ABSTRACT
A 17-year-old man with ulcerative colitis (UC) presented to our hospital with neck pain and fever after vomiting. On examination, a snowflake sensation was noted in the neck. A chest radiograph showed extensive subcutaneous emphysema in the chest. CT scans showed extensive subcutaneous emphysema in the neck, shoulders and axilla, as well as pneumomediastinum and pneumothorax. A diagnosis of pneumomediastinum with exacerbation of UC was made, and he was fasted and treated with antibiotics. Intensive granulocyte and monocyte adsorption apheresis (GMA) was started for exacerbation of UC. His symptoms and the radiological findings of pneumomediastinum improved. He remained in remission on azathioprine. UC is a chronic inflammatory bowel disease (IBD) associated with extraintestinal manifestations (EIM). Very few cases have been complicated by pneumomediastinum. The increase in alveolar pressure due to vomiting and systemic inflammation-related pleural or esophageal damage may cause pneumomediastinum in this case. Prevention of progression to mediastinitis and treatment of exacerbated UC are contradictory. GMA was successful because it was not an immunosuppressive therapy. Our case highlights that rare EIM may complicate exacerbation of UC.
ABSTRACT
A 73-year-old man was admitted with four weeks of intermittent fever. He had a history of total aortic arch replacement for aortic arch aneurysm four years prior. CT scans showed no abnormalities before admission. Repeated blood cultures yielded Streptococcus anginosus and Prevotella melaninogenica, suggesting infective endocarditis (IE). Transesophageal echocardiography revealed a vegetation on the aortic valve, confirming IE. He suddenly presented with massive hematemesis and hypotension. Endoscopy revealed an elevated lesion with a laceration but no active bleeding in the esophagus. CT scans showed a thoracic aneurysm involving the esophagus. A diagnosis of aortoesophageal fistula (AEF) complicated by mycotic thoracic aortic aneurysm (MTAA) was made, and he underwent stent graft interpolation followed by minimally invasive esophagectomy. MTAAs are more prone to rupture than arteriosclerotic aneurysms as they are usually not true but pseudoaneurysms. Antecedent infection, including endocarditis, sepsis, predisposes to MTAA. AEF is a rare but life-threatening cause of gastrointestinal bleeding characterized by Chiari's triad. There have been no reports of such rapid formation of AEF after the graft replacement, as shown here. A recent article reported a rapid formation (16 days) of AEF after thoracic endovascular aortic repair, emphasizing prosthetic infection as the most important risk factor. Our case underscores the importance of suspecting AEF and conducting repeated appropriate examinations even if initial examinations do not reveal any aneurysms.
ABSTRACT
We herein report a case of ulcerative colitis (UC) exacerbated by strongyloidiasis. Parasites including Strongyloides stercoralis and Entamoeba histolytica can cause chronic gastrointestinal inflammation and long-lasting symptoms resembling UC. On the other hand, it is not well-known that such organisms can trigger the exacerbation of pre-existing UC. We would like to highlight the importance of recognition of strongyloidiasis in the management of UC patients who have lived in or migrated from endemic regions, such as Asia, Africa, and South America.
Subject(s)
Colitis, Ulcerative , Strongyloides stercoralis , Strongyloidiasis , Animals , Humans , Strongyloidiasis/complications , Strongyloidiasis/diagnosis , Strongyloidiasis/epidemiology , Colitis, Ulcerative/complications , InflammationABSTRACT
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.
Subject(s)
Abdomen/virology , Duodenal Diseases/virology , Gallbladder Diseases/virology , HTLV-I Infections/complications , Human T-lymphotropic virus 1 , Tuberculosis, Lymph Node/virology , Aged , Gallbladder Diseases/pathology , Gallbladder Diseases/surgery , Humans , Male , Treatment Outcome , Tuberculosis, Lymph Node/surgerySubject(s)
Adenocarcinoma/blood , CA-19-9 Antigen/blood , Colonic Neoplasms/blood , Colonoscopy/methods , Intestinal Mucosa/surgery , Adenocarcinoma/pathology , Adenocarcinoma/surgery , Biomarkers, Tumor/blood , Colonic Neoplasms/pathology , Colonic Neoplasms/surgery , Follow-Up Studies , Humans , Immunohistochemistry , Male , Middle Aged , Neoplasm Staging , Severity of Illness Index , Time FactorsSubject(s)
Abscess/diagnosis , Colonoscopy , Crohn Disease/complications , Mesentery , Peritoneal Diseases/diagnosis , Humans , Male , Middle AgedABSTRACT
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.
Subject(s)
Ceftriaxone/administration & dosage , Whipple Disease/diagnosis , Whipple Disease/drug therapy , Biopsy, Needle , DNA, Bacterial/analysis , Follow-Up Studies , Humans , Immunohistochemistry , Infusions, Intravenous , Intestinal Mucosa/pathology , Intestinal Mucosa/ultrastructure , Japan , Male , Microscopy, Electron , Middle Aged , Polymerase Chain Reaction/methods , Risk Assessment , Severity of Illness Index , Treatment OutcomeABSTRACT
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.
Subject(s)
CREST Syndrome/drug therapy , Cyclosporine/administration & dosage , Immunosuppressive Agents/administration & dosage , Protein-Losing Enteropathies/diagnosis , Protein-Losing Enteropathies/drug therapy , Administration, Oral , Biopsy, Needle , CREST Syndrome/complications , CREST Syndrome/diagnosis , CREST Syndrome/immunology , Dose-Response Relationship, Drug , Drug Administration Schedule , Duodenum/diagnostic imaging , Duodenum/pathology , Female , Follow-Up Studies , Humans , Immunohistochemistry , Long-Term Care , Middle Aged , Protein-Losing Enteropathies/complications , Protein-Losing Enteropathies/immunology , Radionuclide Imaging , Risk Assessment , Severity of Illness Index , Stomach/diagnostic imaging , Stomach/pathology , Treatment OutcomeSubject(s)
Crohn Disease/complications , Intestinal Volvulus/complications , Adult , Colonoscopy , Humans , MaleABSTRACT
A 36-year-old woman with ulcerative colitis presented with fever, chest and back pain, and fatigue sensation of the arm. Her upper limb pulses were absent. Angiography showed multiple aneurysms of the aorta and its branches, consistent with Takayasu's arteritis. She showed HLA-B35 but no B52, which is the typical haplotype among the coexistence cases of both diseases. Prednisolone was effective. The possible pathogenic association of the disorders is discussed.