Eosinophilic gastrointestinal disorders presenting with multiple gastric and colonic ulcerative lesions: a case report

Case Study

Abstract

Eosinophilic gastrointestinal disorders are rare inflammatory conditions marked by eosinophilic infiltration of the gastrointestinal tract. Endoscopic manifestations vary from patient to patient. However, ulcerative lesion is a rare occurence. A 57-year-old patient presented with chronic diarrhea and significant peripheral blood eosinophilia. During endoscopy, multiple ulcers were discovered throughout the stomach, duodenum, and colon. Biopsies showed excess tissue eosinophilia suggestive of eosinophilic gastroenteritis and colitis. The patient responded dramatically with corticosteroid. However, he developed steroid dependency necessitating the use of azathioprine. In conclusion, a rare case of eosinophilic gastroenteritis and colitis presented with multiple ulcerative lesions was described. Physicians should be aware that eosinophilic gastroenteritis and colitis may be a cause of chronic diarrhea, particularly, in patients presented with peripheral blood eosinophilia. Corticosteroid is the mainstay of treatment. In steroid dependency case, azathioprine may be an option. 

Graphical abstract

Oral actinomycosis in Crohn’s disease patient: a case report

Case Study

Abstract

Patients with Crohn’s disease may present with lesions in their oral cavity. Oral lesions may be associated with the disease itself representing an extraintestinal manifestation, with nutritional deficiencies or with complications from therapy including infections. Actinomycosis is a slowly progressive bacterial infection caused by Actinomyces spp., anaerobic Gram-positive bacteria. These organisms are normal inhabitants of mucous membranes, especially of the oropharynx, and cause opportunistic infections. We report a case of a 30-year-old male with Crohn’s disease presenting with painful oral aphthous ulcers and swelling of the upper lip. A diagnosis of oral actinomycosis was confirmed by histopathological examination. The patient was treated with infliximab and a regimen of amoxicillin 1 g three times a day. He had a marked response to the treatment after 2 weeks. The plan was to continue amoxicillin for at least 6 months with regular follow-up. Physicians should be aware that actinomycosis may be a cause of oral lesions in Crohn’s disease patient, particularly in immunosuppressed patient. Bacterial cultures and pathology are the cornerstones of diagnosis and should be performed in suspected cases to prevent misdiagnosis.

Graphical abstract

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