ABSTRACT
Case report: We present a case of a 66-year-old female diagnosed with R. gnavus bacteremia associated with fecal peritonits secondary to small-bowel herniation and perforation. Identification as R. gnavus was delayed because of absence of this species in the MALDI-TOF MS database (Vitek MS, bioMérieux). Identification was provided by 16S rRNA gene sequencing. Review: R. gnavus, a Gram-positive, strictly anaerobic bacterium, is a member of the human gut microbiota. Dysbiosis in the gut microbiota, with increased amounts of R. gnavus, has been described in inflammatory bowel disease. R. gnavus has only been reported occasionally as the cause of infections. Hence the potential pathogenicity is not yet fully recognized, and data regarding the antimicrobial susceptibility profile are rare. Identification of anaerobic bacteria such as R. gnavus is greatly accelerated as a result of the introduction of MALDI-TOF MS. However, as illustrated in this case report, an extensive and up-to-date MALDI-TOF MS database is necessary for providing an accurate identification.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Bacteremia , Gram-Positive Bacterial Infections , Intestinal Perforation , Intestine, Small/microbiology , Microbiological Techniques , Peritonitis , Ruminococcus , Aged , Anti-Bacterial Agents/classification , Bacteremia/etiology , Bacteremia/microbiology , Bacteremia/therapy , Delayed Diagnosis , Female , Gastrointestinal Microbiome , Gram-Positive Bacterial Infections/diagnosis , Gram-Positive Bacterial Infections/etiology , Gram-Positive Bacterial Infections/physiopathology , Gram-Positive Bacterial Infections/therapy , Hernia, Abdominal/complications , Hernia, Abdominal/diagnostic imaging , Humans , Intestinal Perforation/diagnosis , Intestinal Perforation/etiology , Intestinal Perforation/surgery , Laparoscopy/methods , Microbiological Techniques/methods , Microbiological Techniques/standards , Peritonitis/diagnosis , Peritonitis/etiology , Peritonitis/physiopathology , Peritonitis/therapy , Ruminococcus/isolation & purification , Ruminococcus/pathogenicity , Treatment OutcomeSubject(s)
Bile Duct Neoplasms/diagnostic imaging , Bile Duct Neoplasms/pathology , Multimodal Imaging/methods , Papilloma/diagnostic imaging , Papilloma/pathology , Aged , Belgium , Bile Duct Neoplasms/surgery , Biopsy, Needle , Cholangiopancreatography, Endoscopic Retrograde/methods , Cholangiopancreatography, Magnetic Resonance , Follow-Up Studies , Hospitals, University , Humans , Immunohistochemistry , Male , Papilloma/surgery , Risk Assessment , Tomography, X-Ray Computed/methods , Treatment OutcomeSubject(s)
Colon/pathology , Intestinal Mucosa/pathology , Tangier Disease/pathology , ATP Binding Cassette Transporter 1/genetics , Adenomatous Polyps/complications , Adenomatous Polyps/pathology , Colonic Polyps/complications , Colonic Polyps/pathology , Colonoscopy , Colorectal Neoplasms/complications , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/pathology , Foam Cells/pathology , Humans , Male , Middle Aged , Mutation , Tangier Disease/complications , Tangier Disease/diagnosis , Tangier Disease/geneticsABSTRACT
Ectopic varices are dilated portosystemic venous collaterals located outside of the gastro-esophageal region. Whereas they are common endoscopic findings in patients with portal hypertension, ectopic variceal bleeding is rather rare and accounts for only 1 to 5 % of all variceal bleedings. The rectum and the duodenum are the most common sites for ectopic varices, but they can be present along the whole intestinal tract and neighborhood. At present, there is no consensus well established on diagnostic workup for ectopic variceal bleeding and their therapeutic strategies. Further investigation of large series or randomized-controlled trials is needed because nowadays most of the data available are based on case reports. We report here an unusual case of an ectopic variceal bleeding, presented as an acute small intestine bleeding, due to a portosystemic shunt via dilated mesenteric veins and a varicous left ovarian vein in a patient with alcoholic cirrhosis. The involvement of an ovarian vein in ectopic variceal bleeding is rarely described.
