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Multiple Myeloma Presenting as a Fistulous Rectal Mass Eroding Into the Retroperitoneum
Syed, Taseen MBBS, MD1,2; Abdelfattah, Thaer MD1,2; Zot, Patricija MD3; Vachhani, Ravi MD1
doi : 10.14309/crj.0000000000000621
July 2021 - Volume 8 - Issue 7 - p e00621
Abdominal Wall Hematoma Resulting From Abdominal Pressure Applied During Colonoscopy
Dixon, Robert E. BA1; McDonough, Stephanie BS2; Fang, John C. MD2
doi : 10.14309/crj.0000000000000640
July 2021 - Volume 8 - Issue 7 - p e00640
An Easily Neglected Rapid Progressive Emphysematous Liver Abscess
Tsai, Yu-Chi MD1; Kung, Wen-Ching MD2; Huang, Chien-Wei MD1,3
doi : 10.14309/crj.0000000000000631
July 2021 - Volume 8 - Issue 7 - p e00631
An Unusual Case of Countless Biliary Stones
Nammour, Tarek MD1; Shmais, Manar MD1; Soweid, Assaad MD1
doi : 10.14309/crj.0000000000000629
July 2021 - Volume 8 - Issue 7 - p e00629
Endoscopic Ultrasound Detection of Type B Aortic Dissection
Kolli, Sindhura MD1; Bachali, Kruthika BA2; Ramai, Daryl MD, MScBR2; Shahnazarian, Vahe MD2; Etienne, Denzil MD2; Reddy, Madhavi MD2; Gurram, Krishna C. MD3
doi : 10.14309/crj.0000000000000639
July 2021 - Volume 8 - Issue 7 - p e00639
Biliary Fascioliasis: A Scare During Endoscopic Retrograde Cholangiopancreatography
Valões, Ricardo MD1; Bonadeo, Nilton Maiolini MD1; de Souza Quevedo, Pedro PhD2; Duro Barp, Anna Laura MD3; Fornari, Fernando MD4
doi : 10.14309/crj.0000000000000630
July 2021 - Volume 8 - Issue 7 - p e00630
Over-the-Scope Clip for Bleeding Malignant Gastric Ulcer
Steele, Diego Colom MD1; Rustagi, Tarun MD1
doi : 10.14309/crj.0000000000000611
July 2021 - Volume 8 - Issue 7 - p e00611
Color Transition of Meconium: Extensive Type of Hirschsprung Disease
Ataka, Ryo MD1; Takada, Narito MD2; Sekiya, Akane MD3; Doi, Ryuichiro MD1
doi : 10.14309/crj.0000000000000637
July 2021 - Volume 8 - Issue 7 - p e00637
Endoscopic Mucosotomy and Lumen-Apposing Metal Stent Placement for the Management of a Closed Colorectal Anastomosis
Sánchez-Luna, Sergio A. MD1; Sobani, Zain A. MD1; Rustagi, Tarun MD1
doi : 10.14309/crj.0000000000000616
July 2021 - Volume 8 - Issue 7 - p e00616
Enormous Single-Session Septotomy for the Treatment of Late Leak Postsleeve Gastrectomy
Itani, Mohamad I. MD1; Abbarh, Shahem MBBS1; Farha, Jad MD1; Kadhim, Ali MD2; Kumbhari, Vivek MD, PhD1
doi : 10.14309/crj.0000000000000626
July 2021 - Volume 8 - Issue 7 - p e00626
Endoscopic Submucosal Dissection of Localized Gastric Amyloidosis
Lee, Ha Eun MD1; Lee, Moon Won MD1; Kim, Gwang Ha MD1
doi : 10.14309/crj.0000000000000627
July 2021 - Volume 8 - Issue 7 - p e00627
A Curious Case of a Posterior Mediastinal Mass
Deyl, Ivana MD1; Mohy-Ud-Din, Nabeeha MD2; Cheriyan, Aswathy MD, MPH3; Monga, Dulabh MD4; Kochhar, Gursimran S. MD, FACP, CNSC4
doi : 10.14309/crj.0000000000000606
July 2021 - Volume 8 - Issue 7 - p e00606
Gastrointestinal stromal cell tumors (GISTs) are mesenchymal stromal tumors that are characteristically CD117 positive. Distinction from other spindle cell tumors such as leiomyomas and leiomyosarcomas is based on clinical, histological, and molecular features. Endoscopic ultrasonography-guided fine-needle aspiration has become a highly used means of preoperative identification of GIST, especially if immunohistochemical staining for CD117 can be performed. We present a case of a posterior mediastinal mass diagnosed as GIST after being found to be CD117 positive, later found to be a metastatic leiomyosarcoma.
