Unusual Case of Pseudomembranous Colitis Presenting as Fever of Unknown Origin Diagnosed by Tc-99m-HMPAO-labeled Leukocytes SPECT/CT.

The fever of unknown origin (FUO) represents a complex diagnostic challenge due to the wide range of etiologies that could cause it, including neoplastic, infectious, rheumatic/inflammatory, and miscellaneous disorders. Several nuclear medicine techniques have proven to be valuable tools for guiding etiologic diagnosis in the setting of FUO. One of these is technetium-99m (Tc-99m)-hexamethylpropylene amine oxime (HMPAO)-labeled leukocyte scintigraphy, which is a diagnosis method that allows in most cases the localization and evaluation of the extension of an occult infection. This paper presents an uncommon case of pseudomembranous colitis without diarrhea as etiology of FUO diagnosed by Tc-99m-HMPAO-labeled leukocytes.

Recurrent acute pancreatitis is not uncommon in our clinical setting

Data on recurrent episodes of acute pancreatitis (RAP) are scarce. The aim of the study was to evaluate our rate of RAP and risks factors. This is a retrospective, single-center, study of consecutive patients admitted for AP and followed-up. Patients with more than one AP attack (RAP) were compared with patients with only a single AP episode (SAP) Clinical, demographic, outcome measures and severity were studied. 561 patients were included and follow-up over a mean 67.63 months' time. Our rate of RAP was 18,9%. Most patients suffered form only one episode of RAP (93%). Etiology of RAP episodes was mainly biliary (67%). On univariate analysis younger age (p 0.004), absence of high blood pressure (p 0.013) and absent of SIRS (p 0.022) were associated with recurrence of AP. On multivariate analysis only younger age was related to RAP (OR 1.015 95%IC 1.00-1.029). There were no statistical differences in outcome measures between both cohorts. RAP had a milder course in terms of severity (SAP 19% moderately severe/severe versus 9% in SAP). Almost 70% of the biliary RAP patients did not have a cholecystectomy performed. In this subset of patients, age OR 0.964 (95%IC 0.946-0.983), cholecystectomy OR 0.075 (95%IC 0.189-0.030) and cholecystectomy plus ERCP OR 0.190 (95%IC 0.219-0.055) were associated with absent of RAP. The rate of RAP in our series was 18,9%. Younger age was the only risk factor associated. Biliary etiology accounts for a large proportion of our RAP which could have been prevented with cholecystectomy or cholecystectomy plus ERCP.

La Pancreatitis Aguda Recurrente (PAR) es una entidad frecuente de la que hay pocos datos publicados. El objetivo del estudio es hallar la tasa y factores de riesgo asociados a PAR en nuestro medio. Es un estudio retrospectivo, unicéntrico, de pacientes ingresados por Pancreatitis Aguda (PA) y seguidos posteriormente. Se dividen en 2 grupos de pacientes: 1.- pacientes con un solo episodio de PA (PAS) y 2.- pacientes con más de un ingreso por PA (PAR). Se comparan variables clínicas, demográficas y de resultado. Resultados: 561 pacientes fueron incluidos y seguidos durante una media de 67,63 meses. 18,9% tuvieron al menos otro ingreso por PA. La mayoría sufrieron un solo episodio de PAR (93%). La etiología más frecuente fue biliar (67%). En el análisis univariado, una menor edad (p 0,004), la ausencia de hipertensión arterial (p 0,013) y de SIRS (p 0,022) se asociaron con PAR. En el análisis multivariado solo una menor edad se relacionó con PAR (OR 1,015, 95%, IC 1,00-1,029). No encontramos diferencias en las variables resultados entre ambos grupos. La PAR cursó de forma más leve (9% de pancreatitis moderada/graves o graves versus 19%). Casi un 70% de los pacientes con PAR biliar no tenían realizada una colecistectomía tras el ingreso índice. En este subgrupo de PAR, la edad OR 0,964 (95% IC 0,946-0,983), la colecistectomía OR 0,075 (95% IC 0,189-0,030) y la colecistectomía más colangiografía retrógrada OR 0,190 (95% IC 0,219-0,055) se asociaban a ausencia de PAR. Conclusión: Nuestra tasa de PAR fue 18,9%, con una menor edad como factor de riesgo. La etiología biliar fue la más frecuente que podría haberse evitado de haber realizado colecistectomía o colecistectomía más colangiografía retrógrada tras el primer ingreso.

Influence of the onset of the SARS-CoV-2 pandemic on the diagnosis and treatment of ulcerative colitis.

We analyzed how the healthcare restrictions that occurred in hospitals in Spain due to the COVID-19 pandemic, mainly in March, April and May 2020, influenced the diagnosis, management and treatment of ulcerative colitis (UC) in our center.

Villous atrophy persistence in celiac disease despite following a gluten-free diet must be clarified

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Chronic diarrhea due to autoimmune enteropathy.

Chronic diarrhea is a common symptom seen in the Gastroenterology clinic. Occasionally, the diagnosis is a real challenge as there are multiple entities with unremitting diarrhea as a symptom. Herein, we present a patient affected with intractable diarrhea who was transferred to our department. After many laboratory, endoscopy and radiological tests, she was diagnosed with autoimmune enteropathy (AE) and achieved clinical remission with corticosteroids and azathioprine.

Villous atrophy persistence in celiac disease despite following a gluten-free diet must be clarified.

We read with great interest the article recently published in REED by Shadegi et al. Villous atrophy (VA) persists in 35 % and 23.7 % of celiac disease (CD) patients for six and 24 months, respectively, after following a gluten-free diet (GFD). The authors think that the time following a GFD must be longer than two years in some patients to achieve mucosal healing and we agree with this. Our experience comes from a short series of ten females and three males with CD, diagnosed at an average age of 36 years (15-72) based on serology (anti-TG2 > 10 IU/ml or anti-Em positive) and a duodenal biopsy showing VA. All cases followed a GFD, according to the anamnesis and underwent a second duodenal biopsy and anti-TG2 determination after 42 (10-202) months. Immunogenic peptides of gluten (IPG) in feces were determined in four patients.