Gastrointestinal Diseases

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• Linezolid-induced pancreatitis associated with lactic acidosis and relative hypoglycemia: A rare case report Gi Eun Kim, Soubiya Ansari, Ateeque Ali, Ehab Adams, Mugahid Eltahir Views: 537 HTML: 99 PDF: 566

  Background: Linezolid is known to cause side effects, including nausea, diarrhea, and headaches of short duration. As extended use of linezolid is becoming more common, additional rare side effects should be considered.
  Case Presentation: A 68-year-old man hospitalized for osteomyelitis developed severe abdominal pain and altered mental status following five weeks of linezolid therapy. Laboratory studies showed very high lipase levels, lactic acidosis not responding to resuscitation, and relative hypoglycemia. All common causes of pancreatitis were ruled out, and a trial of linezolid withdrawal was done resulting in drastic improvement in the patient's clinical status.
  Conclusions: For patients on extended course of linezolid who develop abdominal pain, drug-induced pancreatitis should be considered as a side effect, and a trial of withdrawal of linezolid should be undertaken.

• Spontaneous recovery of isolated advanced heart block in patient with celiac disease by starting a strict gluten free diet: a case report and review of the literature Ossama Maadarani, Leila Bigdelu, Zouheir Bitar, Mohammad Alhabibi, Hosni Kabbara Views: 405 HTML: 61 PDF: 312

  Cardiac conduction disorder may have a wide range of aetiology and can manifest with symptomatic bradycardia and syncope. Celiac disease is a malabsorptive long-term autoimmune disorder where the small intestine is the primarily affected organ due to gluten intolerance in genetically predisposed individuals. The associations between celiac disease and cardiac pathology are uncommon. We report a case of a 50-year-old woman with a known case of celiac disease who presented with a symptomatic cardiac conduction abnormality that improved with a gluten-free diet.

• Lower limb edema caused by metastatic signet ring cell stomach cancer Dany Cruz, Catarina Pinto Silva, Cristina Marques, Francisca Pereira, Alexandra Leitão, Ana Ogando Views: 542 HTML: 70 PDF: 311

  Overall gastric cancer incidence is decreasing, but incidence of gastric signet ring cell carcinoma has been rising. The diagnosis can be challenging. It has a poorer prognosis because it tends to be diagnosed at advanced stages. Lymphedema is a rare presentation. We report a rare presentation of signet ring cell carcinoma in a 49-year old male, with no underlying medical condition. The patient presented with lymphedema of lower limbs, scrotum and abdominal wall.

• Unresolved chronic diarrhea: A case of ACEI-induced mesenteric angioedema Aastha Bharwad, Chelsea Wuthnow, Mahmoud Mahdi, Kyle Rowe Views: 311 PDF: 296 HTML: 40

  Angiotensin-converting enzyme inhibitors (ACEI) are frequently prescribed for cardiovascular and renal diseases. However, ACEI-induced visceral angioedema is a rare occurrence that often goes unnoticed and poses a diagnostic challenge due to its non-specific and diverse symptoms. Key diagnostic indicators on a CT scan include the ‘target’ sign, elongation of bowel loops, enlarged mesenteric vessels, mesenteric edema with or without ascites, thickened omentum, and the absence of vascular compromise or adenopathy. Discontinuation of ACEI usually results in symptom resolution within 48 hours. While this phenomenon is more commonly observed in females and African Americans, we present a case of a Caucasian male who underwent an extensive diagnostic evaluation, including exploratory surgery, before ACEI-induced angioedema was considered.

• Legionnaires' disease complicated with rhabdomyolysis and acute kidney injury Xin Ya See, Omer Ahmed, Nikita Nand, Waleed Quwatli Views: 415 HTML: 82 PDF: 371

  Legionnaire's disease can cause rare and severe complications such as rhabdomyolysis and acute kidney injury. This case report details a 45-year-old male patient who presented with features of Legionnaire's disease. Laboratory results showed a significantly elevated serum creatinine kinase level and an increased creatinine level. Imaging showed right lower lobe consolidation, and a positive urine antigen test confirmed Legionnaire's disease. The patient was administered azithromycin and underwent fluid repletion to manage the rhabdomyolysis and acute kidney injury, resulting in improved creatinine kinase levels and kidney function. He was discharged and continued on azithromycin for 10 days. His outpatient follow-up showed that creatinine kinase levels had further decreased. This case report emphasises the importance of early recognition and management of Legionnaire's disease and its rare but severe complications.