A Case of Profound Secretory Diarrhea Revealing 2 Primary Neuroendocrine Tumors
Thompson, Ashley A. MD1; Suhail, Fathima K. MD2; Mirchia, Kanish MD3; Rawlins, Sekou R. MD4
doi : 10.14309/crj.0000000000000625
July 2021 - Volume 8 - Issue 7 - p e00625
Neuroendocrine tumors (NETs) are unusual neoplasms with a diverse spectrum of clinical presentations. There is a lack of literature on cases of 2 primary histologically distinct NETs. We report a case of a 40-year-old man who presented with chronic diarrhea. A colonoscopy was performed which discovered a rectal polyp, with pathology showing a well-differentiated NET. A subsequent somatostatin scan revealed a pancreatic tail mass. Biopsy showed a histologically distinct well-differentiated vasoactive intestinal peptide-producing NET. Given that pancreatic and rectal NETs come from different embryonic origins, the diagnosis of 2 primary NETs presents a unique case.
Orthotopic Liver Transplantation in a Cirrhotic Patient With Recent COVID-19 Infection
Gonzalez, Adalberto MD1; Zervos, Xaralambos MD1; Pinna, Antonio MD2; Singh, Kanwarpreet Tandon MD1; Castaneda, Daniel MD1; Reino, Diego MD2; Ebaid, Samer MD2; McWilliams, Carla MD3; Donato, Christian MD3; Al Khalloufi, Kawtar MD1
doi : 10.14309/crj.0000000000000634
July 2021 - Volume 8 - Issue 7 - p e00634
The coronavirus disease 2019 (COVID-19) pandemic has led to a decrease in liver transplantation because of concerns regarding safety and healthcare resource utilization. There are scant data regarding the safety, optimal timing, and preferred postsurgical immunosuppression regimens for liver transplantation in patients recovered from COVID-19 infection. We describe our experience with one of the first reported cases of orthotopic liver transplantation in a patient who had recently recovered from COVID-19 infection. Using our experience as an example, orthotopic liver transplantation in patients that have recovered from COVID-19 may be safe.
Post–Liver Transplant Lymphoproliferative Disorder Presenting as Biliary Stricture
Karb, Daniel MD1; Satyavada, Sagarika MD1; Shah, Raj MD1; Ismail, Mayada MD1; Alencherry, Erin MD2; Beck, Rose MD, PhD3; Cohen, Stanley Martin MD1
doi : 10.14309/crj.0000000000000628
July 2021 - Volume 8 - Issue 7 - p e00628
A 63-year-old man with nonalcoholic steatohepatitis cirrhosis who underwent orthotopic liver transplant presented 1 year later with obstructive jaundice because of a biliary stricture. This anastomotic stricture was initially believed to be ischemic, but further investigation revealed malignant biliary obstruction because of encasement of the bile duct by a mass arising from liver segment VII, later determined to be post-transplant lymphoproliferative disorder with widespread metastasis. After reduction of immunosuppression and systemic chemotherapy, he experienced complete remission. This case illustrates the need to consider post-transplantation lymphoproliferative disorder–related biliary stricture in any postorthotopic liver transplantation transplant patient presenting with obstructive jaundice.
Gastropancreatic Fistula: A Rare Complication of Peptic Ulcer Disease
Dhruv, Samyak MBBS, MD1; Gurala, Dhineshreddy MBBS, MD2; Philipose, Jobin MBBS, MD1,2; Gumaste, Vivek MD2
doi : 10.14309/crj.0000000000000622
July 2021 - Volume 8 - Issue 7 - p e00622
Peptic ulcer disease (PUD) has a significant health burden. Penetration is a rare complication of PUD, where an ulcer erodes into another organ. To the best of our knowledge, we present the fourth case in the literature where a gastric ulcer has penetrated the pancreas. A 67-year-old man with a history of PUD presented to the emergency department for epigastric pain. Endoscopy revealed a large gastric ulcer at the incisura with magnetic resonance imaging demonstrating gastropancreatic fistula. Our case emphasizes on the importance of timely identification and treatment strategies for gastropancreatic fistula, the rarest complications of PUD.
Emphysematous Pancreatitis Mimicking Bowel Perforation
Sandhu, Sunny MD1; Alhankawi, Dhuha MD2; Chintanaboina, Jayakrishna MD, MPH2; Prajapati, Devang MD, FRCPC3
doi : 10.14309/crj.0000000000000641
July 2021 - Volume 8 - Issue 7 - p e00641
Emphysematous pancreatitis is a rare complication of acute necrotizing pancreatitis, which carries a mortality rate of up to 70%. It has only been described in isolated case reports. We report a patient who presented with suspected bowel perforation and was subsequently found to have emphysematous pancreatitis that was managed successfully with multidisciplinary team involvement.
