A Case of Herpes Simplex Virus Colitis in an Immunosuppressed Patient.

Herpes simplex virus (HSV) can cause severe disseminated infections in immunocompromised patients. Gastrointestinal tract involvement seldom includes the colon. We present a rare case of disseminated cutaneous HSV infection with concomitant colonic involvement in an immunosuppressed patient. The patient's clinical presentation and computerized tomography (CT) findings were concerning for colitis. She failed to improve on antibiotic therapy and subsequently underwent flexible sigmoidoscopy. Gross findings and histopathology were consistent with herpes simplex virus colitis. It is essential to recognize this pathology in immunocompromised patients to evaluate the need to hold immunosuppressive therapy and ensure successful treatment to prevent fatal outcomes.

Neutropenic Enterocolitis in a Patient With Acute Myeloid Leukemia.

Neutropenic enterocolitis (NE) is a medical emergency that occurs in neutropenic patients characterized by diffuse circumferential mural thickening predominantly involving the cecum. It is not easily differentiated from various other abdominal conditions (i.e., appendicitis, intussusception, ischemic colitis, small bowel obstruction, pseudomembranous colitis, and viral gastroenteritis), but clinicians should be aware of the diagnostic criteria in order to assist with prompt diagnosis. Although standard treatment has yet to be established, it is necessary to initiate early supportive care to reduce mortality risk. Here we present a case of NE with small bowel obstruction in a patient with acute myeloid leukemia (AML). Clinical findings and CT abdomen/pelvis were consistent with NE. Unfortunately, the patient succumbed to the illness.

Epstein-Barr Virus Reactivation Causing Cholestatic Hepatitis.

Infection with Epstein-Barr virus (EBV) is common and associated with a high seroprevalence. It is often asymptomatic, but infectious mononucleosis (IM) is the clinical hallmark of this disease especially among teens. Hepatic involvement during primary EBV infection often results in mild self-resolving elevation of liver enzymes, typically in association with IM. However, cholestatic hepatitis might sporadically occur. EBV reactivation is rare, especially among immunocompetent patients. Moreover, reactivation of EBV causing isolated cholestatic hepatitis is extremely rare and only reported in patients who are immunocompromised. Here we present a unique case of EBV reactivation causing cholestatic hepatitis in an otherwise healthy and immunocompetent female and we review the epidemiology, clinical presentation, diagnosis, and treatment of EBV induced cholestatic hepatitis.

Is the anesthesiologist necessary in the endoscopy suite? A review of patients, payers and safety.

The use of propofol for sedation during endoscopy has been increasing, particularly given its association with superior patient satisfaction. Propofol sedation may also allow for higher quality endoscopy exams, increased efficiency of endoscopy suites and most particularly, permit better patient compliance with colonoscopy for colorectal cancer screening. However, propofol is typically provided by anesthesia specialists via monitored anesthesia care, and is associated with significant economic burden. Given the increasing use of monitored anesthesia care, which adds significant costs to endoscopy, payers are likely to react with changes in payer policies. One alternative to monitored anesthesia care is non-anesthesiologist administered propofol, which due to safety concerns and a lack of reimbursement has not been widely adopted in the US.

A review of methotrexate-associated hepatotoxicity.

Methotrexate is effective not only in treating psoriasis and rheumatoid arthritis but also various other disorders. The use of methotrexate has been somewhat limited by concerns regarding its adverse effects, including its potential for hepatotoxicity. The purpose of this article is to provide an overview of methotrexate-associated hepatotoxicity, including risk factors, pathogenesis and recommendations for monitoring it by US, UK and European guidelines, as well as providing a brief overview of its mechanism of action and of high-dose methotrexate.