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Successful Diagnosis of Gastric Heterotopic Pancreas Using Direct-Observation Biopsy by Mucosal Cutting
Michigami, Atsushi MD1; Otoguro, Yuhei MD1; Maeda, Satoshi MD1; Ichihara, Shin MD, PhD2
doi : 10.14309/crj.0000000000000738
January 2022 - Volume 9 - Issue 1 - p e00738
Cholangiocarcinoma With Rare Esophageal Metastasis
Matsuoka, Mana MD1; Kobayashi, Katsumasa MD1; Okura, Yukito MD1; Nozaka, Takahito MD1; Sato, Ayako MD, PhD1; Yauchi, Masato MD1; Matsumoto, Taichi MD, PhD1; Furumoto, Yohei MD1; Horiuchi, Takao MD, PhD1; Asano, Toru MD, PhD1
doi : 10.14309/crj.0000000000000717
January 2022 - Volume 9 - Issue 1 - p e00717
Not Your Average Diverticulum: Massive Esophageal Diverticulum After Laparoscopic Gastric Banding
Paka, Pavan K. MD1; El Halabi, Maan MD1; Adeyemo, Oluwasayo MD, MPH2; Smith, Michael S. MD, MBA2; Lung, Edward MD, MPH2; Simoes, Priya MD2
doi : 10.14309/crj.0000000000000726
January 2022 - Volume 9 - Issue 1 - p e00726
Heterotopic Bone Formation in Juvenile Polyp: A Histopathological Entity
Mohanty, Madhusmita MBBS, MD1; Pandey, Neha MBBS1; Senapati, Urmila MBBS, MD1; Nath, Preetam MBBS, MD, DM2
doi : 10.14309/crj.0000000000000705
January 2022 - Volume 9 - Issue 1 - p e00705
Incidental Colonic Ganglioneuroma on Surveillance Colonoscopy
Agarwal, Siddharth MBBS1; Wang, Yaohong BMed, PhD2; Iyer, Prasad G. MD1; Leggett, Cadman L. MD1
doi : 10.14309/crj.0000000000000727
January 2022 - Volume 9 - Issue 1 - p e00727
Endoscopic Ultrasound-Guided Removal of Grill Wire Bristle in Pancreatic Head
Canakis, Andrew DO1; Lee, Linda S. MD2
doi : 10.14309/crj.0000000000000725
January 2022 - Volume 9 - Issue 1 - p e00725
Iatrogenic Esophagopleural Fistula After the Management of Acute Variceal Hemorrhage With Minnesota Tube Placement
White, Rachel V. DO1; Lee, Roland Y. MD1; Shin, Benjamin J. MD2; Birkholz, James H. MD2
doi : 10.14309/crj.0000000000000714
January 2022 - Volume 9 - Issue 1 - p e00714
An esophagopleural fistula (EPF) is a rare condition. EPFs are typically of spontaneous, iatrogenic, or neoplastic origin. A 50-year-old man with hepatitis C and alcoholic cirrhosis presented with a history of recurrent variceal hemorrhage requiring esophageal banding, Minnesota tube placement, and a transjugular intrahepatic portosystemic shunt. His hospital course after esophageal perforation and EPF was complicated by acute respiratory failure and empyema, necessitating intubation and thoracostomy tube placement. To the best of our knowledge, this is the first reported case of EPF secondary to Minnesota tube placement. The EPF completely healed after endoscopic repair.
Rapidly Extensive Recurrence of Esophageal Neuroendocrine Carcinoma After Complete Pathologic Response to Definitive Chemoradiation
Wang, Maxwell M. BA1; Singh, Simi K. MD1,2
doi : 10.14309/crj.0000000000000730
January 2022 - Volume 9 - Issue 1 - p e00730
Primary esophageal neuroendocrine carcinoma is a rare, aggressive malignancy lacking evidence-based treatment guidelines. The timing and nature of relapse after successful treatment of locoregional disease are not well characterized. We report a patient lacking risk factors for esophageal cancer who rapidly developed extensive disease recurrence 4 months after achieving complete pathologic response to nonsurgical treatment. Although optimal survival for early stage nonmetastatic disease is achieved by esophagectomy with adjuvant therapy, definitive chemotherapy is also appropriate for late stage nonmetastatic patients. There are presently no protocols for maintenance therapy. We highlight complex treatment considerations for this rare malignancy.
