Colonizing the Unlikely: Brachyspira in an Immunocompetent Patient.

Chronic diarrhea is a common condition that medical professionals often encounter. We present an unusual case of chronic diarrhea in a relatively young, immunocompetent man that was attributed to Brachyspira. The patient's clinical presentation was not specific, and he underwent workup for common infectious, inflammatory, and autoimmune causes, all unrevealing. During colonoscopy, no abnormalities were detected; however, histopathology revealed the presence of Brachyspira. Following a course of metronidazole, the patient showed marked improvement in his diarrhea. It is worth noting that the patient's social history did not align with the established risk factors mentioned in the existing literature.

Severe Gastrointestinal Bleeding Following Gastrostomy Tube Replacement: A Case of an Unusual Presentation of Enterocutaneous Fistula.

Gastrostomy tubes are widely used and provide an alternative route of enteral feeding when oral intake is not feasible. Previously, a surgical laparotomy was required for its placement, but percutaneous endoscopic gastrostomy and fluoroscopy-guided percutaneous radiological gastrostomy (PRG) techniques have widely replaced the surgical approach given their less invasive nature. Although the complications that might follow these procedures are usually minor, more severe complications can rarely occur. We describe a unique case of severe gastrointestinal bleeding in a patient who underwent PRG tube exchange reflecting an acute complication following an asymptomatic misplaced permanent gastrostomy tube.

Acquired Tracheoesophageal Fistulas: A Case Report and Review of Diagnostic and Management Challenges.

Acquired, nonmalignant tracheoesophageal fistulas (TEFs) often occur in the setting of prolonged use of endotracheal or tracheostomy tubes due to trauma and erosion of the tracheal wall inflicted by tube cuffs or direct tracheal contact. In this report, we present a patient with a tracheostomy who presented with recurrent aspiration pneumonia and was found to have a large TEF that was difficult to treat. We also discuss the diagnostic and management challenges concerning TEFs. TEFs, especially if large, lead to recurrent aspiration pneumonia and can be challenging to manage. Definitive management of TEFs involves surgical repair; meanwhile, endoscopic or bronchoscopic stenting to bypass the fistula can be performed. The fistula location, size, and concurrent positive pressure ventilation make its treatment challenging in those with chronic ventilatory dependence. Early recognition and multidisciplinary management involving gastroenterologists, interventional pulmonologists, and thoracic surgeons are necessary to decide on the best treatment strategy.

Eosinophilic Esophagitis With Subsequent Eosinophilic Colitis: Keeping a High Index of Suspicion.

The prevalence of eosinophilic esophagitis (EoE) has significantly increased, while, in comparison, eosinophilic gastroenteritis and colitis remain rare entities. The diagnosis and management of eosinophilic gastrointestinal (GI) disorders can be challenging given the non-specific manifestations and variable treatment response. Symptoms refractory to initial therapies (e.g., proton pump inhibitors, dietary modifications, topical steroids) should raise suspicion for distal involvement of the GI tract. In this case report, we describe a patient with EoE with a subsequent diagnosis of eosinophilic colitis and symptom response to systemic corticosteroids. In addition, we review recent updates regarding the management of eosinophilic gastrointestinal disorders.

Colonic Gallstone Ileus: Treatment Challenges.

Intestinal obstruction at the level of the colon is rarely caused by a gallstone. Colonic gallstone is more frequently observed in elderly patients and is associated with high mortality due to treatment challenges. Management with less invasive approaches, including mechanical lithotripsy and endoscopy has been evolving. However, the outcomes are variable, and surgery remains the main cornerstone of treatment. We present a case of an 89-year-old male with gallstone ileus at the level of the sigmoid colon in whom treatment with endoscopy was not successful. We performed an extensive review of the literature to understand the most common presentation, diagnostic modalities, and treatment approach of the sporadic reported cases of colonic gallstone ileus.

Erythema nodosum and pernicious anemia.

Erythema nodosum (EN) often presents as a sudden onset of tender, erythematous, subcutaneous nodules on the legs and ankles. Although rare, pernicious anemia may be related to vitamin B12 deficiency. Discussion of this association in the context of a particular patient is presented.