Listeria monocytogenes Meningitis After Treatment With Infliximab in an 8-Year-Old Pediatric Patient With Crohn's Disease
Rani, Uzma MBBS1; Rana, Ajay MBBS2
doi : 10.14309/crj.0000000000000624
July 2021 - Volume 8 - Issue 7 - p e00624
Anti-tumor necrosis factor-alpha agents are used for the treatment of inflammatory bowel disease. Central nervous system infections are rare adverse effects of these medications, and to the best of our knowledge, there are only 2 case reports from the pediatric patient population. We report a case of an 8-year-old patient with Crohn's disease who developed Listeria meningitis while on infliximab.
An Unusual Cause of Large Bowel Obstruction in a Patient With Ulcerative Colitis
Moktan, Varun P. MD1; Koop, Andree H. MD2; Olson, Matthew T. MD3; Lewis, Michele D. MD, MMSc2; Gomez, Victoria MD2; Farraye, Francis A. MD, MSc2
doi : 10.14309/crj.0000000000000638
July 2021 - Volume 8 - Issue 7 - p e00638
Endometriosis is a rare cause of large bowel obstruction and has been infrequently reported in patients with inflammatory bowel disease. We present an unusual case of a young woman with ulcerative colitis, who presented with a large bowel obstruction with colonic stricture and peripancreatic mass concerning for malignancy. The evaluation revealed endometriosis, and her large bowel obstruction was successfully managed with leuprolide and colonic stenting.
Tofacitinib-Associated Cerebral Venous Sinus Thrombosis
Hakma, Zakaria MD1; Gofman, Natalie PharmD, BCPS, BCCCP1; Brown, Danielle PA-C1; Fitzgerald, Ethan BS2
doi : 10.14309/crj.0000000000000632
July 2021 - Volume 8 - Issue 7 - p e00632
Tofacitinib is a Janus kinase inhibitor indicated to treat adult patients with moderately to severely active ulcerative colitis (UC). Although thrombosis is a known adverse event of tofacitinib, there are no reports specific to cerebral venous sinus thrombosis (CVST). We present a report of a patient presenting with a CVST several months after starting tofacitinib. Initially, this 60-year-old man with poorly controlled UC who previously had a nonthrombotic hemorrhage was found to have venous sinus thromboses of the right transverse and sigmoid sinuses. Hematological workup did not reveal any underlying hypercoagulable conditions, aside from UC. This is the first report of a patient with CVST likely resulting from the Janus kinase inhibitor tofacitinib. This case report should prompt compilation of all thrombotic events in patients receiving tofacitinib.
Autoimmune Gastrointestinal Dysmotility in a Patient With HIV Treated With Methylprednisolone and Pyridostigmine
Gromisch, Christopher M. MD, PhD1,2; Machado, Mariana A. MD1,2; Satyam, Venkata MD3; Nunes, David MD3,4
doi : 10.14309/crj.0000000000000636
July 2021 - Volume 8 - Issue 7 - p e00636
Primary autoimmune gastrointestinal dysmotility is a limited form of autoimmune dysautonomia, driven by antiganglionic autoantibodies (AGAs) against enteric neurons. AGAs are observed in other autoimmune diseases, such as Guillain-Barré syndrome, before the development onset of gastrointestinal symptoms. Here, we report a case of a 57-year-old woman with human immunodeficiency virus, who previously developed Guillain-Barré syndrome, presenting with 6 months of intestinal dysmotility. Diagnosis was made by detecting AGAs to ganglionic acetylcholine receptor, alpha-3 subunit, radiographic evidence of duodenal dysmotility, and exclusion of other causes. The patient received high-dose methylprednisolone with low-dose pyridostigmine, which led to significant improvement of symptoms.
Mantle Cell Lymphoma Presenting as Diarrhea in a Liver Transplant Recipient
Ahmed, Abdelwahab MD1; Naji, Abdullah DO2; Zhang, Jinyu MD3; Raoufi, Mohammad MD4; Alhamar, Mohamed MD4; Salgia, Reena MD3; Mullins, Keith MD3
doi : 10.14309/crj.0000000000000635
July 2021 - Volume 8 - Issue 7 - p e00635
We present a 63-year-old man with a medical history of hepatocellular carcinoma who underwent orthotopic liver transplant 10 years prior on long-term immunosuppressive therapy. The patient presented to the clinic with diarrhea, and the workup revealed mantle cell lymphoma. Mantle cell lymphoma is an extremely rare finding in transplanted livers. It is essential to include mantle cell lymphoma, along with a broad differential, during the workup of diarrhea in post-transplant patients.
