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

Pseudomembranous colitis with negative Clostridium difficile PCR presenting with massive ascites: a case report and literature review

Case Study

Abstract

Pseudomembranous colitis (PMC) is characterized by the presence of an inflammatory pseudomembrane overlying the colonic mucosa, and is primarily caused by Clostridium difficile infection (CDI). PMC is often associated with the use of broad-spectrum antibiotics. Common symptoms include watery diarrhea, mucus in stool, abdominal cramps, and fever. We report a case of a 52-year-old female presenting with new abdominal distention, frequent bloody, mucoid, jelly-like diarrhea, and abdominal pain. Peritoneal fluid analysis showed neutrocytic ascites with low serum-ascites albumin gradient (SAAG). A diagnosis of pseudomembranous colitis was confirmed by flexible sigmoidoscopy. However, polymerase chain reaction (PCR) test for Clostridium difficile was negative. The patient was treated with metronidazole (500 mg IV q8h) and vancomycin (250 mg PO QID). Her symptoms resolved after several days of treatment with no ascites found by ultrasound. Neutrocytic ascites can be a complication of PMC. Physicians should also be aware that empirical treatment of Clostridium difficile may cause false negative diagnostic test result. 

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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