Duodenal metastasis: an uncommon cause of occult small intestinal bleeding.

Duodenal metastases are a very uncommon and peculiar cause of upper gastrointestinal bleeding. However, they should be considered in a patient presenting with upper gastrointestinal bleeding and a previous history of malignancy. The importance of recognising the unusual presentation of duodenal metastasis has to be emphasised. We describe two patients with upper gastrointestinal bleeding due to duodenal metastases. In the first patient a periampullary bleeding due to a metastasis of a renal cell carcinoma was detected five years after nephrectomy of the right kidney. In the second patient an occult bleeding caused by a duodenal metastasis of a melanoma was diagnosed. The first manifestation of this melanoma was eight years earlier.

Critical aneurysmal dilatation of the thoracic aorta in young adolescents with variant hyperimmunoglobulin E syndrome.

The autosomal-dominant (AD) form of the hyperimmunoglobulin E syndrome (HIES) has been described as a multisystem disorder including immune, skeletal and dental abnormalities. Recently, the evaluation of patients from families in which HIES was inherited in a manner more consistent with autosomal-recessive (AR) inheritance, showed that AR-HIES is a clinically distinct disease entity. In addition to classical immunologic findings of AD-HIES, the AR form presents with severe recurrent fungal and viral infections with herpes zoster, herpes simplex and characteristic mollusca contagiosa. Furthermore, cerebral vascular sequelae, including vasculitis, infarction and haemorrhage were noted. In this report, we describe the clinical picture of two patients who showed remarkable resemblance to the description of AR-HIES, but also developed fatal aneurysmal dilatation of the thoracic aorta in adolescence. This finding may further consummate the clinical picture of AR-HIES and emphasize the possibility to develop early aortitis, most likely preceding the critical aneurysm formation at older age. This process should be anticipated during childhood in cases with AR-HIES.