• Retroperitoneal hematoma: a sequela of acute hemorrhagic pancreatitis post endoscopic retrograde cholangiopancreatography Yasaman Navari, Amirbehzad Bagheri, Justine Chinnappan, Su Khine, Huda Marcus, Ghassan Bachuwa Views: 414 HTML: 98 PDF: 316

  Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic and therapeutic tool for pancreaticobiliary diseases. Like every other procedure, ERCP can lead to complications that include pancreatitis, cholecystitis, perforation, and rarely, retroperitoneal hematoma. We present a case of post-ERCP acute hemorrhagic pancreatitis resulting in retroperitoneal hematoma and sequelae of unilateral hydronephrosis and ileus. The patient was treated supportively and had good clinical improvement with resolution of hydronephrosis, ileus and more importantly tolerating oral diet without further episodes of abdominal pain.

• Primary splenic diffuse large B-cell lymphoma: a case report Nuno Maia Neves, Ana Pestana Lopes, Susana Carvalho Coelho, Anabela Raimundo, Maria Manuela Mafra, Alexandra Bayão Horta Views: 296 HTML: 104 PDF: 361

  Primary splenic lymphoma (PSL) is a rare disease and an improbable cause of splenomegaly or splenic nodules. On the contrary, splenic secondary involvement as part of an advanced lymphoproliferative disorder is more common.
  The authors present the case of a 49-year-old woman with a primary splenic diffuse large B-cell lymphoma (PS-DLBCL), in which the absence of other organs’ involvement determined an ultrasound-guided biopsy of the spleen to achieve a definitive diagnosis.
  With this case the authors intend to emphasise the extensive differential diagnosis of splenomegaly, splenic nodules or infiltrates, the usefulness of splenic biopsy in establishing the diagnosis and recall a rare disease, with non-specific presenting symptoms, in which the diagnostic workup is challenging.

• Successful treatment of intractable rectal varices with Gelfoam slurry embolisation and coiling Justine Auxilia Irene Chinnappan, Murtaza Shabbir, Smit Deliwala, Anish Bansal Views: 368 HTML: 171 PDF: 348

  A 57-year-old male with heart failure and decompensated alcoholic liver cirrhosis presented with recurrent haematochesia due to rectal varices. After multiple failed therapy with endoscopic band ligation and surgical sclerotherapy, a discussion with an interventional radiologist was arranged. A transjugular intrahepatic portosystemic shunt (TIPS) was deferred due to a history of heart failure. A shared decision to proceed with transhepatic Gelfoam® slurry embolisation with coiling was made. During the procedure, a variant anatomy of the superior rectal vein was identified. The superior rectal vein was found to drain directly into the left portal vein with no connectivity between the inferior mesenteric vein and the rectal varices. As planned, Gelfoam slurry embolisation and coiling was done to the left and right superior rectal vein along with the common trunk it drains. The patient did not develop any further episodes of gastrointestinal bleeding or worsening ascites on follow-up after 6 months. This case represents a successful treatment of bleeding rectal varices when TIPS is contraindicated.

• Intestinal pseudo-obstruction with life-threatening hypokalaemia in a patient with adult-onset Still’s disease Pierre Rossignon, Alain Soupart Views: 292 HTML: 46 PDF: 299

  Adult-onset Still’s disease (AOSD) is a rare autoinflammatory disorder that can lead to a cytokine storm, causing a range of symptoms. Acute intestinal pseudo-obstruction is another rare condition that results in intestinal obstruction without anatomical cause. Although the two conditions are rarely reported together, we present the case of a 62-year-old male who developed acute intestinal pseudo-obstruction in the context of an AOSD flare. This led to severe hypokalaemia and a critical condition. Other symptoms included a high-spiking fever lasting for weeks, polyarthralgias and a typical salmon-coloured rash. After ruling out other potential causes, the patient was diagnosed with AOSD. Our findings suggest that the cytokine storm associated with this disease triggered the acute intestinal pseudo-obstruction and life-threatening hypokalaemia, establishing a causal relationship.
  Only four other cases of AOSD complicated by intestinal pseudo-obstruction have been reported, and this is the first to present with life-threatening hypokalaemia. This case serves as a crucial reminder that, despite being a diagnosis of exclusion, Still’s disease should be considered as a potential cause of intestinal pseudo-obstruction, as prompt recognition and treatment of the underlying cause is crucial in managing this potentially life-threatening condition.

• Monkeypox in a renal transplant recipient: is it a hazard for immunocompromised patients? Farah Heis, Mohamed Heis, Mahrukh Khan, Manjula Ashok Views: 408 HTML: 56 PDF: 380

  There has been a recent outbreak of monkeypox in the United States, mostly among men who have sex with men (MSM). It seems to be a self-limiting disease but can be potentially serious in immunocompromised patients. Monkeypox infection is transmitted mainly through skin-to-skin contact and possibly seminal and vaginal fluids. Very few cases of monkeypox infection in immunocompromised patients have been published in the literature. We report a case of infection in a renal transplant recipient, and describe the clinical course and outcome.