AZA and ADA were withdrawn, whereas descending steroid regimen and oral and topical mesalazine were continued, being the clinical response adequate.

Simultaneous diagnosis of well-differentiated neuroendocrine tumour and gastrointestinal stromal tumour of the stomach: an infrequent finding.

We present the case of a 75-year-old female patient who was referred to gastroenterology consultation due to vitamin B12 deficiency. Anti-parietal cell and anti-intrinsic factor antibodies were positive. An upper gastrointestinal endoscopy was performed for the suspicion of autoimmune gastritis, identifying in the greater curvature of the gastric corpus a 25 mm spherical, subepithelial lesion, suggestive of gastrointestinal stromal tumour (GIST). A 2 mm sessile polyp was observed adjacent to it. Biopsies from both lesions were taken. Histological examination of the submucosal lesion showed mucosa with neuroendocrine cell dysplasia. The polypoid lesion was compatible with a well-differentiated neuroendocrine tumour (G1) with affected margins. A SPECT-CT scan was performed, showing the lesion compatible with GIST expression of somatostatin receptors. There were no signs of distant extension. Using endoscopic ultrasound, the subepithelial lesion was described as a hypoechoic bulge of the fourth layer, measuring 25 x 18 mm. It was not possible to visualize the polyp. EUS-guided fine needle aspiration was performed, and cytology was negative for malignancy. Finally, it was decided to perform an atypical, laparoscopic gastric greater curvature resection. Neuroendocrine tumours (NETs) are epithelial neoplasms derived from cells of the diffuse neuroendocrine system. Gastrointestinal stromal tumours (GISTs), although they represent 1-3% of gastrointestinal neoplasms, are the most common mesenchymal tumours, arising from interstitial Cajal cells. The synchronous finding in the stomach of a well-differentiated NET and a GIST is rare, having been described in a low percentage of cases.

Hepatosplenic schistosomiasis: an uncommon cause of liver disease in developed countries.

Schistosomiasis is a parasitic infection caused by trematode species of the genus Schistosoma. It is prevalent in tropical regions of Africa, Asia and South America, being rare in Europe, where it is usually diagnosed in immigrants and tourists from endemic areas. It has different clinical forms of presentation. Hepatosplenic schistosomiasis produces periportal fibrosis, which can progress to presinusoidal portal hypertension, with all its associated complications. We present the case of a 43-year-old female patient from the Philippines who was referred to gastroenterology consultation due to liver enzyme alteration with a predominantly cholestatic pattern. An aetiological study was performed, with negative results. An abdominal ultrasound revealed signs of chronic liver disease, with transient elastography of 9.5 kPa. A percutaneous liver biopsy was performed, with histological findings consistent with infestation by schistosome eggs, receiving treatment with praziquantel and subsequently verifying its eradication with a stool test.