ABSTRACT
INTRODUCTION: Crohn's disease (CD) is an idiopathic inflammatory disorder of unknown etiology with genetic, immunologic, and environmental influences. Infliximab is a treatment modality for fistulated Crohn's disease. Infliximab induced hemolysis is rare and very few cases reported before in Ulcerative colitis (UC) but not in Crohn's disease. CASE PRESENTATION: We are reporting a 63 years old gentleman who was diagnosed as Crohn's disease and started on Tumor necrosis factor Inhibitor (TNF) -α i.e. (infliximab - Remsima) infusion. The course was complicated by Coomb's negative hemolytic anemia which is suggestive of non-immune drug induced hemolysis. Our patient was treated with steroid and conservative measures. Upon following up, his hemoglobin level as well as all hemolytic markers showed dramatic improvement. Adalimumab was used to treat this patient as an alternative choice without relapse of hemolysis. CLINICAL DISCUSSION: Drug induced Hemolysis is not a well-known complication post receiving Tumor necrosis factor Inhibitor (TNF) -α infusion in patients with Crohn's disease. Coombs negative hemolysis keeps in favor of non-immune drug induced rather than other differentials in our case scenario. CONCLUSION: Although cross-reactivity is expected between one biological agent to another, in our case the use of Adalimumab as alternative choice post Tumor necrosis factor Inhibitor (TNF) -α (Remsima infliximab) induced hemolysis did not cause hemolysis or any type of reaction.
ABSTRACT
INTRODUCTION: Trichobezoar is a rare condition, usually diagnosed in children and young female especially with psychiatric illness. Diagnosis of trichbezoar is usually dependent on the disease history, examination, diagnostic modality including CT scan. Generally this condition can be treated by endoscopy, laparoscopy or laparotomy. Here, we have presented a rare case of trichobezoar which has failed to be treated endoscopically but was eventually treated successfully by laparotomy. CASE REPORT: A 17 years old girl was presented with the initial complaint of epigastric pain for about 9 months duration with symptoms including vomiting and weight loss. Clinical examination showed tenderness and hard mass over epigastric area and it was extending towards the right hypochondrial area. CT scan results also showed that the stomach was filled with large intra-luminal abnormal mass like contents with mottled air pattern extended to fill the pylorus and first part of the duodenum. These findings were the proofs for possible trichobezoar. Endoscopic surgery failed significantly and hence laparotomy was performed, as a result, trichbezoar was removed successfully. DISCUSSION: Trichobezoar can be treated by using endoscopy for removal of hair, laparoscopy or Laparotomy. Laparotomy had 100% successful rate while 5% for endoscopy and 75% for laparoscopy. CONCLUSION: Laparotomy is the best treatment method for trichobezoare. Psychiatric management should be done for any patient with trichotillomania to avoid trichobezoar.
