ABSTRACT
Strongyloides stercoralis is a soil transmitted intestinal nematode that is endemic in the tropical and subtropical regions. In most individuals who are infected, chronic, usually asymptomatic, gastrointestinal infection persists. But, in immunocompromized hosts or in patients receiving immunosuppressive therapy, autoinfection of S. stercoralis may result in the dissemination of larvae, leading to fatal hyperinfection and increased rate of complications. We report a case of hyperinfective strongyloidiasis with bacterial meningitis in a patient receiving steroid therapy. Strongyloidiasis was diagnosed by the presence of filariform larvae of S. stercoralis in the bronchoalveolar lavage cytology and upper gastrointestinal endoscopic biopsy specimen. Her clinical symptoms had progressively aggravated and developed bacterial meningitis during treatment. She died despite aggressive antibiotic and antihelminthic therapy.
Subject(s)
Aged , Animals , Female , Humans , Adrenal Insufficiency/drug therapy , Bronchoalveolar Lavage Fluid/parasitology , Endoscopy, Gastrointestinal , Enterococcus faecium/isolation & purification , Immunocompromised Host , Intestinal Mucosa/pathology , Larva/physiology , Magnetic Resonance Imaging , Meningitis, Bacterial/complications , Steroids/adverse effects , Strongyloides stercoralis/growth & development , Strongyloidiasis/complicationsABSTRACT
Azathioprine (AZA) treatment in transplant or autoimmune patients and subsequent appearance squamous cell carcinomas at various sites, particularly skin and cervix, has shown a close relationship. However, it remains uncertain whether this is true for the patients with Crohn's disease. We report a case of squamous cell carcinoma of the breast occurred in a 35-year-old female with Crohn's disease taking AZA. She was first diagnosed with Crohn's disease 10 years ago and has taken AZA with 5-aminosalicylic acid (5-ASA) on regular follow up in gastrointestinal department for 9 years. She had no family history of breast cancer. She visited breast cancer clinic due to incidentally found right breast mass. A mastectomy on the right breast was performed and 6.3x5.5 cm mass was removed. The mass was microscopically proven to be poorly differentiated squamous cell carcinoma with focal keratin pearl formation. At age of 25, she was first diagnosed with active Crohn's disease. 5-ASA and corticosteroid induced remission. Then, steroid was tapered off and AZA was maintained at 1 mg/kg due to leukopenia at higher dose. She stopped taking AZA at her discretion during her two pregnancies and reported total of 67 months of AZA medication on her breast cancer diagnosis.
Subject(s)
Adult , Female , Humans , Azathioprine/therapeutic use , Breast Neoplasms/diagnosis , Carcinoma, Squamous Cell/diagnosis , Colonoscopy , Combined Modality Therapy , Crohn Disease/drug therapy , Immunosuppressive Agents/therapeutic use , Mesalamine/therapeutic use , Positron-Emission TomographyABSTRACT
Percutaneous endoscopic gastrostomy (PEG) has become a widely used and safe method for long-term enteral feeding in patients who are unable to tolerate oral feeding. Although a number of complications can occur following PEG placement, most of these complications are not life threatening. Serious complications occur rarely after this procedure and they include peritonitis, visceral perforation, major gastrointestinal bleeding, and necrotizing fasciitis. An esophageal perforation following PEG placement is very rare and predisposing factors include Zenker's or epiphrenic esophageal diverticuli, esophageal strictures, and mass lesions. We recently experienced a case of distal esophageal perforation following a PEG tube change. The predisposing esophageal perforation factor in this case was uncertain, and we successfully treated the patient with surgical intervention.
Subject(s)
Humans , Constriction, Pathologic , Enteral Nutrition , Esophageal Perforation , Fasciitis, Necrotizing , Gastrostomy , Hemorrhage , PeritonitisABSTRACT
There are diverse ring-like narrowings in the lower esophagus: mucosal ring, muscular ring, ring-like annular peptic stricture. Esophageal muscular ring is extremely rare and generally asymptomatic. It occurs at the proximal border of the esophageal vestibule that corresponds to the upper end of the lower esophageal sphincter. We experienced a case of lower esophageal muscular ring with a symptom of intermittent mild dysphagia for 40 years and report the findings with a review of the literature.
Subject(s)
Aged , Humans , Male , Deglutition Disorders/etiology , Esophageal Stenosis/complications , Esophagogastric JunctionABSTRACT
The majority of patients with scleroderma have gastrointestinal involvement, and a few experience gastrointestinal hemorrhage, however, gastrointestinal hemorrhage due to Mallory-Weiss syndrome is very rare. We report upon a 24-year-old pregnant woman with scleroderma who had gastrointestinal hemorrhage due to Mallory-Weiss syndrome.
Subject(s)
Adult , Female , Humans , Pregnancy , Gastrointestinal Hemorrhage/diagnosis , Mallory-Weiss Syndrome/diagnosis , Pregnancy Complications/diagnosis , Scleroderma, Systemic/complicationsABSTRACT
Relapsing polychondritis (RP) is a rare multisystem disorder. Myelodysplastic syndrome (MDS) with erythroid hypoplasia/aplasia is a rare form of myelodysplasia. Several cases of RP associated with MDS have recently been described. However, RP associated with MDS with erythroid hypoplasia/aplasia has never been reported. There was only one case report of polymyalgia rheumatica associated with MDS with erythroid hypoplasia/aplasia. In this study, we report a 79-year-old patient with RP, who developed MDS subtype refractory anemia (RA) with erythroid hypoplasia/aplasia, a very characteristic subtype of MDS.
Subject(s)
Aged , Humans , Male , Biopsy , Myelodysplastic Syndromes/complications , Polychondritis, Relapsing/complications , Red-Cell Aplasia, Pure/complicationsABSTRACT
Rapidly progressive glomerulonephritis(RPGN) is clinical syndrome characterized by rapid loss of renal function within several weeks to months, with histologic finding of extensive crescent formation. We report a case of RPGN associated with anti-glomerular basement membrane antibody(anti-GBM Ab) and perinuclear-antineutrophilic cytoplasmic antibody(p- ANCA), which rapidly progressed to chronic renal failure. A 44-year-old male was referred to our hospital for evaluation of pitting edema and proteinuria. Both anti-GBM Ab and p-ANCA were detected in serum. Percutaneous renal biopsy showed many crescents with some fibrinoid materials and heavy deposits of IgG. He was treated with pulse methylprednisolone, followed by oral corticosteroid and cyclophosphamide. In spite of immunosuppressive therapy, his renal function deteriorated rapidly and uremic symptoms including pulmonary edema were aggravated. He was started on hemodialysis and he has received regular hemodialysis without recovery of renal function. Further studies will be needed to determine the clinical significance of combined anti- GBM Ab and ANCA.