A Case of Esophageal Squamous Cell Carcinoma Metastasized to the Colonic Anastomotic Site of Right Hemicolectomy
Zhang, Yingtao MD, PhD1; Dam, Aamir MD2; Nakanishi, Yukihiro MD, PhD1
doi : 10.14309/crj.0000000000000733
January 2022 - Volume 9 - Issue 1 - p e00733
A 73-year-old woman with a history of right hemicolectomy for advanced ascending colon cancer 14 years earlier was referred to our facility for a 2-month history of solid food dysphagia. An esophagogastroduodenoscopy revealed a 7-cm fungating and ulcerated mass in the middle to lower esophagus. The biopsy from the esophageal mass showed a moderately to poorly differentiated squamous cell carcinoma. A colonoscopy showed an end-to-end ileocolonic anastomosis with a 7-mm ulceration in the transverse colon. The biopsy of the ulceration at the anastomotic site showed a moderately to poorly differentiated squamous cell carcinoma with a morphology similar to that of the esophageal mass, rendering the diagnosis of metastatic esophageal squamous cell carcinoma. Colonic metastasis from esophageal squamous cell carcinoma, especially at the anastomotic site, is extremely rare. Although surgical trauma may not have contributed to the anastomotic site metastasis, given the distant timeline, its role in the pathogenesis of metastasis cannot be completely ruled out.
Effect of Naloxegol on Opioid-Induced Esophageal Motility Disorder
Ulteig, Crista MD1; Ciezki, Kristin PhD1,3; Jacobson, Megan PA-C1; Singh, Maharaj PhD3,4; Sharma, Tarun MD1,2
doi : 10.14309/crj.0000000000000723
January 2022 - Volume 9 - Issue 1 - p e00723
Opioid effects on lower gastrointestinal motility are well documented, and increasing attention is being paid to their effect on esophageal motility. Naloxegol is a µ-opioid receptor antagonist that is used for opioid-induced constipation, but its impact on esophageal motility has not been well documented. We report a case series of 3 patients with coexisting esophageal dysmotility and constipation on chronic opioids that improved both symptoms after starting naloxegol. Based on these observational studies, we propose that formal studies be conducted to assess the effect of naloxegol on opioid-induced esophageal dysmotility.
Vedolizumab Therapy in Refractory Enteropathy Associated With CVID
Johnson, Dane MD1; Lee, Goo MD, PhD2; Weber, Frederick MD1
doi : 10.14309/crj.0000000000000721
January 2022 - Volume 9 - Issue 1 - p e00721
Common variable immunodeficiency (CVID) is a disorder of typically adult-onset hypogammaglobulinemia in the absence of other known causes. Noninfectious gastrointestinal tract manifestations are common, and a subset of patients with CVID present with a severe enteropathy manifesting as severe malabsorption, weight loss, and diarrhea. A 63-year-old man presented with CVID and severe enteropathy who failed to improve with cytomegalovirus therapy, multiple empiric therapies, and corticosteroids. Vedolizumab infusions were initiated with a dramatic, rapid, and durable complete clinical response.
Adult Intestinal Toxemia Botulism in a Patient With Crohn's Disease
Abdallah, Mohamed A. MD1; Rank, Kevin M. MD1,2; Keeley, Scott MD1,2; Anderson, Daniel J. MD1; Vaughn, Byron P. MD1
doi : 10.14309/crj.0000000000000718
January 2022 - Volume 9 - Issue 1 - p e00718
Adult intestinal toxemia botulism (ITB) is a rare illness that can be fatal if not recognized. ITB can occur when botulinum neurotoxin–producing clostridia colonize the intestine. Underlying intestinal abnormalities associated with dysbiosis are likely a prerequisite for colonization. Dysbiosis seems necessary for spore germination and neurotoxin production. Botulism neurotoxins are the most lethal poisons known and are classified into 7 serotypes: A through G. The clinical presentation consists of cranial nerve abnormalities and descending flaccid paralysis. Prompt recognition and treatment with botulism antitoxin and supportive measures is often successful, but delayed recognition can be fatal. In this study, we present a case of a 40-year-old woman with Crohn's disease who developed ITB. This is the first case in literature to report adult intestinal botulism from Clostridium botulinum producing toxin B and F in the same patient.
