Endoscope disinfectant-induced colonic pseudolipomatosis: case series of a rare condition.

Aim: Colonic mucosal pseudolipomatosis is a rare and benign endoscopic finding with distinct macroscopic and histological characteristics. Case series: We observed a form of unprecedented colitis in eight patients in a 3-month period. Operators have found, during colonoscopy, flat or slightly raised whitish-yellow plaques, in the colonic mucosa of all patients. Histological examination concluded to pseudolipomatosis. After investigation, the disinfectant machine was found to have technical malfunctioning of the rinse cycle of the endoscope during this period. No other cases were observed after the machine was fixed. Conclusion: Pseudolipomatosis is more an endoscopically induced lesion than a true pathological condition. A careful check of the disinfection process should be carried out when such lesions are detected.

Pseudolipomatosis is a rare and harmless condition that can occur in various parts of the digestive system. It looks like flat or slightly raised whitish or yellow patches mixed with normal gut tissue. Under a microscope, it appears as empty spaces in the tissue layer. We found several cases during colonoscopy over a 3-month period, likely caused by the disinfectant used on the endoscope. Finding these lesions should prompt careful inspection of the disinfection procedure.

Iatrogenic orbital hematoma: an exceptional complication of upper gastrointestinal endoscopy.

Iatrogenic orbital hematoma is a rare event, most often manifested by a painful exophthalmos that could compromise the patient's visual prognosis. We report the case of a 51-year-old female patient with a history of non-ischemic dilated cardiomyopathy and high blood pressure, who developed a painful exophthalmos following an upper gastrointestinal sedation-free endoscopy. The diagnosis of an intra-orbital hematoma was made by computed tomographic scan and a conservative attitude was adopted after a thorough ophthalmological examination. Upper endoscopy may trigger this condition in the presence of pre-existing predisposing factors such as blood clotting disorders, high blood pressure or vascular malformation. This case highlights an uncommon complication of a commonly performed endoscopy that endoscopists should be aware of to provide safe and optimal examination.

A complication called iatrogenic orbital hematoma is a rare occurrence that can potentially harm a patient's vision. We report a 51-year-old patient who experienced a painful bulging of her eye after undergoing an upper endoscopy (a common procedure to look inside the upper digestive tract) without sedation. A CT scan helped doctors diagnose the problem and after a thorough examination, the condition resolved by itself. This case shows that upper endoscopy can lead to complications and endoscopists should be aware of this possibility to make sure the procedure is safe and successful.

Bilateral Sub-deltoid Bursitis in a Patient Receiving Infliximab for Crohn's Disease.

BACKGROUND: Infiximab has been shown to be effective in inducing and maintaining remission of intestinal bowel diseases. Infiximab has been associated with many adverse events. Articular manifestations are commonly reported, but they are of variable clinical expression and aetiology. Among them, inflammatory bursitis has rarely been described. OBJECTIVE: Herein a case of inflammatory bursitis in a patient with Crohn's disease after switching to biosimilar infliximab is reported. CASE REPORT: A 41-year-old man with Crohn's disease evolving from 3 years was referred to infliximab therapy at a dose of 5mg/kg because of an aggressive resistant perineal fistula. After 14 infusions of infliximab, the treatment was switched to infliximab biosimilar using the same dose and frequency of administration. Forty-eight hours after the second infusion, he developed an acute onset of muscle pain and stiffness on both of his shoulders. A musculoskeletal ultrasound was performed and revealed a hypoechoic widening of both subacromial bursae. It was more severe on the left side. DISCUSSION: The diagnosis of non-infective sub-acromial bursitis secondary to infliximab infusion was made as the patient's symptoms resolved rapidly without any antibiotics. Infliximab was definitively stopped and adalimumab was introduced. CONCLUSION: Musculoskeletal side effects of infliximab infusion are uncommonly reported. Among them, bursitis has been reported in only a few cases. Ultrasonography can help early diagnosis of bursitis. The time of occurring of this reaction regarding infliximab infusion, screening of Antibodies to Infliximab (ATI) and clinical outcome after drug discontinuation are the main helpful arguments.

A Stiff Person Syndrome Misdiagnosed as a Psychiatric Illness: A Case Report.

BACKGROUND: Stiff Person Syndrome (SPS) is a rare autoimmune neurological disorder which is often misdiagnosed. We report here a case of SPS with a long diagnosis delay. CASE: A 36-year-old man presented with an 11-year history of progressive stiffness and painful spasms of his both legs, with recent worsening of his condition over the last year resulting in a considerable difficulty of standing up and walking. As the patient developed phobic symptoms, he was considered as having a psychiatric illness and treated with antianxiety and antidepressant drugs. As no real improvement was observed, the patient was referred to internal medicine. Neurological examination showed paraspinal, abdominal and lower limbs muscle contraction with lumbar rigidity. These symptoms were associated to adrenergic symptoms: profuse sweating, tachycardia and high bloodpressure. Initial routine investigations revealed high blood glucose level. Polygraphic electromyographic (EMG) evaluation from paraspinal and leg muscles showed continuous motor unit activity in agonist and antagonist muscle. Electroencephalography and brain magnetic resonance imaging were normal. Immunologic tests according to radio immune assay technique revealed high level of serum anti-glutamic acid decarboxylase (anti-GAD65) antibodies. Diagnosis of autoimmune SPS was retained based on clinical, electrophysiological, and immunological findings. Pregabalin at the dose of 150 mg, three times a day was prescribed with satisfying response. CONCLUSION: SPS is supported by an autoimmune pathogenesis and anti-GAD antibodies seems to be very helpful when SPS is clinically suspected. Treatment of SPS is a challenge, given the scarcity of the syndrome and the absence of established recommendations.