Subclinical Celiac Disease Unmasked by Immune Checkpoint Inhibitor Therapy.

Immune checkpoint inhibitors (ICI) are antibodies that block immune checkpoint proteins from binding with their partner proteins on cancer cells, subsequently allowing cytotoxic T-cell-associated enhancement of antitumor responses. Although ICIs have become the standard of care for various malignancies, their use is often limited by unique immune-related adverse events, including dermatologic, endocrine, inflammatory, hepatic, and gastrointestinal events. Diarrhea and colitis are common lower gastrointestinal tract immune-related adverse events, however, only a few cases have reported the association between celiac disease (CD) and ICIs. We report here a case of a 75-year-old man with new onset CD after exposure to the cytotoxic T-lymphocyte-associated antigen-4 ICI, ipilimumab. Although ICI-induced CD is relatively rare, it is essential to consider it in a genetically susceptible patient undergoing treatment with ICI. Patients with known high susceptibility to CD, such as a family history of CD, or with the ancestry of high celiac penetrance (eg, Northern Europe, North Africa, etc), dermatitis herpetiformis, or chronic bowel symptoms, we feel should have celiac panel testing before initiating ICI therapy.

Diagnosis of Secondary Sclerosing Cholangitis by Port Site Metastasis.

Port site metastasis is an uncommon but challenging pathological entity whereby metastatic cancer is discovered at the operative port site after surgery. Secondary sclerosing cholangitis is a multifocal stricture disease of the biliary system as the result of extra-biliary pathology; rarely, it is due to an infiltrative disorder such as neoplasia. This is the first reported case of secondary sclerosing cholangitis that was diagnosed with metastatic cancer following the discovery of port site metastasis after laparoscopic cholecystectomy.

Rocky Mountain Spotted Fever Masquerading as Gastroenteritis: A Common but Overlooked Clinical Presentation.

Rocky Mountain spotted fever (RMSF) is a tick-borne illness caused by Rickettsia rickettsii. The classic triad of fever, rash, and a recent tick bite is rarely present at diagnosis. Less known, but more common initial presentations include gastrointestinal symptoms such as anorexia, nausea, vomiting, and abdominal pain. In endemic areas, a persistent fever with gastrointestinal symptoms should prompt screening and early initiation of antibiotics to prevent the development of fulminant RMSF and its associated high mortality. This case aims to educate about the gastrointestinal and hepatic manifestations of this diagnostic enigma.

Severe Erosive Esophagitis Secondary to Gastric Outlet Obstruction Related to Pseudomyxoma Peritonei.

Pseudomyxoma peritonei (PMP) is a rare clinical condition characterized by a mucin-producing tumor. PMP tumor cells migrate to abdominal and pelvic sites, eventually enveloping intra-abdominal organs and compressing the gastrointestinal tract. Patients with PMP are often asymptomatic in early stages of the disease, but in later stages develop symptoms including abdominal pain, acute abdomen, increased abdominal girth, vomiting, and bowel obstruction. Nonspecific symptoms combined with a relatively modest accuracy of imaging modalities frequently lead to delay in PMP diagnosis and treatment, thereby increasing morbidity. We present a case demonstrating severe erosive esophagitis as a result of PMP-associated gastric antrum compression.