Giant Mesenteric Lipoma in an Adult
Vijayan, Nithya MD1; Thekkeveettil, Murali MS, MCh2; Sundaram, Sankar MD3; Krishnadas, Sajitha DNB4
doi : 10.14309/crj.0000000000000728
January 2022 - Volume 9 - Issue 1 - p e00728
Lipomas are benign mesenchymal tumors of mature adipocytes and commonly occur in the upper trunk. Mesenteric lipomas are relatively rare tumors of the gastrointestinal system. They are usually asymptomatic, detected incidentally on abdominal imaging, or can present with variable symptoms depending on the location, size, and rapidity of tumor growth. The ileal mesentery is the most common site, occurring in adults ranging from 40 to 60 years. We present the case of an unusually large mesenteric lipoma in an adult male patient who presented with vague abdominal pain.
Metastatic Head and Neck Squamous Cell Carcinoma Masquerading as Crohn's Disease
Bhaskar, Sonya MD1; Mony, Shruti MD2; Taunk, Pushpak MD3
doi : 10.14309/crj.0000000000000724
January 2022 - Volume 9 - Issue 1 - p e00724
Metastasis from head and neck tumors to the small intestine is an extremely rare occurrence with a dismal prognosis. We present a 67-year-old man with metastatic head and neck squamous cell carcinoma that initially presented as recurrent small bowel obstruction and was misdiagnosed as Crohn's disease. On colonoscopy, terminal ileum biopsies of lymphoid-appearing subcentimeter nodules were positive for metastatic squamous cell cancer. Our case highlights the importance of having a high index of suspicion for metastasis in patients with a recent history of head and neck cancers.
Metastatic Cancer of Apparent Colon Origin With No Intraluminal Cancer After Resection of Colorectal Lateral Spreading Lesions
Lee, Christopher J. MD1; Vemulapalli, Krishna C. MBBS, MPH1; Lin, Jingmei MD, PhD2; Rex, Douglas K. MD1
doi : 10.14309/crj.0000000000000716
January 2022 - Volume 9 - Issue 1 - p e00716
We report a case of metastatic adenocarcinoma to the liver that presented 5 months after piecemeal endoscopic mucosal resection of 3 benign lateral spreading adenomas in the cecum. The pathologic features of the metastatic cancer indicated a probable colonic origin. However, when the cancer was identified, there was no endoscopic evidence of recurrent polyp or another primary lesion in the colon.
Lisdexamfetamine-Induced Ischemic Colitis
El Joud, Karim Abou MD1; Abbasi, Misha MD1; Alajati, Bana MD1
doi : 10.14309/crj.0000000000000719
January 2022 - Volume 9 - Issue 1 - p e00719
Gastrointestinal bleeding secondary to ischemic colitis (IC) is relatively infrequent. Drug-related etiologies of nonocclusive IC are very rare. Sympathomimetics have been reported to cause IC, with most cases being associated with the illicit use of amphetamines and methamphetamines. There are also a few reported cases of prescription dextroamphetamine-linked IC. However, there are no reported cases of lisdexamfetamine-linked IC. We exhibit a 32-year-old woman presenting with hematochezia after the use of lisdexamfetamine. Colonoscopy findings in this patient were suggestive of IC. In the absence of risk factors, the cause was attributed to the usage of lisdexamfetamine. The patient was managed conservatively and advised to discontinue the medication.
