Granulomatosis with polyangiitis in a patient with biopsy-proven IgG4-related pulmonary disease and coincident small cell lung cancer.

Granulomatosis with polyangiitis (GPA) was diagnosed in a patient with a 16-month history of IgG4-related lung disease that spontaneously became asymptomatic. Cytoplasmic antineutrophil cytoplasmic antibody (ANCA) was positive at the time of diagnosis of IgG4-related disease (IgG4-RD), but there was no vasculitis or kidney disease. Sixteen months later he developed rapidly progressive glomerulonephritis that responded to cyclophosphamide treatment. While undergoing treatment for GPA, he was found to have a lung mass identified as small cell lung cancer. This mass was present at the time of the IgG4-RD diagnosis. GPA can be confused with IgG4-RD histologically and they rarely coexist. ANCA antibodies are primarily IgG4 subclass. IgG4-RD has been associated with cancer and may improve prognosis. We speculate that this patient may have had small cell lung cancer that incited an IgG4 predominant immune response with coexistent ANCA antibodies that eventually resulted in GPA. Immunosuppressive treatment of GPA likely accelerated the progression of the lung cancer.

Thrombosis of portal venous system after laparoscopic cholecystectomy in a patient with prothrombin gene mutation.

Laparoscopic cholecystectomy is now the gold standard for the treatment of symptomatic cholelithiasis. Portal venous thrombosis after laparoscopic cholecystectomy is rare. We report a case of thrombosis of the portal venous system after laparoscopic cholecystectomy in a patient with a latent prothrombin gene mutation. An abdominal computed tomography and magnetic resonance angiogram of the abdomen revealed portal, superior mesenteric, and splenic vein thrombosis. Testing for coagulation disorders showed a heterozygous form of factor II (prothrombin) G20210A mutation. Because of its rarity, information regarding this complication is limited.

Gastrointestinal Stromal Tumor Masquerading as a Spontaneous Rectal Hematoma.

A 78-year-old Caucasian male with a history of atrial fibrillation and anticoagulation with warfarin presented with a change in bowel habits and weight loss. A computed tomography (CT) scan showed a 3.5 cm rectal mass. After biopsy with colonoscopy and endoscopic ultrasonography, the rectal mass was highly suspicious for rectal hematoma. When the rectal mass did not resolve after 1 month of follow-up, surgery showed the patient to have a rectal gastrointestinal stromal tumor. He is being treated with imatinib and follow-up CT scans. This case illustrates the importance of a high level of suspicion for a gastrointestinal stromal tumor when a rectal mass is found.

Sepsis and pericarditis caused by Campylobacter fetus: case report and literature review.

Heretofore, Campylobacter infections have been predominantly associated with gastrointestinal manifestations. Over the past two decades, an increasing number of case reports have suggested that the spectrum of disease is much broader. To date, only 10 cases of myocarditis/pericarditis in patients with C. fetus have been reported in the English literature out of which at least 4 patients have died. We describe here a further case to include as we review the literature.

Association of Helicobacter pylori infection with the development of colorectal polyps and colorectal carcinoma.

BACKGROUND AND AIMS: Recent studies have suggested a possible association between Helicobacter pylori (HP) infection and colon neoplasia. HP infection causes hypergastrinemia, and gastrin increases colorectal mucosal proliferation, potentially leading to colorectal cancer. We investigated whether HP infection is associated with colon neoplasia. METHODS: We conducted a cross-sectional, single-center study in which patients who underwent routine outpatient colonoscopy and were tested for HP infection on esophagogastroduodenoscopy from January 1, 2008 to November 1, 2009 were identified. Patient demographic data (gender and age) and information on colon polyp characteristics (size, number of polyps, location, morphology, and histology) were abstracted from retrospective chart review. Presence of adenoma/carcinoma was compared in the HP-positive cases and HP-negative controls. RESULTS: A total of 192 patients were included in the study, with 96 patients each in the HP-positive and -negative groups. The two groups did not differ significantly in gender, age, polyp size, number of polyps, polyp location, morphology, and histology. Adenomatous colon polyps were noted in 31% of the HP-positive cases and in 26% of the HP-negative controls (P = 0.52). Colon carcinoma was found in 6% of HP-positive and 2% of HP-negative patients (P = 0.28). CONCLUSION: The higher prevalence of adenomatous colon polyps/carcinoma in HP-positive patients compared to HP-negative patients was not statistically significant. Larger studies are needed to examine further the potential association between HP infection and colorectal adenoma/carcinoma.

An unusual cause of upper GI bleeding: gastric antral vascular ectasia.

Gastric antral vascular ectasia (GAVE) is characterized by red patches or spots in either a diffuse or linear array in the antrum of the stomach. This syndrome is commonly referred to as watermelon stomach because of its typical endoscopic appearance. Patients with GAVE frequently have occult bleeding requiring continual transfusions. It is important to distinguish the differences while treating GAVE in cirrhotics and portal hypertensive gastropathy (PHG) since the treatment options are vastly different.