Colonoscopy Findings of Uncomplicated Enteric Fever Mimicking Koch's Disease.

Enteric fever is a common occurrence in Southeast Asia with a myriad of presentations. Partial treatment often leads to prolonged illness. Along with this, bowel imaging often confounds the picture with tuberculosis. Colonoscopy and biopsy may help to differentiate from tuberculosis. The data on colonoscopy is scarce in enteric fever and is mostly available from case reports of gastrointestinal (GI) bleeding. We have described three cases of enteric fever with GI involvement mimicking tuberculosis. The colonoscopy picture is characteristic of pinkish-bluish ileal mucosa, with edema and decreased distensibility, along with multiple superficial ulcers. The ileocecal valve was involved in all three cases. The ascending colon was involved in two cases. There was complete resolution of lesions after treatment on follow-up. How to cite this article: Verma A, Dahale AS, Gopal P, et al. Colonoscopy Findings of Uncomplicated Enteric Fever Mimicking Koch's Disease. Euroasian J Hepato-Gastroenterol 2024;14(1):120-123.

Limited utility of intraoperative frozen sections in primary malignant tumours involving long bones - A multicenter analysis of 475 cases.

BACKGROUND: In the surgical removal of primary malignant tumours involving long bones, intraoperative frozen sections are used to ascertain the adequacy of tumour clearance. However, with the improved imaging modalities that provide better foreknowledge of the tumour extent, it is possible that the arduous task of performing frozen sections can be safely avoided. This would not only save procedural time but also reduce hospital costs. Presently, there are no clear guidelines regarding the modality required intraoperatively to assess tumour margins in these cases. Hence, in our retrospective multicentre analysis, we aimed at determining the usefulness of frozen sections in these cases. MATERIALS AND METHODS: Our study is a 3-centre retrospective analysis of 475 cases (513 tumour margins) involving the surgical removal of primary malignancies of long bones. The preoperative Magnetic Resonance Imaging (MRI) and intraoperative assessment of the split specimen of the tumours were used to determine marginal clearance in all the cases in addition to frozen sections in 410 of the margins. RESULTS: Of the 410 frozen sections (centres 1 and 2), only one margin was reported positive and another reported indeterminate. All other margins were reported negative. In the first case, a 2 cm additional bone-cut was done whereas in the second, the procedure was proceeded based on the intraoperative agreement without re-cutting the margin. All these margins were negative in the final histopathology. In addition, in Centre 3, where frozen sections were not available, all the 103 cases had negative margins in the final histopathology. CONCLUSION: In primary malignancies involving long bones, intraoperative decision making with the aid of MRI has been sufficiently accurate in identifying the required tumour margin without frozen sections. Hence, the added time and cost incurred by doing an additional procedure can be avoided in these cases.

Naproxen Induced Acute Interstitial Nephritis with Renal Cortical Necrosis.

Drug induced acute interstitial nephritis is an idiosyncratic reaction following a drug exposure. The commonest drugs implicated are nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics and proton pump inhibitors. Renal cortical necrosis is a rare cause of acute kidney injury caused by severe and sustained vasoconstriction of small renal vessels. There is a change in the epidemiology of acute kidney injury especially in developing countries where drug induced acute kidney injury is becoming increasingly common. Naproxen is known to cause renal failure by renal papillary necrosis, tubular damage and acute interstitial nephritis. We present a case of Naproxen induced acute interstitial nephritis with acute cortical necrosis. To the best of our knowledge this is the first documented case of Naproxen induced renal cortical necrosis.

A case of Erdheim Chester disease with central nervous system involvement.

Erdheim Chester disease (ECD) is a rare non-Langerhans cell histiocytosis, commonly involving the musculoskeletal system. Other tissue can also be involved, including the central nervous system with wide spectrum of clinical features, at times being nonspecific. This can cause diagnostic dilemmas with delay in diagnosis and initiation of therapy. Here we describe a 63-year-old man who had presented with ataxia and behavioral changes, bony pains, weight loss, and fatigue. His computed tomography (CT), 99Tc scintigraphy and histopathological features on bone biopsy were consistent with ECD. Thus, ECD should be considered as a differential diagnosis in patients presenting with bony pain and nonspecific features of multiorgan involvement.