Severe Ocrelizumab-Induced Enterocolitis Treated Successfully With Ustekinumab
Shah, Janaki MD1; Al-Taaee, Ahmad MD2; Deepak, Parakkal MBBS, MS3; Gremida, Anas MD3
doi : 10.14309/crj.0000000000000742
January 2022 - Volume 9 - Issue 1 - p e00742
As biologics have become the mainstay of treatment for many autoimmune diseases, their adverse effects are also being identified and described increasingly in the literature. Colitis associated with biologics is a previously described phenomenon in the literature with anti-CD20 (rituximab). The mechanism was thought to be related to B-lymphocyte depletion. We present a case of severe enterocolitis induced by another anti-CD20 monoclonal antibody (ocrelizumab), highlighting a potentially promising therapeutic approach. We performed an extensive literature review and found 4 similar cases. Our case is the first to be salvaged successfully with ustekinumab.
Disseminated Histoplasmosis Mimicking Acute Liver Failure in a Patient Treated With a Tumor Necrosis Factor Inhibitor
Saxena, Damini MD1; Lange, Andrew MD2; Daves, Seanna R. MD1; Punzalan, Carmi S. MD, MS3
doi : 10.14309/crj.0000000000000722
January 2022 - Volume 9 - Issue 1 - p e00722
Disseminated histoplasmosis (DH) is typically seen in patients with organ transplantation or human immunodeficiency virus and rarely presents with acute liver failure. Tumor necrosis factor inhibitors may be immunosuppressive but unlikely to result in DH. A 70-year-old woman with a history of psoriatic arthritis on infliximab presented with altered mental status, fevers, and severe liver injury. She was found to have DH, which resolved on antifungal agents. Because the use of tumor necrosis factor inhibitors has increased, providers should consider this uncommon infection in patients who present with cryptogenic severe liver injury.
Olaparib-Induced Immune-Mediated Liver Injury
Alshelleh, Mohammad MD1; Park, Jennifer MD2; John, Veena MD2; Rishi, Arvind MD3; Bernstein, David MD4; Roth, Nitzan MD4
doi : 10.14309/crj.0000000000000735
January 2022 - Volume 9 - Issue 1 - p e00735
Immune-mediated drug-induced liver injury can be triggered by multiple classes of medications including immunotherapies. Olaparib is a first-in-class oral inhibitor of poly (adenosine diphosphate-ribose) polymerase (an enzyme involved in DNA replication and repair) that is approved as maintenance treatment in platinum-sensitive, epithelial ovarian, tubal, or primary peritoneal cancers with breast cancer 1/2 mutation. We report the first case in the United States of an acute and severe liver injury with associated jaundice and liver synthetic dysfunction secondary to olaparib. The liver injury was resolved with drug cessation and treatment with prednisone taper.
Diagnosis of Gastric Cancer in the Excluded Stomach After RYGB by Jejunogastrostomy Using a LAMS
Schneider, Luca MD1; Kröger, Arne MD2; Gubler, Christoph MD1; The, Frans O. MD, PhD1
doi : 10.14309/crj.0000000000000720
January 2022 - Volume 9 - Issue 1 - p e00720
For patients after bariatric surgery, diagnosis of gastric cancer is a challenge. We present a patient after Roux-en-Y gastric bypass with upper abdominal pain and abnormal computed tomography scan with diffuse wall thickening of the gastric antrum. Various biopsy techniques have been described, with surgical (laparoscopic) exploration being the most common. We were able to successfully diagnose gastric cancer in the excluded stomach by biopsy using a jejunogastrostomy, which proved to be safe and effective.
Esophageal Perforation Successfully Treated With EVT
Panneerselvam, Kavea MD1; Samuel, Ronald MD2; Sealock, Robert J. MD2
doi : 10.14309/crj.0000000000000711
January 2022 - Volume 9 - Issue 1 - p e00711
Esophageal perforation is rare and carries high morbidity and mortality. A high degree of suspicion is needed for timely diagnosis and treatment. A 54-year-old man presented with fever and confusion. Imaging revealed air in the hepatic inferior vena cava and concern for a fistula between the distal esophagus and the inferior vena cava. An upper endoscopic evaluation revealed a dental floss pick penetrating the distal esophagus. The foreign body was removed, and endoluminal vacuum therapy was used to close the perforation. Endoluminal vacuum therapy is an emerging therapy to treat full-thickness gastrointestinal injuries.
