Acute hemorrhagic necrotizing enteritis: a case report and review of the literature.

Acute hemorrhagic necrotizing enteritis (AHNE) is a potentially fatal infection, triggered by beta toxin produced by Clostridium perfringens type C and characterized by extensive hemorrhagic, inflammatory, or ischemic necrosis that mainly affects the small bowel, clinically presenting as diarrhea, hematochezia, abdominal pain and hypotensive shock. AHNE is rarely reported in humans nowadays, we present a case of AHNE in a 51-year-old man presenting as watery diarrhea, hematochezia and abdominal pain along with shortness of breath who unfortunately died of the disease despite active medical treatment and multiple surgical interventions. We aim to improve awareness of clinicians on this fulminant disease, associated with high mortality rates. This is the first case report that attempts to summarize the pathogenesis, clinical characteristics, diagnostic methods, treatment and prognosis of AHNE based on the current English literature. AHNE, which is exceedingly rare in clinical practice, has been associated with poorly specific clinical manifestations, high rates of misdiagnosis in its early stages and mortality rates in severe cases. In patients with a history of ingesting contaminated food and presenting with sudden progressively worsening abdominal pain, diarrhea, hematochezia, accompanied by hypotensive shock or ileus, AHNE should be highly suspected. In order to reduce the mortality of this disease, emphasis should be laid on early recognition and timely surgical intervention in AHNE. In severe cases, death cannot be avoided despite adopting active supportive treatment and timely surgical intervention.

Prediction Model of HBsAg Seroclearance in Patients with Chronic HBV Infection.

BACKGROUND: Prediction of HBsAg seroclearance, defined as the loss of circulating HBsAg with or without development of antibodies for HBsAg in patients with chronic hepatitis B (CHB), is highly difficult and challenging due to its low incidence. This study is aimed at developing and validating a nomogram for prediction of HBsAg loss in CHB patients. METHODS: We analyzed a total of 1398 patients with CHB. Two-thirds of the patients were randomly assigned to the training set (n = 918), and one-third were assigned to the validation set (n = 480). Univariate and multivariate analysis by Cox regression analysis was performed using the training set, and the nomogram was constructed. Discrimination and calibration were performed using the training set and validation set. RESULTS: On multivariate analysis of the training set, independent factors for HBsAg loss including BMI, HBeAg status, HBsAg titer (quantitative HBsAg), and baseline hepatitis B virus (HBV) DNA level were incorporated into the nomogram. The HBsAg seroclearance calibration curve showed an optimal agreement between predictions by the nomogram and actual observation. The concordance index (C-index) of nomogram was 0.913, with confirmation in the validation set where the C-index was 0.886. CONCLUSIONS: We established and validated a novel nomogram that can individually predict HBsAg seroclearance and non-seroclearance for CHB patients, which is clinically unprecedented. This practical prognostic model may help clinicians in decision-making and design of clinical studies.

Cytomegalovirus infection in a T-cell lymphoma patient presenting with multiple gastrointestinal ulcers: a case report.

Background and study aims Gastrointestinal ulcers are responsible for a wide spectrum of diseases. Infection, drug-induced enteritis, malignancy, vasculitis and Inflammatory bowel disease are the most common causes; their clinical expression often varies according to the site and severity of intestinal involvement. We report on a 68-year-old male presenting with dyspepsia and melena and multiple gastrointestinal ulcers on endoscopy. We could not establish diagnosis of peripheral T-cell lymphoma not otherwise specified (PTCL-NOS) despite multiple biopsies taken on several endoscopic sessions, and cytomegalovirus (CMV) infection was documented by presence of inclusion bodies on pathology. The immunohistochemical study showed a mixture of B lymphocytes and predominantly T lymphocytes, negative for cluster of differentiation (CD)7. Southern blot gene rearrangement was positive for T-cell receptor beta. Our patient eventually expired from a massive gastrointestinal hemorrhage following four cycles of chemotherapy. We wish to emphasize that a CMV infection, as a comorbidity, can potentially mask and delay diagnosis of PTCL-NOS, especially in cases with aberrant immunophenotype presentation.