An Unexpected Finding During Oesophago-Gastro-Duodenoscopy in a Patient Presenting With Food Bolus Obstruction.

Oesophageal intraluminal pseudodiverticulosis is a rare benign condition of the oesophageal wall, with not many cases reported in the literature. Usually, patients present with dysphagia and food impaction in association with a proximal oesophageal stricture. Pathogenesis of the disease is not yet established; hence, it remains important to raise awareness about this distinctive pathology. Here, we present a case of a 62-year-old male admitted to Aberdeen Royal Infirmary, Scotland, UK, with a history of food bolus. Upper gastrointestinal endoscopy revealed food bolus impaction with underlying oesophageal pseudodiverticulosis in the distal two-thirds of the oesophagus.

Atypical Presentation of Dysphagia in a Patient Diagnosed Later With Dermatomyositis: A Case Report.

Dysphagia has been reported in 10%-73% of patients with dermatomyositis. We present the case of a 58-year-old female patient who presented to the emergency department of Peterborough City Hospital with acute-onset difficulty in swallowing. Physical examination demonstrates proximal muscle weakness of the upper limbs and symmetrical skin rash over the face, chest, and thighs. Both clinical and laboratory findings pointed towards the diagnosis dermatomyositis. Oesophagogastroduodenoscopy identified no significant abnormality reducing the possibility of dysphagia due to an intrusive lesion, such as an abscess or a malignancy. MRI scan of the lower limbs revealed evidence of proximal myositis. CT neck, chest, abdomen and pelvis exclude any associated malignancy. The patient was treated initially with intravenous pulses of methylprednisolone for three days, and then switched to oral prednisolone and cyclophosphamide cycles and was considered for intravenous immunoglobulins as her symptoms had not completely resolved.

A Rare Case of Mesalazine-Induced Acute Myocarditis in a 19-Year-Old Female With Ulcerative Colitis.

Mesalazine is a commonly used first-line therapy to treat acute mild to moderate ulcerative colitis (UC). Myocarditis is a rare complication of inflammatory bowel disease. This is a case report of a 19-year-old female with myocarditis induced after commencing mesalazine for UC. She was admitted with pleuritic-type chest pain associated with severe dyspnoea and was hemodynamically unstable during admission. She had elevated troponin and N-terminal pro-B-type natriuretic peptide. Transthoracic echocardiogram (TTE) results suggested there was evidence of myocarditis with reduced ejection fraction, which was later confirmed by cardiac magnetic resonance imaging. There was a rapid improvement of cardiac status after stopping mesalazine within two weeks.

Severe Hypophosphatemia Following Ferric Carboxymaltose in a Patient With Inflammatory Bowel Disease.

Inflammatory bowel disease is a chronic inflammatory condition that affects the large and small bowel, which includes Crohn's disease (CD) and ulcerative colitis (UC). Iron deficiency anemia (IDA) is one of the most common complications in people with inflammatory bowel disease. The treatment of choice is intravenous iron infusion. There is a lack of awareness of side effects of intravenous iron (Ferinject) such as hypophosphatemia, which can prolong hospital admission. We present the case of a patient with iron deficiency anemia and vitamin D deficiency who developed severe hypophosphatemia after intravenous injection of ferric carboxymaltose (Ferinject). In this case presentation, our aim is to increase the awareness of prescribers about the risk of developing low phosphate levels after Ferinject and the need to monitor serum phosphate levels.

Stage of disease in hepatitis B virus infection in Zambian adults is associated with large cell change but not well defined using classic biomarkers.

Background: Hepatocellular malignancy in young adults is a prominent feature of hepatitis B virus (HBV) infection in southern Africa. Here we report a cross-sectional study of liver pathology correlated with biomarkers in adults with HBV infection in Zambia. Methods: We analysed liver biopsies from Zambian patients with persistent HBV infection. Results: We analysed 104 patients with HBV infection and evidence of liver disease. We obtained liver biopsies from 53 adults; of these, 12 (23%) were hepatitis B e antigen seropositive. The genotype was evenly distributed between A and E. One biopsy showed malignancy. Stage was 3 or more in 11 of 52 (21%) biopsies free of malignancy and lobular inflammation was found in 50 (94%). Neither alanine aminotransferase (ALT) nor the γ-glutamyl transferase:platelet ratio (GPR) were correlated with the stage of disease but were correlated with total Ishak score (ρ=0.47, p=0.0004 and ρ=0.33, p=0.02, respectively). Large cell change was observed in 10 of 11 biopsies with fibrosis stage 3 or more and 16 of 41 with early disease (p=0.005). Serum α-fetoprotein was elevated, although still within the normal range, in patients with large cell change (median 3.6 [interquartile range {IQR} 1.6-5.1]) compared with those without (1.7 [IQR 1.0-2.8]; p=0.03). Neither ALT nor GPR predicted large cell change. Conclusions: Large cell change was common in young HBV-infected adults in Zambia. Only serum α-fetoprotein was identified as a biomarker of this phenotype.