Contrast-Enhanced, Fluoroscopically Guided Percutaneous Endoscopic Gastrostomy Tube Placement for the High-Risk Patient
Prakash, Preeti MD1; Su, Andrew MD2; Mason, Leona NP3; Tabibian, James H. MD, PhD2,4
doi : 10.14309/crj.0000000000000740
January 2022 - Volume 9 - Issue 1 - p e00740
Percutaneous endoscopic gastrostomy (PEG) tubes can facilitate enteric feeding in patients with severe malnutrition but may be technically challenging to place. We present a man with disseminated tuberculosis and severe cachexia refractory to oral intake and nasogastric tube placement. PEG placement was initially deemed high-risk, through endoscopic, interventional radiologic, or surgical approach, because of severe cachexia and dilated bowel loops interposed between the abdominal wall and stomach. We describe a novel, minimally invasive technique to enhance safety and feasibility of PEG placement, which led to significant improvement in nutritional status and facilitated successful response to tuberculosis therapy.
Successful Hemostasis of Bleeding From an Aberrant Right Subclavian Artery-Esophageal Fistula After Stenting
DeDecker, Lauren BS; El Hage Chehade, Nabil MD; Sowa, Piotr MD; Samarasena, Jason MD; Lee, John G. MD
doi : 10.14309/crj.0000000000000712
January 2022 - Volume 9 - Issue 1 - p e00712
We present a case of a 62-year-old woman with massive upper gastrointestinal bleeding from an aberrant subclavian artery to an esophageal fistula after esophageal stent placement. The bleeding was successfully stopped with endoscopic hemostatic powder therapy allowing the patient to undergo definitive surgical bypass.
Endoscopic Ultrasound–Guided Gastrojejunostomy for Malignant Gastric Outlet Obstruction in a Patient With a Previous Liver Transplant and Pancreaticoduodenectomy
On, Wei MBChB, MRCP1; Huggett, Matthew T. BM, PhD, FRCP1; Upasani, Vivek FEBS, FRCS2; Paranandi, Bharat MBBS, FRCP1
doi : 10.14309/crj.0000000000000725
January 2022 - Volume 9 - Issue 1 - p e00731
A 29-year-old man underwent a liver transplant 5 years earlier for primary sclerosing cholangitis and a subsequent completion pancreaticoduodenectomy after the discovery of a cholangiocarcinoma on histological analysis of his explant. He presented with gastric outlet obstruction secondary to recurrent peritoneal malignant disease–causing extrinsic compression at the gastroenterostomy site. After multidisciplinary team discussions, an endoscopic ultrasound–guided gastrojejunostomy was performed, resulting in technical and clinical success. We report the first application of endoscopic ultrasound–guided gastrojejunostomy in a patient with the aforementioned postsurgical anatomy.
Drooping After Scoping: A Rare Case of Peripheral Facial Nerve Palsy After RoutineEsophagogastroduodenoscopy
Tu, Yixi MD1; Shin, Christopher BA2; Schroeder, Katie MD1
doi : 10.14309/crj.0000000000000687
January 2022 - Volume 9 - Issue 1 - p e00687
Peripheral facial nerve palsy is a prevalent type of mononeuropathy that can have a variety of etiologies. Facial nerve damage because of esophagogastroduodenoscopy, however, is exceedingly rare and has only been reported in 1 patient. We report the first case in the United States of a patient who developed left-sided facial nerve palsy after a routine esophagogastroduodenoscopy, with little meaningful recovery of nerve function. We hope to bring awareness to gastroenterologists of this rare complication with potential long-term detrimental effects that can be avoided with the adjustment of equipment and patient position before the procedure.
Novel Hemostatic Gel As Rescue Therapy for Postsphincterotomy Bleeding Refractory to Self-Expanding Metallic Stent Placement
Gagliardi, Mario MD1; Oliviero, Giovanni MD1; Fusco, Michele MD1; Napoli, Marco MD2; Sica, Andrea MD3; Maurano, Attilio MD1; Sica, Mariano MD1; Zulli, Claudio MD1
doi : 10.14309/crj.0000000000000744
January 2022 - Volume 9 - Issue 1 - p e00744
Endoscopic sphincterotomy (ES) is commonly performed during endoscopic retrograde cholangiopancreatography, and bleeding is a severe adverse event. PuraStat is a peptide developed as a hemostatic agent for endoscopy. We report its use as a hemostatic strategy in post-ES bleeding refractory to combined hemostasis. A patient with choledocholithiasis underwent endoscopic retrograde cholangiopancreatography for stone removal. After the ES, severe bleeding refractory to the injection of diluted epinephrine around the bleeding source and metal stent placement occurred. Hemostasis was achieved with the application of the hemostatic gel. We reported the use of novel self-assembling hemostatic gel as an effective therapeutic tool for post-ES refractory bleeding.
Spontaneous Infection of a Nonmalignant Intraductal Papillary Mucinous Neoplasm
Ashhab, Ashraf A. MD1; Podboy, Alexander MD1; Lo, Simon K. MD1
doi : 10.14309/crj.0000000000000736
January 2022 - Volume 9 - Issue 1 - p e00736
Intraductal papillary mucinous neoplasm (IPMN) is a pancreatic tumor that originates from the epithelium of the pancreatic duct. Although IPMN cysts can be complicated by infection, this has been reported to involve cysts that have ruptured, fistulized into surrounding organs, undergone malignant transformation, or were recently sampled. We present a 76-year-old man with a history of an IPMN who developed spontaneous cyst infection which was managed with fine-needle aspiration and antibiotics. To the best of our knowledge, this is the first reported case of spontaneous infection of a nonmalignant IPMN. Cyst infection should be considered as a very rare cause of unexplained fevers in patients with history of IPMN.
Severe Gastrointestinal Bleeding Due to Hemosuccus Pancreaticus in Chronic Pancreatitis Treated With Percutaneous Trans-splenic Embolization
Leshen, Michael MD1; Dadlani, Apaar MD2; Ohene-Baah, Nana MD3
doi : 10.14309/crj.0000000000000739
January 2022 - Volume 9 - Issue 1 - p e00739
Hemosuccus pancreaticus is a life-threatening but rare cause of intermittent upper gastrointestinal bleeding caused by acute/subacute hemorrhage into a pancreatic duct or pancreatic pseudocyst because of a ruptured pseudoaneurysm. This entity is described in patients with pseudoaneurysms that develop in the context of severe pancreatic/peripancreatic inflammatory changes. Hemosuccus pancreaticus presents a difficult diagnostic and therapeutic conundrum because it tends to involve inflamed, friable, and tortuous vascular pathways. We present a rare case of hemosuccus pancreaticus because of splenic pseudoaneurysm presenting as duodenal hemorrhage and discuss trans-splenic embolization with a combined angiographic and ultrasound-guided approach.
Use of Ruxolitinib for the Simultaneous Treatment of Severe Refractory Ulcerative Colitis and Polycythemia Vera
Swei, Eric C. MD1; Fox, Charlie M. MD2; Bowles, Daniel W. MD3; Rizeq, Mona N. MD4; Onyiah, Joseph C. MD1,5
doi : 10.14309/crj.0000000000000741
January 2022 - Volume 9 - Issue 1 - p e00741
Tofacitinib is the only medicine in the class of Janus kinase (JAK) inhibitors that has been approved for use in moderate-to-severely active ulcerative colitis (UC). The potential of other JAK inhibitors to treat UC has not been fully explored. We present a case describing the successful use of the selective JAK inhibitor, ruxolitinib, to treat a patient with concomitant UC and polycythemia vera.
Primary Signet Ring Cell Carcinoma of the Ileal Pouch
Tetangco, Eula Plana MD, MPH1; Krogh, Katrina MD2; Yang, Guang-Yu MD2; Bellaguarda, Emanuelle MD1
doi : 10.14309/crj.0000000000000713
January 2022 - Volume 9 - Issue 1 - p e00713
A 55-year-old man with a history of ulcerative colitis status post ileal pouch-anal anastomosis underwent evaluation for pouchitis. He was found to have signet ring cell cancer within the pouch. Primary cancers of the ileal pouch are rare. Signet ring cell carcinoma is a rare form of adenocarcinoma that can involve the gastrointestinal tract and other organs. We present a case of a signet ring cell carcinoma arising from an ileal pouch.
Impedance Planimetry for Crohn's Disease Anastomotic Stricture Characterization: A Predictor of Treatment Response?
Ismail, Mohamed Saleh MD, MSc1,*; Akshintala, Venkata S. MD1,*; Kumbhari, Vivek MD, PhD1; Selaru, Florin M. MD, MBA1
doi : 10.14309/crj.0000000000000729
January 2022 - Volume 9 - Issue 1 - p e00729
Intestinal strictures affect one-third of patients with Crohn's disease (CD) within 10 years of disease onset. Quantification of fibrosis and/or inflammation within the stricture may help in choosing the appropriate treatment. Current endoscopic imaging modalities could benefit from the transmural characterization of tissue modeling from fibrosis. We report the application of EndoFLIP during balloon dilation and stricturotomy of CD-related ileocolonic anastomotic stricture. A low EndoFLIP distensibility was noted which improved after endotherapy. This proof-of-concept application supports the use of EndoFLIP to characterize CD anastomotic stricture and real-time assessment of response to endotherapy.
Crohn's Disease in a Patient With Fibrodysplasia Ossificans Progressiva
Havlichek, Daniel III MD1; Guerrero Vinsard, Daniela MD2; Pignolo, Robert J. MD, PhD3; Kane, Sunanda MD, MSPH2
doi : 10.14309/crj.0000000000000737
January 2022 - Volume 9 - Issue 1 - p e00737
Fibrodysplasia ossificans progressiva (FOP) is a rare disease characterized by inflammatory flares of soft tissues, leading to heterotopic ossification and significant cumulative morbidity and early mortality. FOP minor trauma, including intramuscular medication administration, can induce ossification and should be avoided. We present a case of known FOP in a patient who presented with fevers of unknown origin and was found to have biopsy-proven ileal Crohn's disease. Crohn's disease management was complicated by concerns that intramuscular therapies would induce ossification, and oral monotherapy with methotrexate was initiated with excellent results.
Recurrent, Multisubtype Posttransplant Lymphoproliferative Disorder Masquerading as Inflammatory Bowel Disease
Mussarat, Saad MD1; Houston, Kevin V. MD2; Parekh, Parth J. MD, FACP3
doi : 10.14309/crj.0000000000000734
January 2022 - Volume 9 - Issue 1 - p e00734
Posttransplant lymphoproliferative disorder (PTLD) is a severe posttransplant complication that occurs because of immunosuppression within the first year; however, recurrent PTLD or development of multiple histologic subtypes are rare. Our case demonstrates a renal transplant recipient with rare, recurrent PTLD with multiple histologic subtypes (monomorphic and polymorphic PTLD) despite a previous response to rituximab and resolution of inflammatory changes on endoscopy. It is essential that clinicians maintain a high suspicion for PTLD when caring for patients with previous transplantation and that they have a lower threshold for biopsy with endoscopic findings of nonspecific inflammatory changes.
Apple Core Lesions and Ulcerative Masses Due to Disseminated Yersinia enterocolitica in an Immunosuppressed Patient
Tsai, Christina MD1; Apte, Manisha MD2; Curley, Michael A. MD, FRCPC2
doi : 10.14309/crj.0000000000000732
January 2022 - Volume 9 - Issue 1 - p e00732
A 68-year-old man with previous heart transplantation from a cytomegalovirus-positive donor presented with midabdominal pain, bloating, and weight loss. A computed tomography scan noted apple core lesions in the hepatic and splenic flexures, mesenteric lymphadenopathy, and hypoattenuating hepatic lesions concerning for malignancy. Colonoscopy visualized deep, cratered ulcers at both flexures, with extensive scattered ulcers throughout the colon. Biopsies were unrevealing for dysplasia, viral, and fungal causes. Liver lesion aspirates and stool culture eventually grew Yersinia enterocolitica. By diagnosis, the patient had gone into septic shock but improved after antibiotic initiation and remains clinically stable 4 months later.
